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Don’t Get Stranded without a Data Security Action Plan

August 26, 2016
by Mark Shelhart, Sikich LLP
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The cybersecurity challenges that face healthcare providers can seem staggering. Last year, the industry accounted for nearly 70 percent of all records exposed in data breaches, according to the Identity Theft Resource Center, and protected health information breaches impacted more than 113 million individuals, according to the Office for Civil Rights (OCR). Further, with health records increasing in value (surpassing credit card data) for criminals, hacking continues to rise.

Some institutions will report that they are “mostly secure.” And while awareness of threats has increased in the healthcare sector, many providers remain behind the curve on cybersecurity and lack the ability to prevent even common intrusions. Compounding the challenge for providers, state governments have responded to cyberattacks with increased scrutiny. Ever-changing laws dictate what actions a provider must take to both alert patients affected by a breach and offer remediation. Many of these amended laws expand the reach of current notification requirements, add to the definition of “personal information” and increase reporting requirements to state attorneys general.

For example, North Dakota modified its notification law to require any organization that “owns” or “licenses” state residents’ data that includes “personal information” to report the breach to the attorney general if it impacts more than 250 people. This applies even if the organization isn’t based in the state. North Dakota isn’t alone. Several other states, including Connecticut, Nevada, Oregon and Tennessee amended data breach notification laws in 2015 and 2016. And state attorneys general are making it clear that they want to be in the loop early when a breach occurs.

Mark Shelhart

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Navigating this increasingly complex maze of requirements from different states while simultaneously combatting data breaches is not an easy task. That’s why it’s critical for healthcare providers to prepare a comprehensive data security action plan by following these five steps:

1. Benchmark to identify vulnerabilities—A risk assessment is a key first step to help a provider determine where the greatest risks are within the organization. This helps the leadership team then determine what security resources to deploy and where to focus attention.

2. Adopt a consistent security posture—Healthcare providers need to take a consistent security stance across their organizations. This includes thorough application and network penetration testing, vulnerability scanning and ongoing server monitoring and patching. A robust security testing regimen can help reduce vulnerabilities and protect providers’ most important and sensitive information.

3. Evaluate and manage third-party relationships—Hospitals have many vendors that handle everything from payments to data storage. These vital operational relationships can also be perilous if the vendor falls victim to a breach that compromises sensitive hospital and patient data. That’s why it’s crucial to make security a key consideration when selecting vendors and to scrutinize current third-party relationships. Healthcare providers must learn what vendors are legally responsible for in the event of a breach and also do their best to evaluate vendors’ security practices. The bottom line is that all organizations should have a policy requiring their vendors to disclose any security incident.

4. Gain a full understanding of all state and federal regulations—With lawmakers passing new regulations related to breaches on a regular basis, providers need to ensure they have a grasp on their level of legal exposure in different states—well before a breach occurs. Trusted legal advisors, both internal and external, can play a key role in keeping providers up to speed on the latest regulations and should be an integral part of an incident response team.

5. Implement a communications strategy to protect your reputation—Providers also need a reputation management plan and a communications strategy to control their message and handle the flood of press inquiries after a breach. Planning ahead ensures the breached organization is equipped to comply with all relevant authorities and tell a clear and honest story to patients, the general public and the media. Breaches handled poorly can shatter reputations and lead to deteriorating trust. Organizations that invest in thoughtful communications and execute a well-grounded media relations strategy will set themselves up to preserve their reputation and regain their footing for future success.

Healthcare organization leaders should take immediate stock of their security stance. How secure is sensitive data? Is the organization ready to spring into action in case of a breach? With the healthcare industry in the crosshairs, and new laws putting added pressure on providers of all sizes, action can’t be delayed. The companies that adopt an ongoing commitment to security and implement a comprehensive action plan that addresses both pre-breach data security and post-breach reputation management can feel more confident in the face of today’s ever-evolving threats and regulations.

Mark Shelhart is a senior manager for incident response and forensics in the security and compliance practice at Sikich LLP. He can be reached at mark.shelhart@sikich.com.


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Cybersecurity, Telehealth and Interoperability “Top of Mind” for IT Execs in 2019

November 19, 2018
by Heather Landi, Associate Editor
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As health system leaders look ahead to the challenges and opportunities of the coming year, they are increasing their spending to defend against cyberattacks, expressing optimism about reimbursement for telehealth services, and feeling anxiety about Apple, Amazon and Google entering the health care space, according to a new survey.

The second annual survey, conducted by the Pittsburgh-based Center for Connected Medicine (CCM) in partnership with the Health Management Academy, reflects the opinions of healthcare C-suite leaders from nearly 40 major U.S. health systems across the country about their IT priorities for the year ahead. CCM is a collaborative health care executive briefing center jointly operated by GE Healthcare, Nokia and UPMC. The Alexandra, Va.-based Health Management Academy is a membership organization consisting of executives from the country’s top 100 health systems focused on sharing best practices.

Conducted in three parts, the research started with a survey of health system information officers—CIOs, chief medical informatics officers (CMIOs) and chief nursing informatics officers (CNIOs— in May 2018 to determine the top areas of health IT for 2019. A quantitative survey was conducted in July 2018 with questions focused on cybersecurity, telehealth and interoperability. In September 2018, qualitative interviews were completed with 18 C-suite executives, including chief executive officers, chief operating officers, CIOs and CMIOs.

According to the survey report, “Top of Mind for Top Health Systems 2019,” health system executive leaders identified cybersecurity, telehealth and interoperability as the top three areas of health IT that will have the most impact in 2019. Cybersecurity remained at the top of the list from the previous year’s survey, and telehealth and interoperability climbed the ranking. The previous year’s Top of Mind report had identified cybersecurity, consumer-facing technology, and predictive analytics as the top three areas of focus for 2018.

“While consumerism and analytics remain hot topics in health care, it was not surprising to see telehealth and interoperability rise in the minds of health IT executives for 2019. Policymakers, in particular, have emphasized telehealth and interoperability in the past year, and the threats of cyberattacks and data breaches are constant in health care,” the report authors wrote.

While healthcare executive leaders cited those three topics as immediate, pressing concerns, when asked what health IT technologies they anticipated would have the most impact on health care five year from now, health system executive leaders identified artificial intelligence, consumer technology, and genomics. According to the report, one CNIO said: “The technology is moving so fast that it is hard to predict five years out. I would not have picked some of these for 2019 one year ago.”

Cybersecurity

Hackers and other cyber-criminals are stepping up their attacks on the health care industry, leading 87 percent of respondents to say they expect to increase spending on cybersecurity in 2019; no health system was expecting to decrease spending. Half of respondents expect a spending increase greater than five percent.

For 2019, health systems said they would invest cybersecurity resources to bolster current areas of investment, with many focusing on both staff and technology, such as firewalls, intruder detection software, and dual authentication that guard against breach of protected health information (PHI).

Despite increasing financial investment and prioritization of cybersecurity at health systems, executives did not express robust confidence in their organization’s IT recovery and business continuity plans after an attack or breach. Seven out of 10 respondents reported being “somewhat confident” in their recovery and continuity plans; only 20 percent said they were “very confident.”

The most commonly cited challenge in cybersecurity was employee education—62 percent of respondents named “staff” as greatest point of cybersecurity weakness. What’s more, phishing and spear-phishing were cited as the most common types of cyberattacks in the previous 12 months.

According to the report, one CEO commented during an interview: “The people that are up to no good have far better tools than we do on our platforms. If they really target you, they will likely find a way in.… We are not trying to make it impenetrable, but we are trying to make it more difficult to break into our system than others in our market.”

Telehealth

Health information technology (IT) leaders overwhelmingly expect government and commercial reimbursement to provide the majority of funding for telehealth services by 2022; internal funding and patient payments are expected to provide the majority of funding for telehealth in 2019.

Government policy is driving some of this optimism, the report authors wrote. “For example, CMS [The Centers for Medicare & Medicaid Services] published a proposal in July 2018 that provided three new remote patient monitoring reimbursement medical codes. While some critics have said the proposal’s $14 reimbursement for virtual check-ins is too low, the move by CMS appears to cement telehealth reimbursement as a priority for the agency.”

All responding health systems report telehealth accounts for 10 percent or less of their organization’s total care delivery, however, over the next three years, 45 percent of respondents expect use of telehealth to increase by 10 percent or more. Lack of reimbursement was cited as the most significant barrier to adopting greater telehealth services, cited by 70 percent of respondents.

Most health system executives interviewed for the study said their health system had not yet calculated a specific return on investment (ROI) for telehealth. But systems are investing anyway as a hedge that future reimbursement will outweigh the potential losses of today, according to the survey report. “For the moment, reimbursement is widely thought of in terms of physician time, but as technologies evolve, the question will be whether reimbursement will expand to hardware. Investment can also be seen as a bellwether for provider sentiment toward transformation to value-based care,” the report authors wrote.

When considering a telehealth technology system, top features/priorities are “integration with the clinical workflow” and “ease of patient triage and virtual follow-up,” according to the survey.

Need for Innovation Drives Focus on Interoperability

Interoperability has emerged as a key challenge in health care as hospitals and health systems pursue value-based care, consumerism, and other initiatives that require broad sets of data from disparate IT systems, the report noted. As the health care industry continues to evolve, provider health systems are having to think more creatively about their strategies in order to remain successful.

A lack of interoperability has made it more difficult for health systems to address certain key priorities, most commonly improved efficiency / cost reduction, and advanced analytics, the report said. Additionally, executives report challenges addressing care gap closure, longitudinal patient data, and integration with non-owned partners

More than half of respondents (61 percent) said the use of a major electronic health record (EHR) system was not stifling digital innovation at their health system. However, in qualitative interviews, several executives said an EHR was limiting their ability to innovate by locking them into a single vendor’s products, according to the report.

Seventy percent of informatics executive said they were “somewhat concerned” about big tech companies, such as Apple, Amazon and Google, disrupting the health care market; 10 percent were “very concerned,” the survey found.

The report quotes one CEO who said: “They are new competitors that look very different from traditional health care competitors. They are better in their space and can catch up quickly. Current stakeholders are resistant to change. If we’re slow and dodgy we’re going to get lapped.”

The survey also examined the role of the cloud in the future of health IT. The majority of health care data is expected to be stored in on-premises data centers (20 percent) or hybrid / private cloud (60 percent) in the next three years, according to the survey, and 10 percent said they anticipate storing health data in a public cloud.

 

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Health First Data Breach Exposes Information of 42K Patients

November 15, 2018
by Rajiv Leventhal, Managing Editor
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A data breach at Florida-based Health First exposed the personal information of some 42,000 patients, according to various industry media reports this week.

The website DataBreaches.net reported that in early October, the healthcare provider Health First notified the Department of Health & Human Services (HHS) of a breach that affected 42,000 patients.  The breach actually occurred earlier in the year, however, between February and May 2018, according to the report, which received a statement from the organization’s senior vice president, consumer and retail services.

The Health First executive noted that “a small number of our employees were the victims of a phishing scam which compromised some of our customers’ information. The criminals were able to gain access of these employees’ email accounts for a limited period of time.”

Health First officials also told Florida Today this week that the data breach “was fairly low-level, though it could have included some customers' Social Security numbers. Mostly it appears to have involved information such as addresses and birth dates. No medical information was compromised,” according to this report.

Phishing attacks continue to plague the healthcare industry; the single largest breach this year was a hacking incident affecting 1.4 million patient records that involved UnityPoint Health, an Iowa-based health system. That said, cybersecurity professionals are still looking for more advanced ways to get out in front of these attacks, as healthcare has traditionally lagged behind other industries in in phishing resiliency.

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