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In an Ever-Intensifying Threat Environment, Healthcare CISOs Become Part of the Bigger Picture

April 19, 2017
by Rajiv Leventhal
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Establishing a culture of security is critically important in healthcare organizations. As such, the CISO is now becoming a senior executive-level position

One of the most significant points of discussion currently taking place in the healthcare sector is how patient care organization leaders are responding and reacting to the growing cybersecurity threat throughout the industry. Indeed, one quick look at the monthly Protenus “Breach Barometer” report— a snapshot of reported or disclosed breaches impacting the healthcare industry, with data compiled and provided by DataBreaches.net—reveals that the trend of cyber attacks in healthcare is certainly not slowing down; in March, the number of breached records was 2.5 times the number of records breached in January and February combined.

The level of sophistication at which healthcare organizations are responding to this problem varies across the U.S., but there does seem to still be a gap in funds allocated to data security. For instance, a HIMSS Analytics and Symantec study released in February found that even though cybersecurity budgets are increasing, 65 percent of surveyed healthcare organizations are still spending less than 6 percent of funds on security. What’s more, those survey findings indicate that the majority of healthcare organizations still have five or fewer employees allocated to IT security, although two-thirds of participating organizations do have a chief information security officer (CISO), which most often report to the CIO.

Indeed, CISOs within healthcare organizations—not too long ago a position with a limited role—have now become a part of the broader senior leadership team, experts say. Nick Giannas, consultant in search firm Witt/Kieffer’s IT practice, and who specializes in executive searches for CISOs in healthcare and education specifically, notes that “There needs to be an executive to oversee security across all of the organization’s business areas and to encourage a culture of information security.”

He adds that organizations are looking for someone who can build that culture, someone who is a strong communicator, and someone who not only has the cybersecurity expertise, but also the business acumen. “You need to have better alignment between cybersecurity and the business so it doesn’t hinder operations,” Giannas says. “All of this together requires a senior executive; it’s an executive level position, so it’s about having those soft skills such as being able to build a relationship, communicate effectively, and translating those cybersecurity concepts in a way that business leaders can understand. The [CISO] has become a trusted advisor,” he says.

However, while the CISO role is clearly now evolving, Giannas does note that there is an industry-wide gap in terms of skilled candidates. “The demand for qualified CISOs far exceeds the supply of top talent for these positions,” he says. And, he adds, “There is a need to expand and look beyond healthcare to find top talent in other industries who can make a difference and who might be coming from much more secure information security environments. Now that’s not to say that there are not strong individuals in this space in healthcare—because there are—but there are just not enough.”

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Throughout his searches, Giannas does find that organizations are now truly realizing the need for a talented executive leading their information security program. And beyond recognizing and recruiting that top talent, there are also other factors to consider in the hiring process, such as compensation and the actual commitment that an organization will make in terms of dollars to information security. “Gaps do remain in [budget allocation for information security], but if you look at the reports out there, with the threats continuing to evolve, we’re starting to pour more money into cybersecurity. Regarding data breaches, it’s not a matter of if, but when. So making sure you have the right tools and programs in place is important,” he says.

Certainly, these are responsibilities that fall on the CISO, and Giannas says that the forward-thinking provider organizations are starting to deploy advanced technologies such as machine learning intelligence software and predictive analytics to help protect their environments. He notes that the commitment and investment that C-suite leaders are now making in security are actually better than what many people think. “If not for organizations dedicating the resources that they are righty now, we could really be much worse off. And that’s not to say that they aren’t still behind, because they are, but the commitment is starting to pay off,” he says, adding that the pressure is on both CIOs and CISOs to look at new tools in this space. “You hear CIOs saying that cybersecurity is both the first and second thing on the list that keeps them up at night. So it really helps when you have a strong CISO in place that you can rely on. I think there is inherent pressure involved with this position, and the talented CISOs out there are really up to that challenge,” he says.

While Giannas says that in most places, the CISO is reporting to the CIO—a trend that’s in line with what the above-mentioned HIMSS Analytics survey reported—he is hearing organizations talk about moving the reporting structure to someone outside of the IT part of the organization. “I think just as cybersecurity incidences and threats evolve, thus forcing cybersecurity programs to evolve, the CISO position will also evolve. It’s an enterprise function, so you could see a trend in the future that the position will not be reporting into IT. That makes logical sense; it’s the evolution of the position. But that isn’t happening yet,” he says.

As the CISO position indeed continues to grow, a key to that evolution will be how the person in this role establishes a culture of security within the patient care environment. Adam Tallinger, vice president at consulting firm Impact Advisors, says that creating a culture of security carries equal weight to everything else that an organization dedicates culture to. He says, “If you have a culture where someone feels comfortable to reporting some [wrongdoing] or a breach in security, then you will be able to mitigate that, and restrict access to that data a lot quicker than if you have someone who tries to ignore it. Bad news never gets better with age,” Tallinger says.

In the end, just like with anything else in healthcare IT, some organizations are further along than others, so CISOs being able to create a culture of security “is an ongoing process,” Giannas says. “It’s not just about IT, and it’s not just about the information security departments. It’s about everyone playing a role across the organization, at all levels. All CISOs, even in mature environments, would say that they’re still continuing to grow in the area of establishing the right culture.”


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/news-item/cybersecurity/ocr-fines-providers-hipaa-violations-failure-follow-basic-security

OCR Fines Providers for HIPAA Violations, Failure to Follow “Basic Security Requirements”

December 12, 2018
by Heather Landi, Associate Editor
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Florida-based Advanced Care Hospitalists PL (ACH) has agreed to pay $500,000 to the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) for a number of HIPAA compliance failures, including sharing protected health information with an unknown vendor without a business associate agreement.

ACH provides contracted internal medicine physicians to hospitals and nursing homes in west central Florida. ACH provided services to more than 20,000 patients annually and employed between 39 and 46 individuals during the relevant timeframe, according to OCR officials.

Between November 2011 and June 2012, ACH engaged the services of an individual that claimed to be a representative of a company named Doctor’s First Choice Billings, Inc. (First Choice). The individual provided medical billing services to ACH using First Choice’s name and website, but allegedly without the knowledge or permission of First Choice’s owner, according to OCR officials in a press release published last week.

A local hospital contacted ACH on February 11, 2014 and notified the organization that patient information was viewable on the First Choice website, including names, dates of birth and social security numbers. In response, ACH was able to identify at least 400 affected individuals and asked First Choice to remove the protected health information from its website. ACH filed a breach notification report with OCR on April 11, 2014, stating that 400 individuals were affected; however, after further investigation, ACH filed a supplemental breach report stating that an additional 8,855 patients could have been affected.

According to OCR’s investigation, ACH never entered into a business associate agreement with the individual providing medical billing services to ACH, as required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, and failed to adopt any policy requiring business associate agreements until April 2014. 

“Although ACH had been in operation since 2005, it had not conducted a risk analysis or implemented security measures or any other written HIPAA policies or procedures before 2014. The HIPAA Rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s electronic protected health information,” OCR officials stated in a press release.

In a statement, OCR Director Roger Severino said, “This case is especially troubling because the practice allowed the names and social security numbers of thousands of its patients to be exposed on the internet after it failed to follow basic security requirements under HIPAA.”

In addition to the monetary settlement, ACH will undertake a robust corrective action plan that includes the adoption of business associate agreements, a complete enterprise-wide risk analysis, and comprehensive policies and procedures to comply with the HIPAA Rules. 

In a separate case announced this week, OCR also fined a Colorado-based hospital, Pagosa Springs Medical Center, $111,400 to settle potential HIPAA violations after the hospital failed to terminate a former employee’s access to electronic protected health information (PHI).

Pagosa Springs Medical Center (PSMC) is a critical access hospital, that at the time of OCR’s investigation, provided more than 17,000 hospital and clinic visits annually and employs more than 175 individuals.

The settlement resolves a complaint alleging that a former PSMC employee continued to have remote access to PSMC’s web-based scheduling calendar, which contained patients’ electronic protected health information (ePHI), after separation of employment, according to OCR.

OCR’s investigation revealed that PSMC impermissibly disclosed the ePHI of 557 individuals to its former employee and to the web-based scheduling calendar vendor without a HIPAA required business associate agreement in place. 

The hospital also agreed to adopt a substantial corrective action plan as part of the settlement, and, as part of that plan, PSMC has agreed to update its security management and business associate agreement, policies and procedures, and train its workforce members regarding the same.

“It’s common sense that former employees should immediately lose access to protected patient information upon their separation from employment,” Severino said in a statement. “This case underscores the need for covered entities to always be aware of who has access to their ePHI and who doesn’t.”

Covered entities that do not have or follow procedures to terminate information access privileges upon employee separation risk a HIPAA enforcement action. Covered entities must also evaluate relationships with vendors to ensure that business associate agreements are in place with all business associates before disclosing protected health information. 

 

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Eye Center in California Switches EHR Vendor Following Ransomware Incident

December 11, 2018
by Rajiv Leventhal, Managing Editor
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Redwood Eye Center, an ophthalmology practice in Vallejo, Calif., has notified more than 16,000 patients that its EHR (electronic health record) hosting vendor experienced a ransomware attack in September.

In the notification to the impacted patients, the center’s officials explained that the third-party vendor that hosts and stores Redwood’s electronic patient records, Illinois-based IT Lighthouse, experienced a data security incident which affected records pertaining to Redwood patients. Officials also said that IT Lighthouse hired a computer forensics company to help them after the ransomware attack, and Redwood worked with the vendor to restore access to our patient information.

Redwood’s investigation determined that the incident may have involved patient information, including patient names, addresses, dates of birth, health insurance information, and medical treatment information.

Notably, Redwood will be changing its EMR hosting vendor, according to its officials. Per the notice, “Redwood has taken affirmative steps to prevent a similar situation from arising in the future. These steps include changing medical records hosting vendors and enhancing the security of patient information.”

Ransomware attacks in the healthcare sector continue to be a problem, but at the same time, they have diminished substantially compared to the same time period last year, as cyber attackers move on to more profitable activities, such as cryptojacking, according to a recent report from cybersecurity firm Cryptonite.

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Report: 30 Percent of Healthcare Databases Exposed Online

December 10, 2018
by Heather Landi, Associate Editor
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Hackers are using the Dark Web to buy and sell personally identifiable information (PII) stolen from healthcare organizations, and exposed databases are a vulnerable attack surface for healthcare organizations, according to a new cybersecurity research report.

A research report from IntSights, “Chronic [Cyber] Pain: Exposed & Misconfigured Databases in the Healthcare Industry,” gives an account of how hackers are tracking down healthcare personally identifiable information (PII) data on the Dark Web and where in the attack surface healthcare organizations are most vulnerable.

The report explores a key area of the healthcare attack surface, which is often the easiest to avoid—exposed databases. It’s not only old or outdated databases that get breached, but also newly established platforms that are vulnerable due to misconfiguration and/or open access, the report authors note.

Healthcare organizations have been increasingly targeted by threat actors over the past few years and their most sought-after asset is their data. As healthcare organizations attempt to move data online and increase accessibility for authorized users, they’ve dramatically increased their attack surface, providing cybercriminals with new vectors to steal personally identifiable information (PII), according to the report. Yet, these organizations have not prioritized investments in cybersecurity tools or procedures.

Healthcare budgets are tight, the report authors note, and if there’s an opportunity to purchase a new MRI machine versus make a new IT or cybersecurity hire, the new MRI machine often wins out. Healthcare organizations need to carefully balance accessibility and protection.

In this report, cyber researchers set out to show that the healthcare industry as a whole is vulnerable, not due to a specific product or system, but due to lack of process, training and cybersecurity best practices. “While many other industries suffer from similar deficiencies, healthcare organizations are particularly at risk because of the sensitivity of PII and medical data,” the report states.

The researchers chose a couple of popular technologies for handling medical records, including known and widely used commercial databases, legacy services still in use today, and new sites or protocols that try to mitigate some of the vulnerabilities of past methods. The purpose of the research was to demonstrate that hackers can easily find access to sensitive data in each state: at rest, in transit or in use.

The researchers note that the tactics used were pretty simple: Google searches, reading technical documentation of the aforementioned technologies, subdomain enumeration, and some educated guessing about the combination of sites, systems and data. “All of the examples presented here were freely accessible, and required no intrusive methods to obtain. Simply knowing where to look (like the IP address, name or protocol of the service used) was often enough to access the data,” the report authors wrote.

The researchers spent 90 hours researching and evaluated 50 database. Among the findings outlined in the report, 15 databases were found exposed, so the researchers estimate about 30 percent of databases are exposed. The researchers found 1.5 million patient records exposed, at a rate of about 16,687 medical records discovered per hour.

The estimated black-market price per medical record is $1 per record. The researchers concluded that hackers can find a large number of records in just a few hours of work, and this data can be used to make money in a variety of ways. If a hacker can find records at a rate of 16,687 per hour and works 40 hours a week, that hacker can make an annual salary of $33 million, according to the researchers.

“It’s also important to note that PII and medical data is harder to make money with compared to other data, like credit card info. Cybercriminals tend to be lazy, and it’s much quicker to try using a stolen credit card to make a fraudulent purchase than to buy PII data and run a phishing or extortion campaign. This may lessen the value of PII data in the eyes of some cybercriminals; however, PII data has a longer shelf-life and can be used for more sophisticated and more successful campaigns,” IntSights security researcher and report author Ariel Ainhoren wrote.

The researchers used an example of hospital using a FTP server. “FTP is a very old and known way to share files across the Internet. It is also a scarcely protected protocol that has no encryption built in, and only asks you for a username and password combination, which can be brute forced or sniffed

by network scanners very easily,” Ainhoren wrote. “Here we found a hospital in the U.S. that has its FTP server exposed. FTP’s usually hold records and backup data, and are kept open to enable backup to a remote site. It could be a neglected backup procedure left open by IT that the hospital doesn’t even know exists.”

According to the report, hackers have three main motivations for targeting healthcare organizations and medical data:

  • State-Sponsored APTs Targeting Critical Infrastructure: APTs are more sophisticated and are usually more difficult to stop. They will attempt to infiltrate a network to test tools and techniques to set the stage for a larger, future attack, or to obtain information on a specific individual’s medical condition.
  • Attackers Seeking Personal Data: Attackers seeking personal data can use it in multiple ways. They can create and sell PII lists, they can blackmail individuals or organizations in exchange for the data, or they can use it as a basis for further fraud, like phishing, Smishing, or scam calls.
  • Attackers Taking Control of Medical Devices for Ransom: Attackers targeting vulnerable infrastructure won’t usually target healthcare databases, but will target medical IT equipment and infrastructure to spread malware that exploits specific vulnerabilities and demands a ransom to release the infected devices. Since medical devices tend to be updated infrequently (or not at all), this provides a relatively easy target for hackers to take control.

The report also offers a few general best practices for evaluating if a healthcare organization’s data is exposed and/or at risk:

  • Use Multi-Factor Authentication for Web Applications: If you’re using a system that only needs a username and password to login, you’re making it significantly easier to access. Make sure you have MFA setup to reduce unauthorized access.
  • Tighter Access Control to Resources: Limit the number of credentials to each party accessing the database. Additionally, limit specific parties’ access to only the information they need. This will minimize your chance of being exploited through a 3rd party, and if you are, will limit the damage of that breach.
  • Monitor for Big or Unusual Database Reads: These may be an indication that a hacker or unauthorized party is stealing information. It’s a good idea to setup limits on database reads and make sure requests for big database reads involve some sort of manual review or confirmation.
  • Limit Database Access to Specific IP Ranges: Mapping out the organizations that need access to your data is not an easy task. But it will give you tighter control on who’s accessing your data and enable you to track and identify anomalous activity. You can even tie specific credentials to specific IP ranges to further limit access and track strange behavior more closely.

 

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