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In an Evolving Threat Landscape, Healthcare IT Security Leaders Face the Growing Challenge of IoT Devices

July 21, 2017
by Heather Landi
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During a recent webinar hosted by the Center for Connected Medicine, healthcare IT security thought leaders examined the proliferation of internet-connected devices in healthcare and parsed the challenges of cybersecurity and the Internet of Medical Things (IoMT) in an evolving threat environment.

The Center for Connected Medicine is a Pittsburgh-based collaborative health care executive briefing center comprised of five founding partners—GE, IBM, UPMC, Nokia and Lenovo Health. The organization hosted the webinar in an effort to help health system executive leaders better understand the risks and solutions of cybersecurity and IoMT. During the webinar, industry thought leaders explored the threats and how the industry is responding.

“It seems like I read new headlines every day about the latest cyber attack targeting health institutions, many of which have involved IoMT devices,” Rasu Shrestha, M.D., chief innovation officer at UPMC and executive vice president at UPMC Enterprises, who moderated the webinar, said during the presentation.

To get a sense of the current healthcare data security landscape, cyber attacks targeting patient data organizations increased 300 percent from 2014 to 2016, according to a report from TrapX Security. The U.S. healthcare industry is currently spending an estimated $6.2 billion a year in fines and other costs related to health data breaches, reports the Ponemon Institute.

As cyber attacks against the healthcare industry continue to evolve, IoMT devices are becoming a bigger target. Data security leaders at patient care organizations now see the vulnerability of IoMT as a top concern in large part because connected medical devices are proliferating in health care.

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“The trend is not slowing down,” Shrestha said, noting that in the first quarter of this year, healthcare faced more cyber attacks than any other industry vertical, citing data from Vectra Networks. “As you can see, we’re in the midst of an unprecedented barrage of cybersecurity attacks. The time to take action is now. The industry has recognized the challenge and is responding.”

At UPMC, Shrestha said, cybersecurity is a recurring board-room agenda item. “Across the country, healthcare leaders are placing a greater emphasis on protecting their networks and intrusion. There is more attention and spending allocated to cybersecurity, but there is more that needs to be done.”

Garrett Hall, research director, cybersecurity and implementation services at Orem, Utah-based KLAS Research, recently co-authored a report on the healthcare security landscape, which entailed speaking to almost 200 healthcare professionals about their cybersecurity program. Only about 16 percent said their security program was fully functional, he said. During the webinar, Hall delved into the report’s findings and his take on the current security landscape.

“As a healthcare industry, we’re behind the times. There are a number of different reasons. One is that with all the technology advancements, there have been a lot of other priorities that have taken the forefront, with EMRs [electronic medical records], population health, and some other really valuable aspects of healthcare technology, and that has pushed cybersecurity to the back burner a little bit. In addition, there is some trouble that providers report to us about finding good cybersecurity resources in healthcare to fill the gaps and to help organizations prepare and respond to attacks.”

Hall noted that, according to KLAS’s research, about 41 percent of providers reported their organizations have dedicated less than 3 percent of the IT budget to cybersecurity.

“It just hasn’t been a top priority for the board. The good news is, we’re starting to see more of an emphasis on cybersecurity, and, I think, the IoMT has really helped to push some things to the forefront because of the potential for real harm to be done through these attacks. We see more organizations trying to get out in front of attacks and be proactive. The bad news, we are behind. The good news, I think we are catching up,” Hall said.

When asked how healthcare provider organizations can prepare for evolving cybersecurity attacks, Hall responded, “We are seeing that one of the most important ways to prepare and stay ahead of evolving attacks is to do an annual risk assessment to identify gaps and weaknesses, and once you understand those gaps, take that and build a security program or security plan that will allow you to take proactive steps to prepare for attacks and detect and respond to attacks, rather than just wait for something to happen and then react to it. With the evolution of attacks, and with the valuable nature of healthcare information, these attacks are not going to go away. These attacks will continue to change, so staying on top of it with risk assessments and a proactive security program and plan, those are the foundations of what providers should be doing to prepare for whatever may be coming.”

In addition, advanced organizations are leveraging detection strategies, such as security information and event management (SIEM), to monitor activity on their networks for proactive detection, and then build incident response plans and policies, Hall said.

Shrestha noted that UPMC, one of the nation’s largest integrated health systems, has 1,400 applications to manage and support and during annual system reviews, IT leaders identify vulnerabilities associated with each application. “In a typical year, we find more than 1 million vulnerabilities across our environment, which are prioritized by risk and resolved. In fact, UPMC identified and remediated over 3,000 instances of ransomware this last year alone. We recognize the challenge of keeping up with the hackers,” he said.

Shrestha continued, “We also partner with a third-party information security provider that moves 1 billion log files through its systems each day to identify anomalies and potential threats in real time. Our security operations center team investigates all high-risk anomalies that are identified through this process.”

What’s more, providers are becoming increasingly dependent on Internet-based resources to facilitate patient care, Shrestha said, noting that UPMC has 105,000 connected devices to manage and support. These connected devices, which are connected to networks and the cloud, have the potential to act as a gateway to break into a hospital’s main networks, he said.

Drilling down specifically into the vulnerabilities and security risks of IoMT devices, Beth Musumeci, vice president, cybersecurity at GE Healthcare, said the threat is significant, as connected health devices, by definition, “increase the attack surface.”

By 2020, 78.5 million number of people worldwide will be using home health technologies by 2020. By 2019, 87 percent of healthcare facilities will implement IoMT, up 60 percent from this year. The rise in breaches coupled with the rate that we’re implementing IoMT, it’s easy for us to see the challenge we have before us from cybersecurity perspective,” Musumeci said.

She outlined a number of key steps that IT security leaders at patient care organizations should take to strengthen their organization’s security posture to be able to withstand, detect and respond to constantly emerging threats.  First, she said, it’s important for IT leaders to recognize that compliance does not equal protection, she said, and, further to that point, IT security leaders need to know what vulnerabilities exist in their environment and then manage those vulnerabilities regularly and diligently.

“Understand that criminals will take the trouble to know your network, anything you accidentally connect to can accidentally get you attacked. You must know your network. A common oversight is a short-sighted definition of your network; you need to expand beyond you enterprise employees and include third-parties, suppliers, vendors and accountants connecting to your environment. Make sure they are following your security policy, and that includes their suppliers too,” she said.

It’s also critical to have an emergency response plan and policy, and then, practice recovery. “Having an effective and tested recovery plan can prove to be a vital defense, and plan for events like ransomware,” she said.

Applying Advanced Capabilities to Cybersecurity

Rob Marson, head of strategy and business development, Nokia, who also participated in the webinar, outlined cutting-edge techniques that healthcare organizations are deploying to protect against evolving threats. “To stay ahead of some of these threats, we’re starting to see organizations trying to strike the right balance between reactive and proactive security best practices. Security teams are working hard to identify and limit threat vectors, detect faster and respond faster. When I use the words ‘active security’ that means the right blend and balance between proactive and reactive.”

Active security involves constantly measuring the organization’s security posture and risk level, Marson noted. “As Beth [Musumeci] said, it’s more than just auditing for compliance, it’s an ongoing, near-time assessment of network security posture. To do this effectively, you need to rely on security software solutions that can help you automate and measure holistically your security risk and security posture.”

Rapid response is the key to minimize the impact of cyber attacks, Marson said. “Expect to be attacked, so the art is how quickly can you detect and respond appropriately. What needs to happen is we need to eliminate the time between detection and mitigation.”

Marson continued, “By now, it’s well acknowledged that as an industry, there is simply a cyber skillset shortage, and the traditional incident response strategies, which rely on manual processes, now need to turn to automation. Software plays a key role helping you automate your response strategy so you can respond faster and deal with more of those threats.”

Active security is about transforming security operations to become more predictive and more automated, he noted, “so we’re seeing techniques leveraging analytics, machine learning, leveraging threat intelligence to drive rapid and automated responses.”

Shrestha with UPMC noted that predictive analytics applied to data could enable IT security leaders to anticipate vulnerabilities before they occur and remediate faster, and then asked the panelists, “How distant are these capabilities?”

“From a network perspective, I don’t think they are as far off,” Marson said. “Already we’re seeing the application of data science to solve different problems and the application of data science and the evolution of machine learning and big data analytics in the realm of cybersecurity is upon us.”

KLAS’s Hall concluded that technology is critical, yet “training and culture is really the key. He added, “Making sure employees understand the policies, making sure everybody is on the same page about what is appropriate within the security program. We build the right culture to make it a more secure place for healthcare providers.”

 

 

 

 

 

 

 

 

 

 


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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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