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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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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.


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Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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