At the Health IT Summit in San Jose, Cybersecurity Concerns Seen Growing | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

At the Health IT Summit in San Jose, Cybersecurity Concerns Seen Growing

April 14, 2017
by Mark Hagland
| Reprints
Industry leaders at the HIT Summit in San Jose agreed that the threat landscape in healthcare continues to expand

Cybersecurity threats continue to grow by the day in U.S. healthcare, alarming patient care organization leaders, and compelling healthcare IT leaders to step up their cybersecurity efforts. That subject, the mushrooming of cyber threats, was top of mind on Thursday in San Jose, California, during a panel discussion on the topic at the Health IT Summit in San Jose, being held at the Westin San Jose in downtown San Jose.

The discussion, under the title “A Deeper Dive: Understanding and Preventing the Next Generation of Cyber Threats,” was moderated by Tom Andriola, vice president and CIO of the University of California Health. He was joined by Rao Mikkilineni, Ph.D., a professor of IT security at Golden Gate University; Ari Entin, CIO at Natividad Medical Center; M.K. Palmore, an assistant agent in charge in the San Francisco field office of the FBI; and Rich Campagna, senior vice president of products and marketing at Bitglass.

Early on in the discussion, in explaining why the healthcare industry has become the most targeted of U.S. industries, Mikkilineni noted that “The biggest threat has shifted away from the financial services industry to healthcare, as credit cards have become more secure, and as the internal landscape in healthcare has shifted and become much more difficult to secure.”

panelists (l. to r.) Entin, Palmore, Campagna,
Mikkilineni, and Andriola, at the HIT Summit

“Banks say the biggest area of vulnerability for them is working with affiliate banks and other partners,” Andriola said. “We talk about the healthcare world and interoperability; we haven’t built the walls and responses that financial services has,” which could better secure our data.


How to Assess IT Risk in a Healthcare Environment

In this webinar, Community Health System’s CISO Scott Breece and Lockpath's Sam Abadir will discuss the unique IT landscape of the healthcare industry and the challenges this presents for IT risk...

“We’ve had high-profile attacks on us,” Andriola said, noting the large number of hacks of healthcare organizations in the past couple of years. “What does this look like from your perspective?” he asked FBI agent Palmore. “Rao talked about an expansion of threats,” Palmore said. “There are new technologies being developed to make patients’ lives better, but the attack surface is expanding to increased vulnerabilities. And to cyber-criminals, these vulnerabilities become something that they spend quite a bit of time and effort on,” he said.

“I go to a lot of conferences like this,” Palmore continued, “and we spend a lot of time talking about the technology piece and very little time talking about the human piece of this. I will tell you that in 20 years of law enforcement, I have never seen criminals more diligent than cyber-criminals. They are very diligent, and very good at what they do. They’ve figured out how to hack and how to quickly monetize things via the dark web; they’ve created an ecosystem via the dark web. Criminal enterprises used to be man-made and man-operated systems. Now, criminal enterprises span the globe. The actors typically don’t know each other and have never met face to face; they’ve figured out how to interact and pay each other, typically through the use of digital currencies. But the ecosystem they’ve developed, quite frankly, is one that law enforcement has not developed an effective response for.”

In that context, Palmore said, “It’s not uncommon for a cybercriminal to very effectively monetize. The other threat you guys have to worry about, frankly, is nation-states. Nation-state actors have figured out how to exploit your information systems, get access to data, and use it. And so as you’re building these new technologies and exploring new ways to bring new benefits to your patients and certainly to your staffs, you’d better have people to help you figure out how to secure your systems, because there’s someone out there working to” hack them.

What community hospital CIOs need to do

The incentives for cybercriminals to flock to attacking healthcare targets are simply too powerful to leave the healthcare industry unscathed, Entin emphasized. “When the pot at the end of the rainbow is like a swimming pool of gold for some of these ventures, the motivation is huge” for cybercriminals to take on the healthcare industry, he said.  So understanding that you can’t completely protect yourself, is important,” he said. “Especially as a 172-bed county hospital, we can’t afford a huge team of experts,” he said. Instead, “We need to be able to evaluate risks and get really informed about how we can mitigate risks and control them, and to some extent, transfer your risks. There are certain things I can put in place to control my risks or reduce my footprint,” he said.

Importantly, Entin noted, the cybercriminals out there are “looking for that quick hit, sending you the phishing email that leads to encryption, while also ranging up to the more sophisticated attacks. I’ve seen them come in through email, and many are very carefully targeted,” he testified. “And they’re looking for easy targets. They’re looking for organizations that haven’t done all the security work they’ve needed to. We’re not Target or Anthem, we’re a community hospital,” he said. But, he added, “If you’re fully patched, they’re going to move on to easier targets. So for me, it’s about looking at those most common threat vectors, and making yourself secure enough.”

FBI agent Palmore noted that, unfortunately, the healthcare industry continues to offer easy targets for cybercriminals. “The cyberthreat actors are absolute experts on return on investment; they know exactly which path to take, which is the path of least resistance,” he said. “Whatever is the cheapest path for them—spear-phishing, low-level engineering—that’s the path they’ll take. So you have to be on almost a continuous awareness campaign with your staffs. And the quality of the phishing emails they send out has been rising. And quite a few of the breaches we respond to, in the post-mortem, we find quite often that the entry point was spear-phishing. If you’ve researched the click rate for phishing emails, you’ve probably found the click rate hovering somewhere around 80 percent of clicking. And the more people know about these potential vectors, the less likely they are to hit you.”

Devices in peril

“We’re in a very disruptive time right now in terms of the shifts taking place in technology,” Andriola told his fellow panelists. “So what can we do about those shifts?”

“When you bring your own devices into your IT, it opens up a whole host of issues,” Mikkilineni said, referring to the BYOD phenomenon. “So you need to constantly train and educate. You need regular internal training, combined with controlling your BYOD devices.”

And the risks are multi-dimensional, Campagna noted. “OCR”—the Office of Civil Rights, in the Department of Health and Human Services—“fined a healthcare system $650,000 for loss of an iPhone that contained 200 patient records on that device. And what struck me was that that phone was completely unencrypted and open.”

“On the topic of BYOD, as has been a common theme on this panel, even getting down to basics and stopping a lot of these things from happening, can be very useful,” Andriola said. “In terms of cloud, moving to cloud-based applications can actually be a huge opportunity for patient care organizations.” He noted that while no one in healthcare has the funds available to the Microsoft Corporation, which he said spends more than one billion dollars a year on IT security, what is noteworthy, he said, is Microsoft’s ongoing willingness to spend extensively in that area, as “their existence absolutely depends on their security.”

“We have to adhere to the fundamentals,” Palmore stressed. “Time and time again, in the post-mortem leads to the fundamentals: strong password management and effective two-factor authentication. Quite frankly, two-factor authentication, when used correctly, will avert so many problems. And when it really gets down to it, if you want to identify where your greatest areas of weakness are, look to the fundamentals: creating and maintaining good password authentication.”

And, along the dimension of business, Entin emphasized that “You need to look at information security not only from a technical perspective, but also to look at your contracts” with vendors. “If there is a breach, who is liable? There are very standard liability clauses built into contracts that say that you’re on your own if something happens. So you need to work with your legal team to require your business associates to be liable for protecting data.”

And, per what kinds of password protocols to pursue, Palmore said that “I do realize as a user that it is a pain to demand constant changes in passwords, but it’s absolutely worth the protection it provides. So yes, absolutely disallow prior passwords; get folks into using passphrases instead of passwords… And 15 characters is the optimum length for a password. The odds are something like 100 million to 1 against criminals’ ability to break such a password.”




2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


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

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
| Reprints

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.


How to Assess IT Risk in a Healthcare Environment

In this webinar, Community Health System’s CISO Scott Breece and Lockpath's Sam Abadir will discuss the unique IT landscape of the healthcare industry and the challenges this presents for IT risk...

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.


More From Healthcare Informatics


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

September 20, 2018
by Heather Landi, Associate Editor
| Reprints

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.

Related Insights For: Cybersecurity


Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
| Reprints

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.

See more on Cybersecurity