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Information Security Expert Predicts that the “Enron of Data Breaches” is Coming

July 31, 2017
by Rajiv Leventhal
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Although there are steps that can be taken to improve healthcare cybersecurity, one consultant fears that the worst is yet to come
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Recent major cyber attacks on the healthcare community, such as Petya and WannaCry, have created unprecedented levels of fear on IT security professionals. In fact, a cybersecurity report from HIMSS last month noted that these two vulnerabilities in particular continue to affect various industries around the world, only adding to the growing concern. And while much of the focus has been how these attacks have impacted larger organizations in recent months, there hasn’t been a whole lot of discussion on how their small-practice brethren could be affected.

Indeed, small physician practices can fall victim to ransomware and many other types of cyber attacks, as they don’t often have the budget for proper protection to fend off hackers. But experts in the field do attest that there are some low-cost ways they can combat an attack without breaking the bank.

Helping smaller practices in this regard is Jorge Rey, director of information security and compliance at advisory firm Kaufman Rossin. Rey is primarily responsible for the firm’s compliance with federal and state cyber security and privacy information laws and regulations. Recently, Rey spoke with Healthcare Informatics about steps smaller physician practices can take to better protect their data in addition to broader cybersecurity trends he is seeing. Below are excerpts of that discussion.

What are the main things you are working on these days as it relates to healthcare cybersecurity?

We’re an accounting firm, and I work in the consulting division where I specialize on HIPAA [the Health Insurance Portability and Accountability Act] and HITECH [the Health Information Technology for Economic and Clinical Health] consulting. Under those areas, we focus on small and large practices, hospitals and business associates (BAs). We assist clients with their HIPAA compliance requirements, whether it is doing risk assessments, policy and procedures implementation, penetration testing, vulnerability assessments, or technical assessments, so we are helping them translate the requirements of the rules into actionable items that they can use in their operations while still complying. 

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How ready and prepared are most of your clients?

A lot of the organizations have at least something in place, so it’s not like they’re all starting from scratch. It is now about looking at what they have in place and figuring out how they can improve upon that. For example, everyone has a computer with some type of anti-virus, and by doing that you are at least accomplishing being effective with one of the requirements. Depending on how big the organization is might depend on how sophisticated its firewalls are, but everyone pretty much has some type of firewall. They are already backing up their data, too. But when you specialize into different departments, that’s where you start to identify the gaps. 

What’s most concerning for your clients today?

We do have small physician practices who are completely unaware of the requirements. In their minds HIPAA is still a privacy issue, so when you talk to them they think they are HIPAA-compliant because they have a form at the front of the medical office [for patients]. But what they don’t understand is that even after that form, you need to keep the information secure, too. A lot of physician practices are ignorant on the rules and requirements, and that creates concerns. So we spend time trying to educate the doctors or office administrators on the requirements and what they need to do, and that could become overwhelming for them.

As far as the bigger companies, they have more employees and an IT department, so educating the board and senior management about why you need to spend money is probably the biggest issue. So in both cases it is about education.

We are constantly reading about hackers, laptops being stolen, and ransomware, and all of these are huge issues, but not everyone deals with the same threats. It depends on their environment. A lot of people have a false sense of security—they think they are compliant because their laptop is encrypted, but they don’t have the BA agreements and don’t even know that they need them.   

Looking beyond HIPAA and other requirements, true defense is much more than that, right?

Compliance doesn’t necessarily mean security; you could be in compliance with the rules, but that doesn’t mean your information is completely secure. You can have the policies in place, everyone trained, and have all of the things that might pass an audit, but you can still be exposed.

One of the rules requirements is that you need to perform a risk analysis of your health information, be it electronic or paper. Sometimes, and perhaps often, you don’t do a good assessment of that risk analysis, so you fill out the forms and you move on. We often identify that the risk assessment [that was performed] did not truly identify the threat, so you did not truly look at the controls you had in place or should have had in place.

One of the biggest issues we’re seeing out there is phishing—it’s the way ransomware is getting downloaded and the way we are getting hacked. We still see that people don’t have phishing training at all. We know what the biggest threat we have as an industry is, but we are not educating the people who click those links. And then you go back to the board and tell them that they need to spend money on training, and they look at you and ask why they need to spend on that since everyone already knows not to click [bad links]. That’s where the biggest disconnect is.

When you talk about smaller practices, how can they combat attackers without the resources that larger organizations have?

There is no better way to understand the risks than training. The physicians really need to understand what the risks are, and sometimes you need a consultant to help identify that. There have been a few times when we have gone to a physician office and the practice has one server where it keeps all of the sensitive data, and that data is being backed up externally to a different drive. But that’s it.

We understand that they can’t spend thousands of dollars to have the server outside of the office somewhere, but how about we at least lock that server so it can’t be stolen? If we are backing up to another source, are we making sure that information is at least being encrypted? These questions can be asked by someone who has the right expertise and who can give them the [best] advice. So I think going that route, hiring someone who understands security to help them, is the best solution. I will often see physicians spending money on XYZ firewall because their IT guy recommended it, but most of the time you don’t need that—you need to encrypt your backups instead.

In the wake of WannaCry, what impact could a global cyber attack of this nature have on U.S. healthcare organizations?

One of the biggest issues we see in healthcare is that we have old legacy systems from a Windows perspective. We still see medical devices using Windows XP. WannaCry is exploiting old configurations of old servers with old Windows software.

You hear all the time that cybersecurity will get worse before it gets better in healthcare. Do you agree with this?

We have not seen the biggest attack yet, even though we have seen a few really big ones in the last year. I think eventually we will see the Enron of data breaches in which you will see a systemic catastrophic impact on not just an industry, but an entire nation. And at that moment a different approach to cybersecurity will develop. We see oversight right now with people getting fined, and it’s a whole legal battle with consultants and lawyers, but we have not seen something that has created a systemic issue across a nation.

 

 

 


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Assessing the New Cybersecurity Practices Publication: Why Small and Medium-Sized Care Organizations Have Reason to Rejoice

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A new set of voluntary cybersecurity practices just released by HHS offers practical advice and conceptual supports that fill information gaps
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How helpful will the new set of voluntary cybersecurity practices that the Department of Health and Human Services (HHS) released in late December, be, to the leaders of patient care organizations? Only time will tell, as part of the value of the release will only be made manifest as the leaders of patient care organizations move forward to implement some of those practices, and the potential success of such implementations is in some way measured and benchmarked.

But the release is a first start, at least. As Healthcare Informatics Associate Editor Heather Landi reported on January 2, HHS released the set of practices in the form of a publication “that marks the culmination of a two-year effort that brought together over 150 cybersecurity and healthcare experts from industry and the government under the Healthcare and Public Health (HPH) Sector Critical Infrastructure Security and Resilience Public-Private Partnership.”

“Cybersecurity is everyone’s responsibility. It is the responsibility of every organization working in healthcare and public health.  In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively,” Janet Vogel, HHS Acting Chief Information Security Officer (CISO), said in a statement published with the release of the new publication.

Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients (HICP), the primary publication of the Cybersecurity Act of 2015, Section 405(d) Task Group, aims to raise awareness, provide vetted cybersecurity practices, and move organizations towards consistency in mitigating the current most pertinent cybersecurity threats to the sector,” HHS officials stated. “It seeks to aid healthcare and public health organizations to develop meaningful cybersecurity objectives and outcomes. The publication includes a main document, two technical volumes, and resources and templates.”

The overall publication consists of several sections, the first being the HICP, which “examines cybersecurity threats and vulnerabilities that affect the healthcare industry. It explores five current threats and presents 10 practices to mitigate those threats; “Technical Volume 1: Cybersecurity Practices for Small Health Care Organizations,” which offers cybersecurity practices for small healthcare organizations; “Technical Volume 2: Cybersecurity Practices for Medium and Large Health Care Organizations”; the “Resources and Templates” portion, which “includes a variety of cybersecurity resources and templates for end users to reference”; and a Cybersecurity Practices Assessments Toolkit, which “helps organizations prioritize their cyber threats and develop their own action plans using the assessment methodology outlined in the Resources and Templates volume”—that last section being still under development as of Jan. 2.

As Landi reported, “The HICP publication aims to provide cybersecurity practices for this vast, diverse, and open sector to ultimately improve the security and safety of patients. The main document of the publication explores the five most relevant and current threats to the industry. It also recommends 10 cybersecurity practices to help mitigate these threats.”

What’s more, she wrote, “The main document presents real-life events and statistics that demonstrate the financial and patient care impacts of cyber incidents.  It also lays out a call to action for all industry stakeholders, from C-suite executives and healthcare practitioners to IT security professionals, that protective and preventive measures must be taken now. The publication also includes two technical volumes geared for IT and IT security professionals, one focusing on cybersecurity practices for small healthcare organizations, and one focused on practices for medium and large healthcare organizations.”

Among the salient statistics reported in the HICP:

  • Fifty-eight percent of malware attack victims are small businesses.
  • In 2017, cyber-attacks cost small and medium-sized businesses an average of $2.2 million.
  • Sixty of small businesses go out of business within six months of an attack.
  • And, 90 percent of small businesses do not use any data protection at all for company and customer information.

How does that translate into impacts on smaller healthcare organizations? Among other incidents, the HICP notes that:

  • A popular orthopedic practice announced that its computer system was hacked via breach of a software vendor’s log-in credentials. This breach put just under a half-million people at risk of identity theft. Of those, 500 patient profiles appeared for sale on the dark web. The information for sale included names, addresses, social security numbers, and other personally identifiable information (PII). Although not posted for sale, pertinent PHI such as X-ray results and medical diagnoses were also stolen.

 

  • A rural hospital had to replace its entire computer network after a ransomware cyber-attack froze the hospital’s electronic health record (EHR) system. Doctors were unable to review their patients’ medical histories or transmit laboratory and pharmacy orders. Officials were unable to restore essential services and could not pay the ransom for the return of their system. After consultations with the Federal Bureau of Investigation and cybersecurity experts, hospital officials made the difficult decision to replace the entire system.
  •  

Of particular practicality is some of the very basic advice given to the leaders of smaller healthcare organizations. To wit: “Doctors and nurses know that hand sanitizing is critical to prevent the spread of germs. That does not mean health care workers wash up as often as they should. Similarly, we know that cybersecurity practices reduce the risk of cyber-attacks and data breaches. Just as we are able to protect our patients from infection, we should all work towards protecting patient data to allow physicians and caregivers to trust the data and systems that enable quality health care. Just as health care professionals must wash their hands before caring for patients, health care organizations must practice good ‘cyber hygiene’ in today’s digital world, including it as a part of daily universal precautions,” the HICP notes. “Like the simple act of hand-washing, a culture of cyber-awareness does not have to be complicated or expensive for a small organization. It must simply be effective at enabling organization members to protect information that is critical to the organization’s patients and operations. Your organization’s vigilance against cyber-attacks will increase concurrently with your and your workforce’s knowledge of cybersecurity. This knowledge will enable you to advance to the next series of cybersecurity Practices, expanding your organization’s awareness of and ability to thwart cyber threats.”

Meanwhile, both smaller and larger patient care organizations will benefit from the technical supports, including a Security Risk Assessment Tool, a set of recommendations on medical devices and cybersecurity, and an incident response risk management handbook.

What this set of resources does is to fill a gap between theory and technical practice in a key area. Will it shift the entire landscape of cybersecurity for patient care organizations? No, that would be a far-too-ambitious goal. But the healthcare IT leaders of smaller and medium-sized patient care organizations in particular, will welcome practice advice and supports, as they move forward in their journeys around cybersecurity. Any such journey is inherently challenging, and federal publications and resources like these will be of real value in moving patient care organization HIT leaders forward.

 

 

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HHS Releases Voluntary Healthcare Cybersecurity Practices

January 2, 2019
by Heather Landi, Associate Editor
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In late December, the Department of Health and Human Services (HHS) released voluntary cybersecurity practices to the healthcare industry with the aim of providing practice guidelines to cost-effectively reduce cybersecurity risks.

The “Health Industry Cybersecurity Practices (HICP): Managing Threats and Protecting Patients” publication aims to provide guidance to healthcare organizations of all types and sizes, ranging from local clinics to large hospital systems.

The industry-led effort was in response to a mandate set forth by the Cybersecurity Act of 2015 Section 405(d), to develop practical cybersecurity guidelines to cost-effectively reduce cybersecurity risks for the healthcare industry.

According to HHS, the publication marks the culmination of a two-year effort that brought together over 150 cybersecurity and healthcare experts from industry and the government under the Healthcare and Public Health (HPH) Sector Critical Infrastructure Security and Resilience Public-Private Partnership.

“Cybersecurity is everyone’s responsibility. It is the responsibility of every organization working in healthcare and public health.  In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively,” Janet Vogel, HHS Acting Chief Information Security Officer (CISO), said in a statement.

While technologies are vital to the healthcare industry and help provide life-saving treatments and improve patient care, these same technologies are vulnerable to myriad attacks from adversaries, ranging from criminals and hacktivists to nation-states, according to HHS. These technologies can be exploited to gain access to personal patient data or render entire hospital systems inoperable. Recent cyber-attacks against the nation’s healthcare industry continue to highlight the importance of ensuring these technologies are safe and secure.

“The healthcare industry is truly a varied digital ecosystem. We heard loud and clear through this process that providers need actionable and practical advice, tailored to their needs, to manage modern cyber threats. That is exactly what this resource delivers; recommendations stratified by the size of the organization, written for both the clinician as well as the IT subject matter expert,” Erik Decker, industry co-lead and Chief Information Security and Privacy Officer for the University of Chicago Medicine, said in a statement.

The HICP publication aims to provide cybersecurity practices for this vast, diverse, and open sector to ultimately improve the security and safety of patients. The main document of the publication explores the five most relevant and current threats to the industry. It also recommends 10 cybersecurity practices to help mitigate these threats.

The main document presents real-life events and statistics that demonstrate the financial and patient care impacts of cyber incidents.  It also lays out a call to action for all industry stakeholders, from C-suite executives and healthcare practitioners to IT security professionals, that protective and preventive measures must be taken now. The publication also includes two technical volumes geared for IT and IT security professionals, one focusing on cybersecurity practices for small healthcare organizations, and one focused on practices for medium and large healthcare organizations.

 

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CynergisTek, Protenus Partner on Privacy Monitoring Programs

December 26, 2018
by Heather Landi, Associate Editor
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CynergisTek, Inc., an Austin, Texas-based healthcare cybersecurity firm, is partnering with Protenus, a healthcare compliance analytics company, to combine the companies’ technology tools and services with a focus on patient privacy monitoring programs.

The partnership will grant health systems access to Protenus’ analytics platform that leverages artificial intelligence to gather data related to potential patient privacy risks, along with CynergisTek’s patient privacy monitoring services.

According to the Protenus research, insider incidents accounted for 23 percent of all breaches that occurred at health systems in Q3 2018. This figure will only continue increasing, indicating that now more than ever, health systems need a cost-effective solution to meet the daily challenges of managing patient privacy.

To address this need, CynergisTek and Protenus formed a preferred partnership to combine CynergisTek’s healthcare consulting experience and privacy programs with Protenus’ healthcare analytics technology to offer health systems both the people, processes, and technology components of a strong patient privacy monitoring program, according to the companies.

“As health systems face mounting challenges in creating and maintaining robust patient privacy monitoring programs, we identified a need to partner with a company offering complementary services so that health systems can act on the insights uncovered by our analytics,” Nick Culbertson, CEO and co-founder of Protenus, said in a statement.

 “Data privacy is evolving as a dominate theme in conversations, both in healthcare and other industries, and health systems need to take an end-to-end approach to patient privacy to truly address this complex and mission-critical challenge,” Mac McMillan, CEO and president of CynergisTek, said in a statement.

 

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