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A New Era in Network Segmentation?

February 26, 2018
by Mark Hagland
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Healthcare IT leaders across the U.S. are in the middle of a sea change in the area of network segmentation
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If there’s a single IT security strategy that nearly all patient care organizations have implemented at least in part, it’s network segmentation—the purposeful separation of elements of an organization’s information technology network in order to enhance IT security. Yet at the same time, this is an area in which, industry experts say, there is also a vast lack of understanding of the underlying principles and strategies needed to make network segmentation actually help facilitate greater security, in practice.

And of course, the challenges facing the IT leaders of patient care organizations are also facing IT leaders in every type of business organization, in every industry. John Friedman, a managing consultant at the CyberEdge Group consulting firm, puts it this way in his recent white paper, “The Definitive Guide To Micro-Segmentation,” published last year by Illumio, a Sunnyvale, Calif.-based cloud computing security solutions provider: “We can no longer rely on perimeter defenses to keep the bad guys out, and are not doing so well catching them inside the data center either.

Most IT security professionals are familiar with frameworks such as Lockheed Martin’s Cyber Kill Chain,” Friedman notes. But, he says, “Statistics show that it is extremely difficult to reduce the 'dwell time' of attackers once they have a foothold inside the data center. Virtualization and cloud technology exacerbate this challenge. It is hard to protect applications that can be executing anywhere, with pieces being moved around continually. In this environment, limiting lateral movement within the data center becomes a top priority for IT groups. If a cybercriminal compromises the credentials of an employee who uses application A, can we make sure he can’t reach applications B, C, and D? If a hacker uncovers the password of a system administrator in location X, can we make sure she has no way to connect to systems in locations Y and Z?” That remains a fundamental IT security challenge in healthcare.

“This is very difficult work,” confirms Fernando Blanco, CISO at the 60-plus-hospital CHRISTUS Health, which is based in Irving, Texas, and operates across the United States, as well as in Mexico, Colombia, and Chile. “We started a couple of years ago on the journey, and basically, we work on a risk basis. Implementing segmentation adds complexities to the network,” Blanco adds. “It’s necessary, but introduces hardships to the users and to the network team. So we decided to start small, determining the key applications we most needed to protect. We started with a list of about 20 applications, and ended up with about 15 key applications, including our EHR”—electronic health record—“and have segmented those,” beginning with the EHR, three years ago. Blanco and his colleagues are currently focused on PCI (payment card industry) applications, as well as the applications connected to the delivery of care to military veterans.

“When I think about segmentation, it’s [about] data sensitivity, locality, and location,” says Chris Convey, vice president, IT risk management and CISO, at Sharp Healthcare in San Diego. “There’s an art and a science to it. Groups of IoT elements should probably be segmented off; medical devices should probably be segmented off. We’re looking at micro-segmentation. [In the manual network segmentation world], “[Y]ou have to go out and configure every switch and router, but now you can use logical networking, and software-based networking, and that’s where the industry’s going,” he went on. “And micro-segmentation is where things need to go. Because patching medical devices is a constant headache. So the logical choice is network segmentation and micro-segmentation.”


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Meanwhile, in Florida, Thien Lam, vice president and CISO at the 14-hospital Clearwater-based BayCare Health System, reports that “In terms of network segmentation, we’ve created a separate network for the medical devices, so that the medical devices don’t talk directly to the production network; they have their own VLAN (virtual local area network). Also, we have devices that we put in front of the medical devices—they’re like a mini-firewall, to make sure the medical devices aren’t vulnerable to an attack. The issue,” Lam notes, “is that the manufacturers themselves—most of the time, they don’t provide patches. They’ll ask you to upgrade a device or replace an old one, but that can cost millions of dollars. So with regard to network segmentation, we want to make sure that we put the medical devices on a VLAN, so that they can’t talk directly to the Internet. At the same time, we micro-segment them by putting a mini-firewall in front of each medical device, and we’ve also locked a USB port on the device.”

More broadly, he says, “We have a plan moving forward that we’re in the process of executing on. Most of us have had flat networks, where everything can talk to everything—your network at home, your car, everything—we’ve spent 20 years creating that connectivity. Now, with all the incidents taking place, it’s clear that that’s no longer a good idea. So now we have to look at this from a role-based standpoint. What we’re planning to do is that we’re going to segment by facility. So if there is an infection within one facility, we want to isolate that facility from the rest of the network, so that the malware or ransomware can’t spread.”

A Sea Change of Epic Proportions

Blanco and fellow healthcare IT leaders across the U.S. are in the middle of a sea change in this area. What’s pushing it? Well, fundamentally, of course, it’s the acceleration of cyber threats against data and IT security in healthcare.

John Robinson, a senior advisor with the Naperville, Ill.-based Impact Advisors consulting firm, puts it this way: “From a senior management perspective, the biggest issues are, firstly, nobody’s really clear what it is. There are so many variations on the theme,” the North Ridgeville, Ohio-based Robinson says. “There’s network segmentation, micro-segmentation, security segmentation, network partitioning. It’s a million names for essentially the same thing.” Among those terms, he says, “The most understood, and the one that has the potential to become the standard term here, is micro-segmentation. But it’s a misnomer. It’s what I would call tentacle segmentation, really. Micro-segmentation has a nice ring to it. What that really is, is a technical approach that makes network security more flexible, by applying software-defined policies, rather than manual configuration.”

Meanwhile, in terms of how the IT security professionals in patient care organizations are doing network segmentation, Robinson says, “The vast majority of healthcare organizations are still back in the manual configuration phase, trying to address rapidly evolving threat vectors with a manual methodology that just can’t keep up. You can’t type fast enough, basically, to do manual configuration in order to keep up with the threat vectors that are accelerating on a daily basis.”

The new wave in this area? Software configuration. “Creating a software-defined network,” Robinson says, “allows you to apply policies, processes, and procedural rules to the traffic and data on the network itself, as opposed to manual configuration, where you are still manipulating software, but where you’re still essentially twisting wires. So this is not something that’s an alternative to manual configuration. You still need to electronically twist the wires, as it were, to keep your basic physical infrastructure chugging along, but you apply software definitions to that network so that you’re looking not at physical attributes of connectivity, but at the data flowing across that physical infrastructure, and applying polices and rules to that data, to make sure it goes where you want it to go, and doesn’t go where you don’t want it to go.”

A key difference between software-configured and manually-configured network segmentation? “You can start with, 'I’m not going to let anybody in,' and then loosen from there, whereas with the physical configuration, you’re starting off allowing everyone to connect,” Robinson notes.

Thinking About How to Protect Data

Another element that is connected to, though distinct from, network segmentation itself, is that of processes around data risk analysis or assessment, and auditing. Many patient care organization leaders are in fact quite unaware of what kinds of data they have, and where those different kinds of data reside—which is why network segmentation without analytical processes can end up being flawed, says Stephanie Crabb, co-founder and principal in the Panama City, Fla.-based Immersive consulting firm. “Looking at this from a data lens—the data we’re creating, saving, and moving—we need to move towards more data-centric types of audit and protection philosophies and approaches,” Crabb says.

And what does that mean in practice? “Let’s look at the OCR,” Crabb says, referring to the Office of Civil Rights within the Department of Health and Human Services, “and at the OCR’s enforcement and activities. One of the first things that the OCR has identified, and why they haven’t encountered a single organization doing risk analysis/assessment to their standard, is that many organizations simply have not gone about the work of identifying their ePHI [electronic protected health information], where it lives in their organization, where it flows, and what’s done with it. The simple fact is that most organizations simply do not have a good handle on what sensitive data they possess, what ePHI they have, where it lives, and where it goes.”

What’s more, Crabb says, “The false sense of security from network segmentation or defense in depth is that it says, we have a good handle on structured data, and we can put that inside a structured environment, with defense in depth. But without knowing what we have, we may have a very false sense of security, based on how we’ve architected that defense in depth, that is blind to other types of sensitive data—for example, contract performance data with our payers. We’re constantly looking at our performance to contract, especially in risk contracts. And as we pull that analysis together to do population health, etc., those things are typically packages that don’t live inside databases.” The fact is that a huge amount of ePHI lives outside the EHR, she points out. “There are many types of data way outside the EHR, in fact. But without classifying those things and knowing where they live, we may not have adequate protections, and some of these highly valued, highly sensitive assets may have almost no protections around them at all.”

On a practical level, Crabb says, “For example, it’s not uncommon for smaller organizations to email packages of information to board members in advance of board meetings. They’ll often email those board packets to board members’ personal email accounts. Now, we may have a highly secure email drive around our four walls. There, our defense in depth and network segmentation may work for us. But if the data is delivered to a highly insecure location, that’s where all that sound infrastructure in segmentation, is great, but our walls, our perimeter, are not what it used to be. So if we perform that discovery, and classify those data and information aspects, that allows us to determine whether our network segmentation model or defense in depth model, really protects our sensitive data or not. And when we discover data that lies outside those parameters of protection, we can remediate those weaknesses.”

In his white paper, Friedman recommends that IT security leaders take a granular approach to network segmentation, leveraging what he calls “dynamic segmentation: techniques, three in particular. “Abstraction is the ability to express security policies in terms of application concepts (such as web, application, and database tiers) rather than in terms of network constructs (such as IP addresses, subnets, and VLANs),” he writes. “Intelligence is the ability to detect when changes are made to applications or the infrastructure, and then reconfigure policies to adjust for the changes.” And, he says, “Automation is the ability to rapidly deploy new and revised security policies to monitoring and enforcement points, without human intervention. Depending on the implementation, micro-segmentation can increase your adaptiveness in other ways as well, such as helping provide consistent security across data centers and cloud platforms,” he writes. “It addresses the challenge of stopping lateral movement by dividing IT environments into controllable compartments. It makes security dynamic by allowing security rules to be expressed in terms of application concepts, and reconfigured automatically when applications and infrastructure components change.”

How rapidly will dynamic segmentation/micro-segmentation strategies come to be applied in patient care organizations? Probably not super-quickly, given all the prioritization challenges. But all those interviewed for this article agree—the time is ripe to move towards more advanced network segmentation strategies, at a time of accelerating threat vectors.


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4.4M Patient Records Breached in Q3 2018, Protenus Finds

November 7, 2018
by Rajiv Leventhal, Managing Editor
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There were 117 disclosed health data breaches in the third quarter of 2018, leading to 4.4 million patient records breached, according to the Q3 Protenus Breach Barometer report.

Published by Protenus, a cybersecurity software company that issues a Breach Barometer report each month, the most recent data shows that although the number of incidents disclosed in Q3 decreased somewhat from Q2, the number of breached records increased from Q2 to Q3. Also, the number of affected patient records has continued to climb each quarter in 2018—from 1.13 million in Q1 to 3.14 million in Q2 to 4.4 million in Q3.

In Q3, the report noted that the single largest breach was a hacking incident affecting 1.4 million patient records that involved UnityPoint Health, an Iowa-based health system. Hackers used phishing techniques, “official-looking emails”, to gain access to the organization’s email system and capture employees’ passwords. This new incident follows one that took place at the same organization in April when 16,400 patient records were breached as a result of another phishing attack.

For incidents disclosed to HHS (the Department of Health & Human Services) or the media, insiders were responsible for 23 percent of the total number of breaches in Q3 2018 (27 incidents). Details were disclosed for 21 of those incidents, affecting 680,117 patient records (15 percent of total breached patient records). For this analysis, insider incidents are characterized as either insider-error or insider-wrongdoing. The former includes accidents and other incidents without malicious intent that could be considered “human error.” 

There were 19 publicly disclosed incidents that involved insider-error between July and September 2018. Details were disclosed for 16 of these incidents, affecting 389,428 patient records. In contrast, eight incidents involved insider-wrongdoing, with data disclosed for five of these incidents.

Notably, when comparing each quarter in 2018, there has been a drastic increase in the number of breached patient records as a result of insider-wrongdoing. In Q1 2018, there were about 4,600 affected patient records, in Q2 2018 there were just over 70,000 affected patient records, and in Q3 there were more than 290,000 affected patient records tied to insider-wrongdoing.

What’s more, the report found that hacking continues to threaten healthcare organizations, with another increase in incidents and affected patient records in the third quarter of 2018. Between July and September, there were 60 hacking incidents—51 percent of all Q3 2018 publicly disclosed incidents. Details were disclosed for 52 of those incidents, which affected almost 3.7 million patient records. Eight of those reported incidents specifically mentioned ransomware or malware, ten incidents mentioned a phishing attack, and two incidents mentioned another form of ransomware or extortion. However, it’s important to note that the number of hacking incidents and affected patient records have dropped considerably when comparing each month between July and September 2018.

Meanwhile, of the 117 health data breaches for which data was disclosed, it took an average of 402 days to discover a breach from when the breach occurred. The median discovery time was 51 days, and the longest incident to be discovered in Q3 2018 was due to insider-wrongdoing at a Virginia-based healthcare organization. This specific incident occurred when an employee accessed thousands of medical records over the course of their 15-year employment.

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Survey Reveals Disconnect Between Perception and Reality of Medical Device Security

November 6, 2018
by Heather Landi, Associate Editor
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A recent survey of healthcare IT professionals found a troubling disconnect between IT leaders’ confidence in the visibility and security of their connected medical devices and the effectiveness of legacy solutions to secure connected medical devices.

The vast majority of healthcare IT professionals (87 percent) feel confident that the connected medical devices in their hospitals are protected in case of a cyberattack. However, the survey also revealed a contradiction between the confidence that healthcare professionals have in the visibility of connected medical devices and security of their networks, and the inefficient and ineffective legacy processes many still rely on to keep them secure.

The survey from Zingbox, a provider of Internet of Things (IoT) security solutions, is based on responses from 400 U.S.-based healthcare IT decision-makers and clinical and biomedical engineers and indicates that there continues to be a widespread misconception that traditional IT security solutions can also adequately secure connected medical devices.

Seventy-nine percent of respondents say their organization has real-time information about which connected medical devices are vulnerable to cyber attacks. And, 69 percent feel traditional security solutions for laptops and PCs are adequate to secure connected medical devices.

“Most organizations are thinking about antivirus, endpoint protection and firewalls, but there are many devices — like medical monitoring equipment — and no one is thinking about securing them,” Jon Booth, Bear Valley Community Hospital District IT director and Zingbox customer, said in a statement. Additionally, as noted in a Gartner report, Market Trends: Five Healthcare Provider Trends for 2018 published in November 2017 notes: “Generally, medical devices are not replaced for at least 10 years, with many running old software that has not been updated or patched.”

And there are other challenges: the Zingbox survey revealed 41 percent of healthcare IT professionals do not have a separate or sufficient budget for securing connected devices.

When asked about inventory of connected medical devices, majority of clinical and biomedical engineers (85 percent) were confident that they have an accurate inventory of all connected medical devices even though many rely on manual audits, which are prone to human error and quickly become outdated.

What’s more, close to two-thirds (64 percent) of responses from clinical and biomedical engineers indicate reliance on some form of manual room-to-room audit or use of static database to inventory the connected devices in their organization. Just 21 percent of responses say their devices receive preventative maintenance based on device usage as opposed to some kind of fixed schedule.

The survey also shows that more than half (55 percent) of responses indicate clinical/biomedical engineers must walk over to the device or call others to check on their behalf whether a device is in-use before scheduling repairs. Many make the trip only to find out that the device is in-use by patients and must try again in the future hoping for better luck, according to the survey.

“Despite the recent progress of the healthcare industry, the survey exemplifies the continued disconnect between perception of security and the actual device protection available from legacy solutions and processes. Unfortunately, much of the current perception stems from the use of traditional solutions, processes and general confusion in the market,” Xu Zou, CEO and co-founder of Zingbox, said in a statement. “Only by adopting the latest IoT technology and revisiting decade-old processes, can healthcare providers be well prepared when the next WannaCry hits.”


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HHS Opens Rebranded Healthcare Cyber Center

November 2, 2018
by Heather Landi, Associate Editor
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The U.S. Department and Health and Human Services (HHS) this week officially opened the Health Sector Cybersecurity Coordination Center (HC3), designed to strengthen coordination and cybersecurity information sharing within the healthcare sector and promote cybersecurity resilience.

According to HHS officials, HC3 is an operational cybersecurity center designed to support and improve the cyber defense of the healthcare and public health sector. The center will work to cultivate cybersecurity resilience by providing timely and actionable cybersecurity intelligence to health organizations and developing strategic partnerships between these organizations.

The Administration, under President Donald Trump, has designated the Department of Homeland Security (DHS) as the lead organization to combat cyber threats and develop preventive strategies across the entire economy, with HHS given the role to focus cybersecurity support on information sharing within the healthcare and public health (HPH) sector.

“HHS is proud to work with the health community to better protect Americans’ health data and confidential information,” HHS Deputy Secretary Eric Hargan said in a statement, adding that the announcement “is a recognition of the importance we place on stakeholder engagement as part of our cybersecurity work.”

Jeanette Manfra, assistant secretary for cybersecurity and communications in DHS, said in a statement that HC3 is a “vital capability for the early detection and coordination of information between the private sector and the federal government, and with cyber professionals across the federal government.”

“We believe that when a risk is shared across sectors, the only way to manage that risk successfully is to manage it collectively. We know that the majority of the cybersecurity attacks that occurred over the past year could have been prevented with quality and timely information - and the heightened importance of sharing information cannot be stressed enough,” Manfra said.

The opening of HC3 respresents the second healthcare-focused cybersecurity center in two years. In June 2017, the Healthcare Cybersecurity and Communications Integration Center (HCCIC) launched and was designed to focus its efforts on analyzing and disseminating cyberthreats across the healthcare industry in real time. However, the fledgling HCCIC was almost immediately mired in controversy due to abrupt changes in leadership. In just six months after HCCIC began operations, the HCCIC’s top leaders were reassigned.

In November 2017, there were reports that HCCIC's work was stalled as it was at the center of an investigation into contracting irregularities and possible fraud allegations. The cyber operations center was “paralyzed” by the removal of its top two officials, according to reports. Leo Scanlon, deputy chief information security officer at HHS, who ran the HCCIC, was put on administrative leave in September 2017  and his deputy, Maggie Amato, left the government. The HHS Office of the Inspector General then confirmed, at the time, an ongoing investigation into the reassignment of HCCIC leadership.

About a week letter, the House Committee on Energy and Commerce issued a letter saying it was examining whether HHS retaliated against two key HHS cybersecurity officials and whether those actions weakened the federal agency’s role in responding to healthcare cybersecurity incidents.

During the summer of 2017, HHS officials had touted the center’s success in light of the WannaCry ransomware attack back in March 2017, in which the U.S. healthcare system saw minimal impact. In an interview with Healthcare Informatics this past March, former HHS Deputy CISO Scanlon said the HCCIC, which played such a promising role during the WannaCry incident, had been "derailed" by the leadership reassignments.

There also were rumors back in March that the HCCIC would be rebranded and housed within Homeland Security in order to align with DHS’s information-sharing efforts. Scanlon said at the time that the effort to create a healthcare-specific cybersecurity information-sharing center was now "back to square one.”

It seems those rumors bore out as the new cyber center, HC3, is housed within DHS, whereas HCCIC, which is now gone, was intended to be a standalone entity partnering with NH-ISAC.

In the past year and a half, Congressional leaders have voiced concerns about the lack of clarity on the direction of HCCIC and HHS’ overall cybersecurity capabilities. Back in June, members of the House Energy and Commerce Committee and the Senate Committee on Health, Education, Labor and Pensions wrote a letter to HHS leaders citing concerns about the leadership changes, specifically the reassignment of senior officials responsible for the day-to-day operation of the HCCIC. “HHS’s removal of senior HCCIC personnel has had undeniable impacts on HCCIC and HHS’s cybersecurity capabilities.”

According to HHS and DHS officials, the mission of the new cybersecurity center, HC3, is now more important than ever with the healthcare sector reporting over 400 major breaches from 2017 to 2018. “Within the HPH sector, the threats are significant and hackers covet having the potential to access sensitive medical data, damage medical equipment, secure intellectual property for financial gain, or even conduct terrorist attacks.  The HC3 provides a service to healthcare organizations that enables them to protect their assets and patients,” Administration officials said in a press release.

To address these threats to the sector, HHS has developed a “coordination center” in the HC3 to coordinate the activities across the sector and report to DHS threats, profiles, and preventive strategies. The HC3’s role is to work with the sector, including practitioners, organizations, and cybersecurity information sharing organizations to understand the threats it faces, learn the bad guys’ patterns and trends, and provide information and approaches on how the sector can better defend itself, officials said.


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