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.”
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.