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RWJBarnabas Health's CISO on the Changing Cybersecurity Threat Landscape

March 20, 2017
by Heather Landi
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Healthcare organizations need to be proactive and thoughtful in assessing the security of their organizations, Syed says
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Chief information security officers (CISOs) at healthcare organizations are facing a number of security threats and challenges, including an increase in ransomware and other cyberattacks targeting the information systems at patient care organizations. Hussein Syed, CISO at the West Orange, N.J.-based RWJBarnabas Health, an integrated healthcare system in New Jersey, is acutely aware of these challenges and the need to use new processes and tools to adequately mitigate the risks of data breaches and ransomware attacks.

“Today’s hackers operate as professional organizations, meaning they do a lot of planning and diligence before executing attacks. This means healthcare organizations must be equally proactive and thoughtful in how we assess the security of our organizations,” Syed said back in February during the announcement of a healthcare security readiness program developed by VMWare and Intel Health and Life Sciences.

RWJBarnabas Health was an early participant in the VMWare/Intel healthcare security readiness program, which offers healthcare organizations free assessments to benchmark the organization’s security maturity, priorities and capabilities against their peers. According to Syed, the assessment tool provides valuable insight into the organization’s security posture compared to other healthcare organizations when it comes to breach mitigation in order to identify and implement solutions to further reduce risks. RWJBarnabas health was formed last year as the result of a merger of Barnabas Health and Robert Wood Johnson Health System. The health system, with a service area covering five million people, consists of 11 acute care hospitals, three acute care children’s hospitals, ambulatory care centers and geriatric centers

During the HIMSS17 Conference in Orlando, Syed, who has been in the CISO role at RWJBarnabas for two years, spoke with Healthcare Informatics Assistant Editor Heather Landi about how the threat landscape in healthcare has changed and the steps that RWJBarnabas Health is taking to combat cybersecurity threats and challenges in this evolving environment. Below are excerpts from that interview.

Leading up to the HIMSS17 conference, what were you interested in seeing?

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I came here with a pretty open mind. This is a different conference for me [compared to the RSA Conference in San Francisco, a cybersecurity conference] because I’m not walking up to a booth thinking that they are selling security technologies. I walk into the HP booth and they are talking about imaging and after a little conversation, they say, ‘we also use these technologies, such as encryption, to provide security to the solutions as well.’ The paradigm has slightly shifted. [The health IT vendors] talk about how to do the security and meet HIPAA [Health Insurance Portability and Accountability Act] security requirements. A couple of years ago we would laugh when vendors would say ‘our products are HIPAA compliant.’ Nothing is HIPAA compliant unless you configure it to be HIPAA compliant. That’s changed as vendors now say ‘this product is designed to meet HIPAA compliance requirements.’

Hussein Syed

The healthcare market has changed; it’s not just HIPAA anymore. Five or six years ago, people worried about HIPAA. Now I’ve seen, last year, there were about 16 to 17 major ransomware challenges that the healthcare market had to face and they ranged from small health systems to large ones. And you can say that the smaller ones are not doing their job and that’s why they got infected, but it’s just the luck of the draw where there was a small gap and somebody was able to infiltrate and get through and encrypt the data. Anybody can be a victim, no one is safe from that anymore.

For healthcare CISOs, what are the top priorities right now?

Right now, we’re looking very carefully around how to build our environment to be safe, to be protected from risk. That’s a big challenge, and most organizations have gone through the basics stuff, such as malware protection, locking down the USB ports and email encryption and email filtering/spam protection solutions. So they’re well on the road to have a basic infrastructure in place. Now you need to go to the next level, because the threat landscape is changing. You can start looking at the predictions that analysts are making about what you should worry about for next year. And you can look at all those things and map everything with what you have, with the cybersecurity frameworks that you have adopted, and check off what’s there and what’s not there and evaluate where you can make a better mark.

What are the steps that RWJBarnabas is taking to enhance information security?

We have zeroed in on a number of things that we need to focus on in 2017. One thing we have to do is we have to get a very good handle on access management. And, I’m not just talking about the user accounts, I’m talking about the whole life cycle of user predicting and intelligence around the use of those credentials, such as, when do people log in and log off, what do they do, what is their behavior, so we get a picture and understand a user’s normal behavior. We’re also looking at collecting all those data around user access so we can quickly identify threats. Secondly, we’re serious about overlaying it with multiple factor authentication, whether it’s single sign-on or two-factor authentication.

In order to improve security controls to prevent breaches, we also are focused on implementing micro-segmentation of networks and installing new DDoS and web application firewalls. With regarding to segmenting the environment, traditionally healthcare networks got built and those environments grew and people created bigger networks and there is a misunderstanding where IT folks think that VLAN is segmenting the environment; it’s segmenting it from a routing and switching perspective. You actually have to segment the environment by using firewall technology or micro-segmenting, that way you have multiple environments in the same virtualized chassis or same network, but they are separate from each other so one doesn’t know the other exists and problems here don’t bleed over to the other side. That is an active project, starting Q2, to work out a very strong micro-segmentation strategy and implementation.

The other area that we have focused on is identifying where our structured and unstructured data is and locking it down. It’s easier to lock down structured data because sits in a database and it’s known to people and what we look at there is privileged account management—who has access to it, how are they accessing it, how often do they access sit, what type of data do they extract from that system and where do they put it? We are working to further secure the databases by using database activity monitoring so that we can create a profile and then if there is a change in that profile, we are making sure that we are notified and alerted and protecting that. In addition to that, what we want to do is have an inventory of unstructured data is so we can encrypt that environment. Traditionally, we have mobile devices, laptops, desktops, but now we’re focusing on encrypting databases and encrypting file shares and tying it to the data and access management that we have. So the user who needs to have access to that data is the only one who can de-crypt that data, nobody else. So if that data is exfiltrated or stolen, it’s encrypted data and it’s protected. And there are two benefits with that—one, we have fewer people looking at that data, and second, if it is accessed, it’s only for legitimate reasons.

Insider data breaches are an ongoing challenge. What are you doing to address that challenge?

We are focused heavily on creating awareness about threats, about breaches, about infiltrations, and where things can happen, creating awareness that even if it’s not a breach, it could be disruptive to the environment. We are focused on training to educate users, including phishing exercises and internal webinars. If a department is having a meeting, even if it’s only three to four minutes where we can come in and talk about [cybersecurity], it helps to keep it fresh in [employees’] minds and creates better awareness.

As you mentioned ransomware and other cyberattacks are a growing threat to healthcare organizations. What are you doing to mitigate that risk?

It’s a patient safety issue, it’s a revenue management issue, it’s a reputational issue and it’s a huge expense issue too, so what we have done is we have blocked all servers to be allowed to go to the internet and we have removed access for everybody to download any software. If a user needs software downloaded, then they go into a quarantine state, download it, un-package it, run it through protection to make sure it’s clean before it’s allowed to be installed. We’re actively removing administrative rights from workstations. For outbound Internet traffic, we have implemented proxies so every traffic that leaves our network has to be authenticated traffic. We also block almost all the categories around software downloads, spyware and questionable sites, and we’ve logged anything that is not categorized. So, for example, we have 110 categories of business, and for websites not categorized, it blocks it. The user then fills out a form providing the business reason they need to go to this website and that form goes to our one of our security analysts to review it. If feel that it is a legitimate website with no threat, they will permit it, otherwise the security analyst will write back, ‘These are the reasons you are blocked, it’s not the website that you are trying to go to, it’s a phishing website.’ And we’ll educate our users to Google the business and then pull up their website rather than type in the domain name provide in the email. And sometimes you’ll get this email from the users saying, ‘wow, that’s how creative [cybercriminals] are, and then they’ll go home and tell their family about this, so it’s helping to educate others.

 

 

 


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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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