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Should Healthcare Organizations be Looking at Biometrics for Health IT Security?

January 11, 2017
by Heather Landi
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Most cybersecurity experts predict that data security threats against the healthcare industry will only continue to increase and evolve in 2017 as widespread malicious and criminal hacking poses an increased risk to protected health information (PHI) and healthcare organizations’ information systems.

According to data from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) breach portal, also referred to as the “wall of shame,” the number of hacking/IT incidents at healthcare providers skyrocketed last year. In 2014, there were 18 reported data breach incidents classified as “hacking/IT incidents” at healthcare provider organizations, as reported to HHS. In 2015, there were 30 reported “hacking/IT incidents” that caused a data breach at healthcare provider organizations. Last year, that number jumped to 95, or more than triple the number of hacking incidents at healthcare provider organizations. Additionally, when looking at all data breaches reported to HHS by healthcare providers, there were 251 data breaches last year.

Facing an increasingly hostile cyber threat landscape, the leaders of healthcare delivery organizations are under pressure to protect their health data and information systems and many are turning to technology solutions to strengthen their IT security.

During a webinar sponsored by HIMSS Analytics (a division of the Chicago-based Health Information and Management Systems Society) exploring health IT security trends, HIMSS Analytics researchers presented data from a survey of healthcare executive leaders, including CTOs, CIOs, CISOs, IT/Security VP/directors, patient care heads and patient access heads, about their organizations’ use of biometric technology and the potential opportunity for biometric technology for the purposes of data security.

“Security in healthcare today is a huge topic and there are a lot of issues that organizations have to deal with in terms of providing patient protection, providing data protection and securing sites, such as securing their own facility and as well as other sites such as off-site storage, and there’s no one true answer,” Brendan Fitzgerald, director of research, HIMSS Analytics, said. “From the healthcare industry standpoint, I think security solutions, collectively, can be used in tandem to help thwart an attack and can only increase the efforts made by security groups within organizations to help strengthen security. Biometrics are not a silver bullet, but used collectively with other organizational tools around security can begin to make it more difficult for hackers to have access.”

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To provide an outline of the threat landscape, Matt Schuchardt, director of product development and innovation, HIMSS Analytics, cited data from HIMSS Analytics Logic and the HHS breach portal indicating that the number of reported security breaches at healthcare providers increased 167 percent in the last year. “More than 20 million Americans had their healthcare information exposed due to malicious hacking attacks just in 2016, and the volume and the depth of those attacks is significantly larger than what’s happened in previous years,” he said.

From a threat perspective, where the activity is happening has changed significantly in the last few years, as the network server is the new target, he said. “There was minimal network breaches in previous years, a lot of stuff around laptops, personal devices and some small number via the EMR, but the primary target today is the network itself. And we need to think about that with regard to biometrics, how do you secure that network in ways that make it easy to access the data but difficult to breach for unauthorized guests,” he said.

Taking a look at projections for data breaches at healthcare providers in the next two years, and the numbers are quite stark. “We’re looking at 45 million peoples’ records impacted in the next two years alone, so certainly the time to do something about this, is now,” Schuchardt said.

According to the data Schuchardt presented, there is a disturbing trend of repeated health system exploits. Since 2011, 31 different health systems in the U.S. have reported being breached multiple times by hackers. These 70 breaches impacted the privacy of 9 million patients. Additionally, almost half, (45 percent) of those 70 breaches were in 2016 alone, he said.

Hacks from 2010 to 2015 impacted 614,060 patients, an average of 122,812 per year. All in, the number of patients impacted by hacking in 2016 was 6,075 percent above the previous five years, he said. “The threat is real, it is growing and it is targeting your organizations in a variety of locations and with a variety of modalities. You need to think about how do you make the data available so patients and providers can access the information wherever care is happening, but keep the nefarious people away from it and its real challenge and it’s something we need to figure out relatively quickly,” he said.

Currently, the use of biometric solutions—fingerprints, hand geometry, retina or iris scans—for data security purposes is limited, but is beginning to pick up momentum across the healthcare space, Fitzgerald said.

Of the respondents to the survey, about half (47 percent) report that their organizations are currently using biometrics in different areas of hospital operations and not necessarily for security. Certain areas within healthcare organizations have been using biometric technology for some time, such as fingerprint biometric solutions for medication dispensing and employee identification, and that still seems to be the primary areas where biometric solutions are used. Sixty-two percent of the survey respondents reported using biometrics for medication dispensing and management, while 43 percent use the technology for employee identification.

According to Fitzgerald, the concept of biometrics is quickly moving away from being considered a convenience for end users to being a necessary security tool. The survey found that 28 percent of healthcare organizations are using biometrics for two-factor (multi-factor) authentication and 23 percent are using it for enterprise single sign-on. Additionally, 21 percent use biometrics for patient identification, 19 percent for facility access, 19 percent for application specific sign-on and 9 percent for data center protection.

“Two-factor authentication identification is an area where provider organizations may focus as a combination of security requirements, such as token and biometric, would strengthen accessibility to facilities, restricted areas, patient data and personal health information,” he said.

“One area that’s picking up speed than in the past is the area of employee identification and it’s less about tracking employees and more about making sure that you have the right employee at the right place and at the right time, so that can mean preventing access or allowing access to certain areas, such as data centers, any particular departments or wings in the hospital, and all that goes hand-in-hand with employee identification,” he said.

While fingerprint biometric solutions are the most widely used, HIMSS Analytics researchers found that palm print biometrics are being increasingly used for patient identification and organizations have reported that it has “helped reduce patient fraud in some cases and certainly helps to identify patients to their specific patient record,” Fitzgerald said.

Looking ahead, about one-third of survey respondents who do not currently use biometric solutions within their organizations have plans to do so, and while this represents modest future plans, there is a high ceiling for growth, Fitzgerald said.

For instance, larger organizations have more interest in using biometrics in the future, as over half of the organizations with plans to use the technology fall into the category of facilities with 251 to 500 beds or greater than 501 beds. However, Fitzgerald noted that data security is a universal issue across the healthcare market and interest from smaller facilities of less than 50 beds up to 200 beds registered at about 40 percent of those with plans to use biometric solutions.

When asked which areas their organizations plan to deploy biometric solutions, 62 percent of executive leaders who responded to the survey cited enterprise single sign-on and 50 percent cited employee identification. This indicates that organizations are looking to make the use of technology more efficient and hassle-free as possible for employees while also keeping the security of technology in mind, Fitzgerald said.

“The enterprise single sign-on is what most healthcare organizations are looking to use biometrics for in the future. Think of all the different types of data breaches that occur that can impact an institution, whether it’s a misplaced or stolen laptop or access to a particular area or access to a computer on the floor, so the enterprise single sign-on and incorporating that with either a token or some sort of multi-factor identification can certainly help bolster the level of security that’s really needed across the healthcare sector now,” he said.

The use of biometric technology for patient identification can help provide patients greater assurance about the security of their healthcare records, Fitzgerald noted. Additionally, 37 percent of respondents cited two-factor identification as an area where they plan to deploy biometric solutions and 25 percent cited facility access, while 12 percent cited data center protection.

“There are some challenges that go along with working with biometrics which may dissuade some organizations from actually looking at this technology on a serious level, such as workflow challenges in terms of identity management and clinical workflow,” he noted.

During the webinar, Fitzgerald also presented HIMSS Analytics data on healthcare IT application demand projections in 2017 to forecast where the market is headed. With regard to biometric technology adoption, Fitzgerald projects increasing interest from healthcare providers and growth could be as high as 10 percent in the next two years. “This is one of the technologies where negative events will cause the actual adoption to increase, but looking at the overall adoption of biometric security as a standalone application in hospitals in the U.S., the adoption curve has been slow,” he said. “But we do see some hospitals making investments in biometric security in the year or next 24 months.”

Addressing the slow adoption curve at healthcare organizations, Fitzgerald noted there are technical and cultural challenges to implementing biometric technology solutions. “This is a complicated system to implement, it requires sensors and connections into your data, and you also need to have readers and iris scanners, and you also need people comply with it. I think there’s some friction in terms of use. The technology has improved in terms of ease of use and improving the readability of the fingerprint, so that it’s readable when someone is wearing a glove, for instance, but the slowness and early phases of this has to do with the technological challenges of deploying one of these solutions and the social engineering required for compliance.”

He concluded, “The technology is more mature, the deployment of it is easier and the rewards are still very high.”

 


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OCR Fines Providers for HIPAA Violations, Failure to Follow “Basic Security Requirements”

December 12, 2018
by Heather Landi, Associate Editor
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Florida-based Advanced Care Hospitalists PL (ACH) has agreed to pay $500,000 to the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) for a number of HIPAA compliance failures, including sharing protected health information with an unknown vendor without a business associate agreement.

ACH provides contracted internal medicine physicians to hospitals and nursing homes in west central Florida. ACH provided services to more than 20,000 patients annually and employed between 39 and 46 individuals during the relevant timeframe, according to OCR officials.

Between November 2011 and June 2012, ACH engaged the services of an individual that claimed to be a representative of a company named Doctor’s First Choice Billings, Inc. (First Choice). The individual provided medical billing services to ACH using First Choice’s name and website, but allegedly without the knowledge or permission of First Choice’s owner, according to OCR officials in a press release published last week.

A local hospital contacted ACH on February 11, 2014 and notified the organization that patient information was viewable on the First Choice website, including names, dates of birth and social security numbers. In response, ACH was able to identify at least 400 affected individuals and asked First Choice to remove the protected health information from its website. ACH filed a breach notification report with OCR on April 11, 2014, stating that 400 individuals were affected; however, after further investigation, ACH filed a supplemental breach report stating that an additional 8,855 patients could have been affected.

According to OCR’s investigation, ACH never entered into a business associate agreement with the individual providing medical billing services to ACH, as required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, and failed to adopt any policy requiring business associate agreements until April 2014. 

“Although ACH had been in operation since 2005, it had not conducted a risk analysis or implemented security measures or any other written HIPAA policies or procedures before 2014. The HIPAA Rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s electronic protected health information,” OCR officials stated in a press release.

In a statement, OCR Director Roger Severino said, “This case is especially troubling because the practice allowed the names and social security numbers of thousands of its patients to be exposed on the internet after it failed to follow basic security requirements under HIPAA.”

In addition to the monetary settlement, ACH will undertake a robust corrective action plan that includes the adoption of business associate agreements, a complete enterprise-wide risk analysis, and comprehensive policies and procedures to comply with the HIPAA Rules. 

In a separate case announced this week, OCR also fined a Colorado-based hospital, Pagosa Springs Medical Center, $111,400 to settle potential HIPAA violations after the hospital failed to terminate a former employee’s access to electronic protected health information (PHI).

Pagosa Springs Medical Center (PSMC) is a critical access hospital, that at the time of OCR’s investigation, provided more than 17,000 hospital and clinic visits annually and employs more than 175 individuals.

The settlement resolves a complaint alleging that a former PSMC employee continued to have remote access to PSMC’s web-based scheduling calendar, which contained patients’ electronic protected health information (ePHI), after separation of employment, according to OCR.

OCR’s investigation revealed that PSMC impermissibly disclosed the ePHI of 557 individuals to its former employee and to the web-based scheduling calendar vendor without a HIPAA required business associate agreement in place. 

The hospital also agreed to adopt a substantial corrective action plan as part of the settlement, and, as part of that plan, PSMC has agreed to update its security management and business associate agreement, policies and procedures, and train its workforce members regarding the same.

“It’s common sense that former employees should immediately lose access to protected patient information upon their separation from employment,” Severino said in a statement. “This case underscores the need for covered entities to always be aware of who has access to their ePHI and who doesn’t.”

Covered entities that do not have or follow procedures to terminate information access privileges upon employee separation risk a HIPAA enforcement action. Covered entities must also evaluate relationships with vendors to ensure that business associate agreements are in place with all business associates before disclosing protected health information. 

 

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Eye Center in California Switches EHR Vendor Following Ransomware Incident

December 11, 2018
by Rajiv Leventhal, Managing Editor
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Redwood Eye Center, an ophthalmology practice in Vallejo, Calif., has notified more than 16,000 patients that its EHR (electronic health record) hosting vendor experienced a ransomware attack in September.

In the notification to the impacted patients, the center’s officials explained that the third-party vendor that hosts and stores Redwood’s electronic patient records, Illinois-based IT Lighthouse, experienced a data security incident which affected records pertaining to Redwood patients. Officials also said that IT Lighthouse hired a computer forensics company to help them after the ransomware attack, and Redwood worked with the vendor to restore access to our patient information.

Redwood’s investigation determined that the incident may have involved patient information, including patient names, addresses, dates of birth, health insurance information, and medical treatment information.

Notably, Redwood will be changing its EMR hosting vendor, according to its officials. Per the notice, “Redwood has taken affirmative steps to prevent a similar situation from arising in the future. These steps include changing medical records hosting vendors and enhancing the security of patient information.”

Ransomware attacks in the healthcare sector continue to be a problem, but at the same time, they have diminished substantially compared to the same time period last year, as cyber attackers move on to more profitable activities, such as cryptojacking, according to a recent report from cybersecurity firm Cryptonite.

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Report: 30 Percent of Healthcare Databases Exposed Online

December 10, 2018
by Heather Landi, Associate Editor
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Hackers are using the Dark Web to buy and sell personally identifiable information (PII) stolen from healthcare organizations, and exposed databases are a vulnerable attack surface for healthcare organizations, according to a new cybersecurity research report.

A research report from IntSights, “Chronic [Cyber] Pain: Exposed & Misconfigured Databases in the Healthcare Industry,” gives an account of how hackers are tracking down healthcare personally identifiable information (PII) data on the Dark Web and where in the attack surface healthcare organizations are most vulnerable.

The report explores a key area of the healthcare attack surface, which is often the easiest to avoid—exposed databases. It’s not only old or outdated databases that get breached, but also newly established platforms that are vulnerable due to misconfiguration and/or open access, the report authors note.

Healthcare organizations have been increasingly targeted by threat actors over the past few years and their most sought-after asset is their data. As healthcare organizations attempt to move data online and increase accessibility for authorized users, they’ve dramatically increased their attack surface, providing cybercriminals with new vectors to steal personally identifiable information (PII), according to the report. Yet, these organizations have not prioritized investments in cybersecurity tools or procedures.

Healthcare budgets are tight, the report authors note, and if there’s an opportunity to purchase a new MRI machine versus make a new IT or cybersecurity hire, the new MRI machine often wins out. Healthcare organizations need to carefully balance accessibility and protection.

In this report, cyber researchers set out to show that the healthcare industry as a whole is vulnerable, not due to a specific product or system, but due to lack of process, training and cybersecurity best practices. “While many other industries suffer from similar deficiencies, healthcare organizations are particularly at risk because of the sensitivity of PII and medical data,” the report states.

The researchers chose a couple of popular technologies for handling medical records, including known and widely used commercial databases, legacy services still in use today, and new sites or protocols that try to mitigate some of the vulnerabilities of past methods. The purpose of the research was to demonstrate that hackers can easily find access to sensitive data in each state: at rest, in transit or in use.

The researchers note that the tactics used were pretty simple: Google searches, reading technical documentation of the aforementioned technologies, subdomain enumeration, and some educated guessing about the combination of sites, systems and data. “All of the examples presented here were freely accessible, and required no intrusive methods to obtain. Simply knowing where to look (like the IP address, name or protocol of the service used) was often enough to access the data,” the report authors wrote.

The researchers spent 90 hours researching and evaluated 50 database. Among the findings outlined in the report, 15 databases were found exposed, so the researchers estimate about 30 percent of databases are exposed. The researchers found 1.5 million patient records exposed, at a rate of about 16,687 medical records discovered per hour.

The estimated black-market price per medical record is $1 per record. The researchers concluded that hackers can find a large number of records in just a few hours of work, and this data can be used to make money in a variety of ways. If a hacker can find records at a rate of 16,687 per hour and works 40 hours a week, that hacker can make an annual salary of $33 million, according to the researchers.

“It’s also important to note that PII and medical data is harder to make money with compared to other data, like credit card info. Cybercriminals tend to be lazy, and it’s much quicker to try using a stolen credit card to make a fraudulent purchase than to buy PII data and run a phishing or extortion campaign. This may lessen the value of PII data in the eyes of some cybercriminals; however, PII data has a longer shelf-life and can be used for more sophisticated and more successful campaigns,” IntSights security researcher and report author Ariel Ainhoren wrote.

The researchers used an example of hospital using a FTP server. “FTP is a very old and known way to share files across the Internet. It is also a scarcely protected protocol that has no encryption built in, and only asks you for a username and password combination, which can be brute forced or sniffed

by network scanners very easily,” Ainhoren wrote. “Here we found a hospital in the U.S. that has its FTP server exposed. FTP’s usually hold records and backup data, and are kept open to enable backup to a remote site. It could be a neglected backup procedure left open by IT that the hospital doesn’t even know exists.”

According to the report, hackers have three main motivations for targeting healthcare organizations and medical data:

  • State-Sponsored APTs Targeting Critical Infrastructure: APTs are more sophisticated and are usually more difficult to stop. They will attempt to infiltrate a network to test tools and techniques to set the stage for a larger, future attack, or to obtain information on a specific individual’s medical condition.
  • Attackers Seeking Personal Data: Attackers seeking personal data can use it in multiple ways. They can create and sell PII lists, they can blackmail individuals or organizations in exchange for the data, or they can use it as a basis for further fraud, like phishing, Smishing, or scam calls.
  • Attackers Taking Control of Medical Devices for Ransom: Attackers targeting vulnerable infrastructure won’t usually target healthcare databases, but will target medical IT equipment and infrastructure to spread malware that exploits specific vulnerabilities and demands a ransom to release the infected devices. Since medical devices tend to be updated infrequently (or not at all), this provides a relatively easy target for hackers to take control.

The report also offers a few general best practices for evaluating if a healthcare organization’s data is exposed and/or at risk:

  • Use Multi-Factor Authentication for Web Applications: If you’re using a system that only needs a username and password to login, you’re making it significantly easier to access. Make sure you have MFA setup to reduce unauthorized access.
  • Tighter Access Control to Resources: Limit the number of credentials to each party accessing the database. Additionally, limit specific parties’ access to only the information they need. This will minimize your chance of being exploited through a 3rd party, and if you are, will limit the damage of that breach.
  • Monitor for Big or Unusual Database Reads: These may be an indication that a hacker or unauthorized party is stealing information. It’s a good idea to setup limits on database reads and make sure requests for big database reads involve some sort of manual review or confirmation.
  • Limit Database Access to Specific IP Ranges: Mapping out the organizations that need access to your data is not an easy task. But it will give you tighter control on who’s accessing your data and enable you to track and identify anomalous activity. You can even tie specific credentials to specific IP ranges to further limit access and track strange behavior more closely.

 

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