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Time for Enlightened Leadership on IT Security in 2017

January 11, 2017
by Mac McMillan
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As the new year begins, it’s time for the leaders of patient care organizations to make IT security a major priority for their enterprises—stat

2017 is here, and, like any new year, promises both opportunities and challenges. The question is, what will we do with it? Will it be a year of great progress, one of marking time, or worse yet one of falling further behind? Meeting the cybersecurity challenges of the future is a job for leaders. There should be no doubt that healthcare institutions are under attack on a regular basis now from external threats, while continuing to face the insidious abuse of insiders. As the old saying goes, “they have it coming and going.” Yet many patient care organizations still do not have a well-defined cybersecurity strategy, dedicated resources, advanced technologies required to fight the threat, or budget adequately for security protections. Strategy, resources, budget are all the responsibility of leadership.

 

Just something as straightforward as conducting risk assessments demonstrates the lack of priority and responsibility that some institutions place on cybersecurity. They expect third parties that host their data or systems to have minimally a SOC-2 performed—an independent third-party assessment. They wouldn’t think of acquiring another entity without an independent audit performed by a credible certified third party. But many will question the value of a third-party security assessment even when they do not have the resources or expertise in-house to perform an assessment to save dollars. CISOs often report that they hear from their leadership the question, “Why do we need to do this when nothing has happened?”, which is ironic because we are in an industry that values health check-ups and insurance to hopefully avoid and manage the things that CAN happen, to include the higher cost of healthcare from not doing the right things. They also value seeing the right medical professional to diagnose the condition, as opposed to self-diagnosis. Leadership in healthcare needs to wake up - cyber events CAN and DO happen and the money spent in prevention (such as credible third-party assessments) CAN and DOES help avoid incidents and mitigate the impacts when and if they occur. What is interesting is that other sectors, with far more sophisticated security organizations and much further along in the cyber maturity, such as government, banking, energy, etc. are required to seek independent assessments because they value that objective third-party review.

 

If 2016 was any indication of what to expect, and many think it is only the precursor to more, then we can absolutely count on cyber incidents happening in our industry. Which means they are something that leadership needs to take seriously, plan for, and ensure their organization is ready to tackle. It’s the definition of what the legal field calls reasonable security. You know there is a credible threat, you know the impacts can be costly to the business, you therefore take responsible action to address. That manifests itself in four primary areas; strategy, resources, budget and governance. Like any other area of the business leadership must first assess the maturity and adequacy of its cybersecurity readiness and independent third-party assessment is an invaluable tool to assist them in doing that. That assessment needs to be performed against the right yardstick to ensure its value, and that yardstick today is not the HIPAA security rule. The HIPAA security rule does not represent a credible security standard or a reasonable approach to defining or building a comprehensive cybersecurity program. Developed in the late 1990s, it has failed to keep up with the changes in the environment, technology, threat or even current security protocols. Enlightened leadership recognizes that they need to assess their organization’s readiness using more comprehensive and up-to-date requirements. A growing majority of entities in healthcare use the NIST Cybersecurity Framework (CSF) for healthcare. The NIST CSF covers 98 subcategories of controls that should be evaluated to assess the overall readiness of the cybersecurity program appropriately. The HIPAA Security Rule by comparison only addresses 19 of those subcategories. The NIST CSF provides the thorough review that contemporary organizations need to understand how resilient their enterprises are to cyber incidents while addressing compliance mandates as well.

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2017 also ushers in new leadership at the government level, and it will be interesting to see how they view cybersecurity readiness as a priority. Presidential Policy Directive (PPD) 21 re-identified 16 sectors as part of our national critical infrastructure. I say re-identified, because we, as a nation, have always had as a priority the protection of those critical areas necessary to maintaining our country and caring for our citizens. Healthcare has always been one of those critical infrastructures. Last year Executive Order – Promoting Private Sector Cybersecurity Information Sharing was issued to promote the sharing of cybersecurity threat information between public and private sector groups to increase awareness and enhance readiness. However, 12 months later we still do not have a comprehensive solution for collecting, analyzing and disseminating cyber threat information to healthcare entities. How will General Mike Flynn, newly appointed National Security Advisor; General John Kelly, newly appointed Homeland Security; and Congressman Tom Price, newly appointed Health & Human Services, view protecting the healthcare sector and patient information?

One thing seems certain, according to just about every security expert interviewed and those companies publishing research studies that next year is going to see more cyber events. And there is a growing concern that institutions have just as much to worry about with indirect attacks as they do deliberate attacks. The Dyn DDOS event was a great demonstration of this point. Many healthcare organizations lost access to their hosted EHR, their web presence and other web based applications even though they were not the intended target. The threat is real and continues to expand to all things connected. In order for healthcare organizations to be ready leadership needs to ask five questions:

1. Do we have a comprehensive cybersecurity strategy based on an adequate security framework?
2. Do we have enough and the right resources, internal and/or external, to adequately address cybersecurity?
3. Are we spending enough to create the proper balance between security and operations?
4. Are we assessing our program thoroughly, appropriately and objectively?
5. Does our security readiness meet the litmus test for reasonableness?

Determining the answers to those questions, and addressing the issues they bring up, will be tremendously important, as the threats to patient care organizations inevitably continue to accelerate this year.

Mac McMillan is founder and CEO of the Austin, Tex.-based CynergisTek consulting firm.

 


Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

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Study: Health Plans Accounted for 63 Percent of Breached Records in Past Seven Years

September 25, 2018
by Heather Landi, Associate Editor
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Mass. General study analyzes numbers, trends in health care data breaches nationwide, 2010-2017
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Health plans accounted for the greatest number of patient records breached over the past seven years, according to an analysis of U.S. health care data conducted by two Massachusetts General Hospital (MGH) physicians. 

Their report, published in JAMA, examined changes in data breaches during a period when electronic health records were being widely adopted across the country. 

While the largest number of data breaches took place at heath care providers—hospitals, physician offices, and similar entities—breaches involving the greatest number of patient records took place at health plans.

Lead author Thomas McCoy, M.D., director of research at the MGH Center for Quantitative Health, said in a statement, “While we conduct scientific programs designed to recognize the enormous research potential of large, centralized electronic health record databases, we designed this study to better understand the potential downsides for our patients – in this case the risk of data disclosure.”  

McCoy and senior author Roy Perlis, M.D., director of the Center for Quantitative Health, analyzed all data breaches reported to the Office of Civil Rights of the U.S. Department of Health and Human Services from January 1, 2010, to December 31, 2017.  They examined trends in the numbers and types of breaches reported in three categories: those taking place at health care providers, at health plans and at business associates – entities that do not provide or reimburse for health services but have legitimate access to patient data in support of plans or providers.

Protections for private patient data and mandatory public reporting of breaches of data confidentiality were established by the 1999 Health Insurance Portability and Accountability Act (HIPAA) and 2009 Health Information Technology for Economic and Clinical Health Act. Between 2010 and 2013, data breaches involving at least 29.1 million patient records were reported. The researchers surmised that the ongoing transition to electronic health records may increase such breaches, and used public data to examine the nature and extent of breaches from2010 through 2017.

The researchers’ analysis covered 2,149 reported breaches involving a total of 176.4 million patient records, with individual breaches ranging from 500 to almost 79 million patient records. Over the seven-year period, the total number of breaches increased every year (except in 2015) from 199 in 2010 to 344 in 2017. 

During that seven-year period, almost three out of four breaches occurred at healthcare providers, as 1,503 breaches took place at healthcare providers, or 70 percent of all breaches. In those breaches, 37.1 million records were compromised (21 percent of all breached records).

However, breaches involving health plans accounted for 63 percent of all breached records, or 110.4 million records. There were fewer total breaches at health plans during that seven-year period, with 278 breaches, or 13 percent of all breaches.

Business associates accounted for 28.7 million records breached, or 16 percent of all records breached.

The study also indicates changing trends over time with the adoption of EHRs and digital technology, as the most common type of breach in 2010 was theft of physical records. By 2017 data hacking or other information technology incidents accounted for the largest number of breaches, followed by unauthorized access to or disclosure of patient data, according to the study.

Similarly, the most common type of breached media in 2010 was from laptop computers followed by paper and film records, while by 2017 network servers or emails accounted for the largest number of breaches. Overall, the greatest number of patient records were breached from network servers.

“While the total of 510 breaches of paper and film records impacted about 3.4 million patient records, the 410 breaches of network servers impacted nearly 140 million records; and the three largest breaches together accounted for a bit more than half of all records breached,” McCoy said.  “As we work to make breaches less common and less consequential, we need to better understand systemic risk factors for data breach and the harms that arise from data disclosure.”

Furthermore, during this seven-year period, there also were increases in hacking or information technology (IT) incidents and unauthorized access, which both surpassed theft by 2016.

Perlis said in a statement, “For me, the message is that working with big data carries big responsibility. This is an area where health plans, health systems, clinicians and patients need to work together. We hear a lot about the huge opportunity to improve how we care for patients – but there is also risk, which we need to manage responsibly."

McCoy is an assistant professor of Psychiatry and Medicine, and Perlis is a professor of Psychiatry at Harvard Medical School.

 

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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.

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Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.

 


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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