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Washington Debrief: Lawmakers Explore Cyber Risks of Connected Devices, IoT in Hearing

November 21, 2016
by Leslie Kriegstein, Vice President of Congressional Affairs, CHIME
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Key Takeaway: The House Committee on Energy and Commerce held a joint hearing last week to examine the role of connected devices, including medical devices, and their role in recent cyber attacks.

Why It Matters: The internet of things (IoT) and the growth of connected devices has exposed additional security vulnerabilities, presenting new avenues for bad actors to exploit, including in healthcare. Among the many devices that could be coopted by threat actors are medical devices, both in the traditional sense and those that blur the lines between consumer devices with the potential to inform clinical decision making.

CHIME and AEHIS submitted a statement that was included in the hearing record that outlined the role medical devices could play in a distributed denial of service attack (ddos) and possible actions for Congress to take to enhance security of medical devices in coordination with the Food and Drug Administration (FDA). Among the recommendations included ensuring the FDA has proper resources to manage vulnerability disclosures and to evaluate security during the device approval process.

Members of the Subcommittees on Communications and Technology and Commerce, Manufacturing and Trade explored the range of security issues facing the healthcare industry, including roles and responsibilities for medical device manufacturers and healthcare providers. Members and witnesses discussed what incentives may need to be inserted into the marketplace to ensure that security is intrinsically designed into the product rather than added as an afterthought.

Congressional Outlook for the Remainder of 2016 – 21st Century Cures, Government Funding

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Key Takeaway: As the final days of the 114th Congress come to a close a few healthcare bills may still stand a chance.

Why It Matters: Congress is set to adjourn for the year on December 16, leaving limited time to consider legislation. Among the top legislative candidates for consideration that includes health IT provisions is the 21st Century Cures Act, which will be reconciled with the work of the Senate Health, Education, Labor and Pensions Committee’s Innovation Initiative.

 The House passed a comprehensive bill, the 21st Century Cures Act (HR 6) in an overwhelmingly bipartisan fashion in July 2015, which included provisions on interoperability, information blocking and telehealth. The Senate HELP Committee instead approved a number of individual bills, including the Improving Health Information Technology Act (S.2511) which also addressed a number of health IT issues. CHIME staff has compared the health IT provisions of the two existing bills here.

Another bill that CHIME would like to be considered is the EHR Regulatory Relief Act (S.3173). This legislation sponsored by Senator John Thune (R-SD) and the group of republican senators known as the “REBOOT” group, would instate 90-day reporting periods for the Meaningful Use program perpetually as well as adjust the troublesome all-or-nothing structure of the EHR Incentive Program for all providers beginning in the 2016 program year and for eligible hospitals thereafter when Medicare clinicians move to the Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act. CHIME has endorsed this legislation and if you’d like to tell you Congressional delegation to support this legislation, you can do so here.  

The current government funding package expires on December 6, therefore Congress must also pass either short-term continuing resolution (CR) or a series of appropriations bills to fund the government through FY17. Most recent discussions suggest that a short-term package will fund the federal government through March of 2017 to allow the new Administration and new Congress to influence the funding package based on their policy priorities.

Health IT Money

Key Takeaway: AHRQ Funding Opportunity

Why it Matters: AHRQ intends to publish a Funding Opportunity Announcement to conduct research that demonstrates how health information technology (IT) can improve patient-centered health outcomes and quality of care in primary care and other ambulatory settings through the scale and spread of successful, health IT-enabled practice models that use patient-reported outcome (PRO) measures to achieve these objectives. More information can be found here.

New NIST Cyber Resource

Key Takeaway: NIST has published a groundbreaking new security guideline on systems security engineering.

Why it Matters: The new NIST guideline addresses the longstanding problem of how to engineer trustworthy, secure systems—systems that can provide continuity of capabilities, functions, services, and operations during a wide range of disruptions, threats, and other hazards. The publication addresses the engineering-driven perspective and actions necessary to develop more defensible and survivable systems, inclusive of the machine, physical, and human components that compose the systems and the capabilities and services delivered by those systems.

OCR November Newsletter

Key Takeaway: OCR focuses on best practices to prevent breaches.

Why it Matters: OCR’s November 2016 Cyber Awareness Newsletter shines the spotlight on best practices to prevent breaches due to weak authentication. Authentication is a process used to verify whether someone or something is who or what it purports to be in the electronic context, while keeping unauthorized people or programs from gaining access to information. In the healthcare sector, healthcare entities usually use login passwords or passphrases to access information on public or private networks, internet portals, computers, medical devices, servers, and software applications. OCR suggests that healthcare entities take a second look at their safeguards to decrease the possibility of being exposed to potential threats, and how to reduce breaches of electronic protected health information. Read OCR’s full article.

Malcom Baldridge Quality Award

Key Takeaway: NIST Now Accepting Applications for the Malcom Baldridge Quality Award

Why it Matters:  High-performing U.S. businesses, nonprofits, health care, and education organizations should consider applying next year for the nation’s most prestigious and only Presidential award for organizational excellence: the Malcolm Baldrige National Quality Award. 2017 Baldrige Award application forms and guidance are now available online to help organizations learn how to apply and begin preparing to submit a complete application by the deadline of May 2, 2017 (and eligibility package due date of February 21, 2017).

CMS Quality Webinar

Key Takeaway: QR-EHR Incentive Program Alignment Outreach and Education Webinar on common errors for quality reporting data architecture (QRDA) Category I test & production files.

Why it Matters:  This Outreach and Education webinar for participants in the Hospital Inpatient Quality Reporting (IQR) Program is scheduled for Wednesday, November 30, 2016. This presentation will provide an overview of several topics related to the mandatory electronic Clinical Quality Measure (eCQM) submission process for the Hospital IQR and Medicare EHR Incentive Programs for Calendar Year 2016. The topics include the top-ten eCQM QRDA test and production file submission errors, tips to troubleshoot the errors, and a review of tools and reference materials to assist facilities to successfully submit files. You may register for the webinar here.

 


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/news-item/cybersecurity/ocr-fines-providers-hipaa-violations-failure-follow-basic-security

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.

Related Insights For: Cybersecurity

/news-item/cybersecurity/report-30-percent-healthcare-databases-exposed-online

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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