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A Layered Approach to Fighting Cybercrime

November 13, 2014
by Rajiv Leventhal
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Data breaches are on the rise in healthcare, and one IT expert says the industry isn’t making it a priority

Data breaches in healthcare have been steadily on the rise; a report from Redspin, Inc., a Carpinteria, Calif.-based provider of IT security assessments, revealed that in 2013, the number of protected health information (PHI) breaches were up 138 percent from 2012, with 199 incidents of breaches of PHI reported to the Department of Health and Human Services (HHS) impacting over 7 million patient records. The report, the fourth annual one from Redspin, found that nearly 30 million Americans have had their health information breached or inadvertently disclosed since 2009.

Breaches are coming from different fronts, varying from outside hackers to internal staff to accidental incidents. But what’s clear is that the industry being seriously affected by cybercrime. A 2013 white paper from RSA, the security division of the Hopkinton, Mass.-based vendor EMC, concluded that cybercrime in the healthcare industry is still in its relative infancy—and only because the exchange of healthcare information online is also in its relative infancy. “Recent history provides ample evidence to conclude that the increase in healthcare data sharing via electronic health records (EHRs), personal health records, insurance portals, and prescription sites will inspire a commensurate increase in cybercriminal activity targeted at healthcare organizations,” the report’s authors said. Undoubtedly, the increase in breaches at a time when cybercrime is apparently only in its “relative infancy” has to be very worrisome for patient care organizations.

Like all hospitals, email is a primary communication tool for the Dothan-based Southeast Alabama Medical Center (SAMC), a 400-bed community facility serving Southeastern Alabama and portions of the Florida panhandle. And also like other healthcare facilities, Southeast Alabama Medical Center is challenged by a deluge of spam, phishing schemes and adware.

The double use of phishing and malware within the same cyber attack is not uncommon or new. Earlier this year, in Sacramento, Calif., UC Davis Health System notified 1,800 patients of a phishing scam that compromised three physicians’ email accounts.  In these attacks, hackers will often send emails or other communications to those inside the IT network in an effort to get victims to download self-executing programs that install malware compromising the entire system.

At SAMC, secure collaboration between the organization, health networks, research institutions as well as intra-departmental collaboration is a necessity. But the high-tech environment created to facilitate this collaboration and data exchange is often filled with security challenges. According to Clyde Williams, SAMC’s IT technical manager, many data breaches are tough to anticipate and control. “Most of our users are relatively intelligent, but people are still naïve on the internet and with email, so even our smartest users fall victim to little phishing things,” he says.  “People at the department director level might get an email that that says it’s coming from a system administrator, so they want to reply to it, or click the link inside of it,” he adds.

Email attachments may carry malware, or phishing scams, where attackers simulate trusted brands, can gather personal information from unsuspecting users. Williams says SAMC has a layered approach, and before even thinking about cybercrime, you need to think about managing access to inappropriate material or controlling the flow of email into the facilities. “One thing we do with our web content filters, we specifically block all access to uncategorized content. So if someone is on the internet and there’s an obscure site, we pop up a warning message that says, ‘Hey this site is uncategorized, are you sure you want to go there?’” Williams says.  

SAMC has also tapped the Gulf Breeze, Fla.-based web security company AppRiver, using its inbound and outbound spam and email filtering technology to block unwanted messages and keep its system free of adware, spyware and viruses. “We’re probably more meticulous than most organizations when it comes to being restrictive,” says Williams. “In fact, you could say that we’re more restrictive than we should be. But we have not had any direct breaches of patient information here, and our layered approach—with AppRiver being one of those layers—definitely contributes to that,” he says.

According to the EMC white paper, intentional incidents are evident by the sheer number of data breaches targeting healthcare organizations as well as the estimated 250,000 to 500,000 medical identity thefts that take place each year. But Williams says that it’s the accidental breaches that he sees most, and that the healthcare industry isn’t yet a main target. “It’s not usually someone reaching in and trying to specifically extract data, but maybe it was a vulnerability that got exploited, and someone  stumbled across a hospital  and decided to break in and get some of the data out,” he says. Also, there are lost or stolen devices such as laptops, hard drives, and mobile devices with PHI on them, he notes. “But from what I’ve seen, I don’t think the industry is a target yet.”


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It seems that sooner or later a hacker will get in to almost every network. Are there ways to determine what the risks are once they get in?

Often times organizations have many copies of data throughout their environment, does this make it easier for the hackers (and more difficult to protect). Also, are there particular environments that are more prone to being hacked? Network segments that contain DMZ, QA, or test may not have the same level of security as other more protected areas of the environment.

The more information that we can pass on to the next organization to be breached, the better.