Lessons Learned from 2016: It’s Time to Address Internal Security Threats to Health Data | Heather Landi | Healthcare Blogs Skip to content Skip to navigation

Lessons Learned from 2016: It’s Time to Address Internal Security Threats to Health Data

January 15, 2017
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A Protenus report found that it took an average of 607 days for a healthcare organization to discover an internal data breach
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Throughout 2016, the message from cybersecurity experts has been fairly consistent and increasingly urgent—leaders at patient care organizations need to prioritize IT security. And, at the risk of sounding like a broken record, a recent year-in-review report on health data breaches makes one thing quite clear—healthcare leaders are still not doing enough to protect patient data.

According to a new “Breach Barometer” report from Baltimore-based healthcare cybersecurity vendor Protenus, and in collaboration with DataBreaches.net, the healthcare industry was plagued by breaches involving patient or health data in 2016, with hacking and ransomware incidents reminding us how vulnerable protected health information (PHI) remains.

According to an analysis by Protenus and DataBreaches.net, there were 450 data breach incidents either reported to the U.S. Department of Health and Human Services (HSS) or disclosed in the media in 2016; that’s more than one health data breach per day for the entire year, and these breaches resulted in 27 million affected patient records. If these trends continue, 2017 can expect to see a continued average of at least one breach disclosed per day.

A Healthcare Informatics news article about the Protenus report briefly highlights the key findings, yet the report findings about insider wrongdoing caught my attention. Many data security experts have pointed out that employees are the weakest link in the cybersecurity fence and, with this in mind, it's important to review these data breach incidents with an eye toward lessons learned and to find a way forward for protecting patient privacy.

Protenus reported that 43 percent of the 2016 health data breaches (192 incidents) were a result of insiders, and for the 162 incidents out of those 192 that Protenus has data for, 2 million patient records were affected. Now, while hacking accounted for the majority of patient records breached in 2016, insider incidents resulted in a larger number of breach incidents (120 vs. 192 respectively).

According to the Protenus report, the average number of breached patient records due to insider error was more than three times the number attributed to insiders with malicious intent. However, the report also noted that this figure was distorted by two large insider error incidents in August and December, which, when removed, shows the two categories to have roughly similar averages.

“While it is reassuring that not all insider breaches are with ill-intent, healthcare organizations need to make employee training, frequent reminders, and re-training a priority,” the report authors wrote.

One key reason why I think the insider incidents should be highlighted is that there is mounting evidence that that problem of insider data breaches has largely gone unaddressed as healthcare organizations focus on catching up with the external threats. Additionally, insider breaches tend to fly under the radar and can go undetected for quite some time. To this point, the report authors noted that in one incident, hospital employees were potentially inappropriately accessing patients’ medical information for years without being detected, because the hospital didn’t have technology in place to monitor or protect patient privacy. The hospital found potentially inappropriate accesses to the medical records beginning no later than 2013, and possibly much earlier.

“Without technology in place to provide alerts when access to a medical record is inappropriate, the organization now has to notify every single patient they’ve encountered since 2013, which will probably end up being a very costly process,” the report authors wrote.

The Protenus report findings also indicate that it took an average of 233 days for a healthcare organization to discover they had a health data breach. Perhaps most troubling is that the time to discovery specifically in cases of insider wrongdoing was more than double that—607 days. It goes without saying that it is critical for healthcare organizations to have a more proactive approach to monitoring patient data, as the sooner a breach is detected, the quicker organizations can mitigate the risk of significant damage being done with their patient’s data.

While limited budgets and resources are likely to blame for some organizations’ data breach detection capabilities, the report authors also surmise that organizations are still taking a reactive rather than proactive approach to privacy monitoring, and this can allow inappropriate access to the patient data to go unnoticed for extended periods of time.

In a recent interview, Mac McMillan, CEO of the Austin, Tex.-based CynergisTek consulting firm, had a similar view of healthcare data security. “I think there are some folks who are beginning to be a bit more proactive, but for the most part, we’re still a very reactive industry,” he said.

Regarding insider data breaches specifically, McMillan said, “They are going to continue to be a problem until we realize as an industry that we need to move to behavioral modeling and behavioral analysis to stop the threat. This is one of those situations where the methods we are using are antiquated. We’re typically monitoring users today based on rules, so in other words, somebody goes outside their prescribed boundary in terms of what they are doing, or some known convention in the system in terms of their profile. The problem is that most insiders that are perpetuating harm, they know what those rules are and so they are careful not to cross those boundaries. And, if you’re not actually looking at behavior, you’re not going to catch that.”

McMillan noted that an employee who comes to work everybody and does their job is generally going to look at x number of patients during their shift and they are going to have a behavioral pattern that is reflective of a person who is doing their job. "The person who is snooping or trolling around in the database or stealing identities is going to typically have a profile that is two to three times different than the person who is just doing their job. As long as they do that within the confines of their profile, the system never says anything, and never alarms. The only way to really detect that is to use behavioral analysis," he said.

Most cybersecurity experts agree that, in order to address the risk of insider breaches, healthcare organizations to step up employee training while also utilizing technology to detect inappropriate access to medical records.

Another cause for concern is that while the HHS Office for Civil Rights typically focuses on larger privacy violations, it’s been pointed out that small-scale violations of medical privacy often cause the most harm. As a real-world example, the Protenus researchers reported about a hospital employee who shared details of an adolescent's attempted suicide with people at his school. “The child was bullied and made fun of by his peers, resulting in his mother suing the responsible healthcare organization. This type of small-scale breach greatly affected the patient’s life and could end up costing the hospital significantly in legal fees, fines, and settlement,” the report authors wrote.

Besides the negative headlines and the financial impact to an organization, there is also the trust factor, and that should stay front and center in healthcare leaders’ minds as well. Protecting and securing patients’ health data is essential to maintaining and increasing patients’ trust in their healthcare providers.

As the Protenus report authors noted, “Critically, healthcare must move beyond thinking about privacy, security or compliance alone—these are merely three pillars of our true goal: ensuring trust. As an industry, we must think about the fundamental shifts we can effect to build and maintain this trust.”

Due to increasing attention to the impact of insider incidents, the Protenus report authors predict that 2017 will be "the Year of Insider Breach Awareness,” as healthcare organizations begin to realize that this constant and significant problem has gone unaddressed for too long. There are many patient care organizations proactively addressing the problem, and have been for quite some time, by utilizing security technology solutions--behavioral analysis is one, as McMillan noted--and investing resources in employee training and education. There are lessons to be learned from those organizations and you can expect to see Healthcare Informatics sharing those lessons learned in the coming year as healthcare IT leaders continue to grapple with data security challenges.



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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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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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