Without Transformational Investments in Data Security, Healthcare Will Continue to be Vulnerable | Heather Landi | Healthcare Blogs Skip to content Skip to navigation

Without Transformational Investments in Data Security, Healthcare Will Continue to be Vulnerable

August 3, 2017
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In the past two years as I have reported on healthcare data breaches and cybersecurity issues, the overarching message that I’ve repeatedly heard from data security experts is that the threats against healthcare information systems and patient data will get worse before they get better.

That sentiment was echoed again in Protenus’ Breach Barometer Mid-Year Review, which was released this week, which indicates that, so far, 2017 is on track to worsen or surpass last year in terms of number of breach incidents and/or number of breached patient records. In fact, 2017 is on track to exceed the 2016 trend of one health data breach per day, according to Protenus.

From January to June 2017, there were a total of 233 breach incidents reported to the U.S. Department of Health and Human Services (HHS), the media, or state attorneys general, according to Protenus, a health data protection startup, and DataBreaches.net, a website that follows and reports data breaches. The two organizations collaboratively develop the Breach Barometer reports. There were a total of 450 incidents in 2016. And, so far, in 2017, 3.16 million patient records were affected by these breach incidents

Another big takeaway from the Protenus/DataBreaches.net report is that insider threats remain constant. The report states that 41 percent of the health data breaches so far in 2017 (96 incidents) were a result of insiders, and 1.17 million patient records are known to have been affected. In fact, insiders are increasingly responsible for a significant amount of health data breaches, 28 percent more than hacking and ransomware.

According to Robert Lord, co-founder and CEO of Protenus, 2 million patient records were affected by insider activity for the entire year in 2016, so the 1.17 million patient records impacted so far this year represents a 20 percent increase versus this time last year.

“The insider threat is a silent, continuous threat that is not being addressed,” Lord said during a webinar presenting the mid-year data breach findings.

Looking at hacking incidents, so far in 2017, there have been 75 separate breach incidents that were the result of hacking, Protenus reports, yet incidents involving hacking or malware are likely underreported. On the HHS breach reporting tool, or “Wall of Shame,” hacking and/or malware are often simply reported as “hacking” or an “IT incident. And in many cases, Databreaches.net has found through independent research that incidents were not reported at all.

“We saw about 120 hacking incidents in 2016, so that’s about 60 incidents at the half year. Unfortunately, we’re seeing 25 percent more than that as there’s been 75 hacking incidents so far in 2017. I wish I could share better news with you, but, depending on how you slice it, things are not getting better, and maybe they are getting worse,” Lord said.

The Protenus report findings, and other cybersecurity studies, should serve as a call-to-action for healthcare organizations to increase efforts to thwart inappropriate access to their patients’ most sensitive data. Yet, the perspective of many cybersecurity experts is that this call-to-action may be falling on deaf ears at the senior leadership and board level at patient care organizations.

A recent survey of healthcare IT security leaders by KPMG, an audit, tax and advisory services firm, indicates that the number of healthcare organizations making investments in information security has actually declined since 2015.

When asked about “readiness to defend against a concerted cyber attack,” 35 percent of CIOs, CISOs, CTOs and CSOs at provider and payer organizations said they are “completely ready” versus 16 percent in 2015. In the survey, respondents were asked to rate their “readiness” at a level of 1 (not at all ready) to 5 (completely ready). Thirteen percent of respondents rated their organization at level 3 and 52 percent rated their organization at level 4. None of the organizations rated themselves as level 1 or 2.

KPMG’s survey, conversely, found that cyber security as a board agenda item has declined over the past two years (79 percent versus 87 percent in 2015). In addition, KPMG found a disconnect regarding cyber investment in this volatile environment. A smaller majority of healthcare companies made investments in information protection in the prior 12 months (66 percent versus 88 percent in the 2015 survey).

The KPMG survey results indicate a disconcerting trend, and, in fact, Protenus’ Lord referenced this particular survey during the webinar presenting his company’s data breach findings.

“One of the consistent things we see is that no matter how much light has been shone around these things—and people are talking about it and there’s more awareness—but there is just not transformational levels of investments in this space. There are good faith efforts; a lot people care. Security and privacy officers are often understaffed and under-resourced and they can’t do a lot more without senior level or board buy-in. In order to make changes, we’ve got to take a new approach to this,” he said.

Lord also surmised that as awareness about data security issues has increased, health systems are now just “checking that box” and board members may assume that they have focused on data security enough. “Simply, awareness efforts are reaching security and privacy teams but not getting up to the board. We need to continuously make sure we have that advocacy and that engagement. There needs to be a greater understanding that privacy and security are not just two buzzwords or two departments, but strategic pillars of our organizations. There needs to be a strategic orientation toward trust, and this is an opportunity to build trust with patients,” Lord said.

What’s become very clear to everyone is that health data protection needs to be a priority to increase patient trust in the healthcare organizations where they seek care. Let’s all keep our focus on the fact that behind the data breach incidents are specific medical records, and behind the medical records are real patients with real lives.

As an example of the ripple effect for patients, earlier this spring, the Bangor, Maine-based Behavioral Health Center was the victim of a cyber attack. According to media reports, the attacks compromised around 4,000 patients’ private information. At the time, Databreaches.net reported that there was an ad placed on the dark web offering to sell the information for $10,000. Unfortunately, reports of hackers selling health data on the dark web have become fairly common now, and while the seller claimed that the health data included the usual information—names, addresses and Social Security numbers—as the clinic is a behavioral health center, the medical histories also included highly sensitive information, such as therapy sessions and psychiatric evaluations.

DataBreaches.net also reported that the Maine clinic is now closing and the breach factored heavily into the decision to close. “It couldn’t bounce back from the liability issues,” DataBreaches.net reported.

There seems to be agreement among cybersecurity experts that transformational change and investment are needed at patient care organizations in order to protect patient data. This will likely entail increasing IT security budgets, but it also means there needs to be a change in mentality at the boardroom level. Until that happens, there is widespread concern that the current upward trajectory of increasing healthcare data breaches will not change, and might only get worse.

 

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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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