A Cross-Industry Survey Finds Broad IT Security Unpreparedness among CISOs | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

A Cross-Industry Survey Finds Broad IT Security Unpreparedness among CISOs

August 24, 2017
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IDG Connect’s new study finds a very low level of data and IT security leaders’ preparedness to meet accelerating threats

How prepared to manage threats are chief information security officers (CISOs) and others responsible for data security in business organizations across the United States and the United Kingdom? If the results of a new survey are to be believed, not really all that prepared.

As Healthcare Informatics Associate Editor Heather Landi reported yesterday, the results of a recent survey on the subject have just been released, and they are cause for concern.  As Landi reported, “A recent survey of IT information security decision makers found that 68 percent of respondents have, at best, only modest confidence in their ability to manage digital threats, and a quarter of healthcare information security decision makers cited little to no confidence in their ability to assess digital risks. RiskIQ, a San Francisco-based digital threat management solutions company, released new independent research on the state of digital defense, with the predominant finding being organizations believe their digital transformation efforts have outpaced security capacity. The survey, called the ‘2017 State of Enterprise Digital Defense Report,’ includes a range of industries, including healthcare and pharmaceutical, as well as financial services, banking, technology, retail, manufacturing, publishing and media, entertainment and hospitality, and consumer goods.”

As our news article noted, “The research, conducted by IDG Connect, a Framingham, Mass.-based research company, examines the current landscape of digital threats and the maturity of defenses to protect an organization’s digital presence. The findings quantify the security management gap and business impact of external web, social, and mobile threats. Survey respondents included 465 IT information security decision makers in organizations with more than 1,000 employees in the U.S. and U.K.” Further, in conducting the survey, RiskIQ researchers wanted to get IT security leaders’ perspectives on the challenges facing all industries, and how well they felt they  were doing in rising to meet those challenges.

Here's the most worrisome part of all of this. As Landi reported, “About a third of respondents have significant confidence in their ability to improve, but it discovered a very significant number of respondents—about a fifth—that have zero to little confidence that things are on the up. And over two-thirds (68 percent) have, at best, modest confidence to manage digital threats. What’s more, 69 percent cited no to modest confidence to mitigate or prevent external digital threats, and 70 percent of respondents have no to modest confidence in reducing their digital attack surface, expressing the least confidence in threats against web, brand, and ecosystem assessment.”

And, when it comes to healthcare, “Respondents in the healthcare and pharmaceutical sector felt particularly at a loss with almost a quarter (24 percent) saying they felt little to no confidence in their ability to assess digital risks, according to the survey findings.”

Now, let’s put this into perspective: while 24 percent of respondents in the healthcare and pharmaceutical sector felt “little or no confidence in their ability to assess digital risks,” across industries, 70 percent of respondents said they felt “no to modest confidence in reducing their digital attack surface,” while 69 percent “cited no to modest confidence to mitigate or prevent external digital threats.” To be fair, the IDG folks did not offer a trans-industry statistic that was an apples-to-apples comparison with that 24-pecent figure from healthcare. But clearly, the levels of confidence around data security are low across industries. What’s more, one must also keep in mind that British healthcare organizations are different from American ones, in that they are governed by the National Health Service of the U.K., which is very different from how American hospital organizations are governed.

Other results from the survey probably speak to the size and scope gap across industries, not only healthcare. As IDG’s summary noted, “Larger companies felt that they were better able to update control systems and collaborate across departments, perhaps showing the benefits of scale”; while “Smaller companies felt best able to inform others about the status of external attacks, perhaps reflecting the benefits of having a smaller base to worry about.”

Still, the IDG folks noted that “Digital threat management appears more progressive among organizations in financial services, manufacturing, and consumer goods, as expressed by overall expenditure.” That analysis matches everything we know about the stages of development of data and IT security across different industries, with the healthcare industry coming late to the issue—decades after the banking and financial services industry, the consumer retailing industry, and even the transportation and hospitality industries, had already moved to strategize around and implement comprehensive data and IT security strategies.

And here’s an important element in all this. “When it comes to threats outside the firewall—often related to assets that are not easily under control of IT or not owned by the company –digital threats appear more difficult to discover, validate, assess and remediate in a timely manner,” the report’s researchers note. “Most likely, those challenges are still being underestimated and under-reported. There is, roughly speaking, a bell curve in opinions as to the ability to address threats with the highest number feeling that their ability to improve execution of digital defense capabilities is about as hard as it was the previous year. Many organizations still openly admit that they have great difficulty in dealing with external threats, and a significant minority are at the extreme end of the scale. All are being affected across several digital channels,” they note. “Breaking these numbers down by demographics, retailers were most confident of their ability to withstand external threats while large organizations were also more confident than the rest, suggesting that they benefit from the larger budgets and manpower at their disposal. But generally,” they add, “considering the growth in CSO/CISO appointments, rising awareness of the seriousness of security threats, new and incoming privacy governance rules such as GDPR, the increase in state-sponsored cyber-attacks and prevailing high-profile media stories on affected organizations, the overall finding towards digital defense maturity is low.”

It was also helpful to get a sense of which specific types of threats assume what levels of scope, in this. Survey respondents told IDC researchers that the following threats had “a frequent and significant impact on their organization in the past 18 months”: malware, ransomware and browser lockers (77 percent); targeted attacks (67 percent); credential or IP theft or sale (64 percent); mobile app exposures and unknown/unauthorized, or rogue company mobile apps (63 percent); domain infringement or DNS exposure or redirect (61 percent); and website infrastructure exposures—unknown, rogue sites, components, and apps (61 percent).

Moving forward—with outside help

So, what does all this mean for healthcare IT security leaders, going forward? These results speak to the historical background and context of where the leaders of patient care organizations in the U.S. are right now. And one of the key things we’re finding out at Healthcare Informatics, as we interview healthcare leaders for our publication and bring them onto discussion panels at our summits that make up our Healthcare Informatics Health IT Summit Series, is this: healthcare IT leaders are waking up fast—propelled forward by spectacular cyberattacks like WannaCry and Petya/Not Petya, and attacks on individual health systems and health plans—and are beginning to ramp up now in a serious way to meet the future.

What we’ve found in our interviewing and in our moderating of panels at our Summits, in the past year, is that awareness is accelerating in this are now, and so is activity, even as many healthcare IT leaders find themselves rather behind the proverbial eight ball, at this stage of the game.

There was some (relatively) good news in this survey’s results. According to IDG, “Forty-four percent of organizations plan to increase digital defense investment by 15 to 25 percent, and 14 percent will increase tool and service expenditure by more than 25 percent; both U.S. and U.K. have similar spending expectations,” IDG noted. And organizations are using an average of 35 tools to “thwart web, social, and mobile threats.”

In addition, the report’s authors noted, outsourcing some of the tasks involved in data and IT security is becoming more popular, across industries. “Across the board, respondents are today outsourcing well over a quarter of digital threat management tasks (29 percent),” they note. “And they plan to do more: in a year, the percentage will rise to over 33 percent, and the year after that, it will rise further to 37 percent—representing a 12.95 percent compound annual growth rate…. In many respects, the outsourcing of some digital defenses to MSSPs”—here, they are referring to “managed security service providers”—most commonly referred to in the U.S. as security operations centers, or SOCs”—is occurring as these providers are adding such services to provide value to their existing customers. Service providers that offer endpoint security or security information management services are incorporating threat intelligence to their analysis and reporting processes,” they add.

It’s good to get information, insights, and perspectives on these data and IT security issues that cross industries—and in this case, countries (per the U.S. and the U.K.). And while on the other hand, finding out that some other industries still lag behind in terms of ramping up to meet the intensifying data and IT security threats, might be slightly heartening, that is no excuse for laggard organizations to tarry. The risks are simply too high—and rising by the day.

But IT leaders in all industries are learning now, and learning relatively fast. There’s no time in healthcare to dawdle around healthcare IT security work, but reading the results of surveys like this one does provide context and framing for the challenging journey ahead—and that is a good thing.



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Florida Provider Pays $500K to Settle Potential HIPAA Violations

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) to settle potential 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, a Colorado-based hospital, Pagosa Springs Medical Center, will pay OCR $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


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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