At iHT2-Denver, CISOs Offer Stimulating Insights into the Top IT Security Priorities Being Pursued by Industry Leaders | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

At iHT2-Denver, CISOs Offer Stimulating Insights into the Top IT Security Priorities Being Pursued by Industry Leaders

July 13, 2016
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At iHT2-Denver, the CISOs of CHRISTUS Health and SCL Health shared important insights on key issues facing the industry

It was an honor, and very intellectually stimulating, to moderate a panel discussion on Tuesday on data security with two chief information security officers—what’s more, a discussion with two exceptionally thoughtful CISOs who have a broader vision of where IT security fits into U.S. healthcare right now.

Our panel discussion, entitled “Security & Data Protection: Engaging the Enterprise,” was the first panel of the day yesterday, at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization under the Vendome Group umbrella), and being held at the Ritz-Carlton Denver. My fellow panelists were Fernando Blanco-Dopazo, vice president and CISO at the Irving, Tex.-based CHRISTUS Health, a 60-hospital, 175-clinic integrated system; and Howard Haile, vice president and CISO at SCL Health, an eight-hospital, 190-clinic integrated health system based in Denver.

To begin, I asked how both CISOs saw the current landscape for healthcare data and IT security. Haile stated that “It’s sort of flipped on us in the last few years. Historically, the main focus had been individuals snooping on patient records that they weren’t supposed to be looking at, or committing fraud on an individual level. But, as verified by a Ponemon Group survey a few weeks ago, the main issue is now primarily external cyber-threats. Another big issue,” he added, “is around medical devices on the network that are now connected. And,” he said, “the last one is the rapid pace of change, per the Affordable Care Act, and cloud computing,” phenomena that are putting more data out into potential exposure. He also agreed with my adding into the mix the acceleration of merger and acquisition activity among hospital-based organizations, with such developments adding to the challenge and complexity of enhancing hospital and health system data security.

What about the fact that the healthcare industry has historically lagged behind numerous other industries, including banking and financial services, manufacturing, transportation, and others, in ramping up data security? Blanco noted that “Healthcare has been behind other industries on cybersecurity, partly because the risks of cyberattacks were seen as lower until recently.” Specifically, he pointed to the February 2015 hack of the information systems of the Indianapolis-based Anthem, one of the country’s largest health insurers, as being a key moment in the history of healthcare cybersecurity. As a result of greater awareness in the past year and a half since that attack, Blanco said, “I see a shift in healthcare hiring professionals from other industries.” What’s more, CISOs, whether recruited from other industries or recruited from within healthcare, he noted, are very quickly being pushed into the limelight, presenting regularly to c-suites and to boards of directors at hospitals and health systems. “I participated in a meeting of Catholic healthcare CISOs last week,” he noted, “and every one of us has been presenting regularly to boards.” That alone is a very telling sign, he noted.

Now, what happens when IT security executives from other industries do come into healthcare? “It’s not a very easy job,” Blanco said, “and it’s often an unpopular one. The perception has historically been that, when asked, ‘Can we do that?’ the answer of CISOs is always ‘No.’ But,” he quickly added, “we’ve got to shift the dialogue so that the answer is, ‘Yes, and here is what we must do to get there.’” There remains a large chasm between larger, better-resourced patient care organizations that have the resources to more often say “yes,” he noted, and those small organizations that find themselves continually stretched to try to accomplish things that must be accomplished. Inevitably, the CISOs of the larger, better-resourced organizations find it easier to obtain the financial and strategic support they need in order to achieve their IT security goals.

Haile noted that one of the goals is that “We want the aspirations of the business to be able to flourish in a secure environment”; and for that to happen, CISOs will need to be able to communicate to senior leaders in their organizations precisely how investment in IT security will help their senior leadership to reach key business objectives in their organizations.

When it comes to security strategies themselves, Blanco noted that, in healthcare, “We as an industry tried to build a ‘security wall’ around patient care organizations, and that didn’t work. The reality,” he said, “is that there will inevitably be hacker attacks that will be successful. Instead of believing that cyberattacks can be entirely prevented, what you have to do is to build a resilient organization,” he emphasized.

What about accessing external resources, including security operations centers, or SOCs? Haile emphasized both the importance of external resources, as well as the limitations of making use of those resources. “Yes,” he told the audience, “do hire a SOC. But even after you’ve done so, you still have to build a timely response capability” to prepare for any potential cyberattack that does to any extent disable an organization’s information systems. In fact, he said of SCL, “Most of our security is handled in-house.”

Blanco concurred: “We’ve outsourced behavioral monitoring to our SOC,” he said, “but we also recognized that we needed to rethink our incident response preparation. Our incident response process was very IT-focused; now, it’s focused on the business. I formed an incident response group,” he noted, “with representation from human resources, communications, compliance, and legal, among other areas within our organization,” with the point being making certain that his organization would be prepared on a strategic level to meet any such challenges.

Another area that we discussed fairly extensively was the complexity around end-user education and training. As all of us agreed, on the one hand, continuous end-user education and training are absolutely essential, given the unique reality in healthcare that every staff member and clinician in every patient care organization represents a potential point of vulnerability for that organization. Healthcare as an industry really stands out compared to others, we agreed, because of that aspect.

At the same time, Blanco noted, “The challenge around end-user education is, how do we measure its success? If 80 percent of end users watch a training video, does that constitute ‘success’? We created our own phishing e-mails” at CHRISTUS Health, he told the audience. “And we blasted those phishing e-mails to all staff members. Now, most progressive organizations in the defense, financial services, and other industries, see an open rate of around 3 to 5 percent from such phishing tests. Needless to say, our initial results were higher than that! Fortunately, after conducting end-user education, we were able to significantly reduce our open rates.” Part of the complexity in all this, Blanco said, was the need to engage in the sequence of phishing tests in order to document to the organization’s c-suite the need to fund IT security technology and processes.

Meanwhile, Haile said, “One of the challenges around end-user education and training is this: after you do initial training, you initially see improvement in terms of lower open rates; but over time, such rates rise again. So there is a need to engage in regular training and education, in any case.”

The insights and perspectives shared by both of these very thoughtful CISOs underscore how challenging and complex all of this is. As both Howard Haile and Fernando Blanco-Dopazo made clear on Tuesday morning, there is a forest of issues to consider and manage around IT security. It’s also very clear that there is no simple checklist or menu that CISOs or anyone else can follow that will magically “take care of” everything. Instead, at this moment in the evolution of healthcare IT security, there remain massive issues to work through in the next few years, at a time of straitened reimbursement and growing demands for data- and information-sharing, even as the cybersecurity and other data security threats only accelerate.

So it was bracing and refreshing to engage in a robust discussion of the panoply of issues facing IT security leaders right now in U.S. healthcare, and particularly satisfying to discuss that range of issues with Howard Haile and Fernando Blanco-Dopazo, two exceptionally thoughtful and insightful CISOs. As things move forward in the next few years, it will be leaders like these who will help to develop winning strategies in IT security, and who will create strategic and tactical templates that others can follow. Will it be easy? By no means. But Tuesday’s discussion helped to underscore how much thought and effort are being focused on this vital area of healthcare operations, even as so many other areas demand executive-level attention these days.




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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.

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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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