It Is Time to Drastically Rethink Password Management in Healthcare? Some Might Say So | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

It Is Time to Drastically Rethink Password Management in Healthcare? Some Might Say So

September 6, 2016
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It was intriguing to read an op-ed article in InfoWorld this summer, in which its author suggested that business organization leaders rethink their password management policies and practices

It was very intriguing to read an op-ed article that appeared in InfoWorld in June. Written by Roger A. Grimes, under the headline “The days of long complicated passwords are over,” it brings up some of the most current thinking around password use and protection within organizations and information networks. Among other things, Grimes challenges his readers’ assumptions about the usefulness of passwords, or at least of passwords alone, as a protective mechanism for networks, saying that, while “Traditional password recommendations, as implemented by most companies, typically call for passwords at least eight to 12 characters long, complexity that includes at least three different character sets (letters, uppercase, lowercase, numbers, symbols, and so on), and the stipulation that passwords should be changed at least every 90 days,” the emerging reality is that password complexity, or lack of it, is no longer a significant issue, in his view. Instead, he notes that, “[O]ver the last decade, hackers have changed the way they attack passwords. Back in the day, most password attackers literally guessed at user’s passwords. They found an externally accessibly portal where they could guess using manual or automated methods -- or they found the password hash and used rainbow tables to convert passwords back to the plaintext equivalents.”

Indeed, Grimes tells the readers of InfoWorld, “Today, almost all password attacks are one of two types. Users are either socially engineered (phished) out of their password, or the attacker steals their hash and uses it during other authentication attempts. In both scenarios, long and complex passwords offer little protection. Yes, some attackers and malware still try to guess passwords, but they're now in the minority.” Instead, he says, “New password attack methods require new policies.”

Here is a summary of Grimes’s recommendations:

1.       Keep passwords for end-users to 8 to 12 characters—requiring more inevitably leads to end-users coming up with passwords that are unnecessarily complicated and difficult to remember. In fact, he says, “You can add complexity requirements, but it doesn’t increase protection by much anymore.”

2.       Further, he says, organizations should change their policies that require end-users to change their passwords an average of every 45 to 90 days, instead to spans of 120 to 180 days. Indeed, he says, “I’ve seen a few companies push forced password changes to one year without any increase in password hacking issues. That said,” he adds, “I still think highly privileged accounts should have their passwords changed very frequently, perhaps as often as once per day or once per use. It virtually assures you’ll need additional software to accomplish this, but since those accounts are the ones attackers target, it makes sense.”

3.       On the other hand, Grimes urges his readers to establish a rule that the end-users in their organization cannot use the same password anywhere else—a requirement that he admits is essentially impossible to enforce.  “This recommendation is huge—and hard to enforce,” he writes. “When you reuse passwords across security domains, websites, or various services, you increase your hacking risk exponentially. Many big, recent hacks have occurred due to password reuse.” Further, he adds, “Many companies even download (or subscribe to a commercial service that downloads) illegally obtained website password databases to see if their employees' passwords are located in them. If so, the employee gets a warning –and may even get fired.”

4.       Finally, Grimes urges his IT executive readers to move towards multi-factorial authentication. “I’m particularly enthusiastic about the recommendation to implement risk-based, multifactor authentication challenges. It makes sense that higher-risk scenarios should require greater authentication assurance. For instance,” he says, “if you log into your email account from your normal computer from your normal location, it may even be OK to allow some sort of auto logon using a stored, simple password. But if you try to log on to the same email account from a new computer in a new country, you need stronger measures. Hotmail works this way for me right now: I use a simple password on my own computer at home, but if I log on to the same account from a new hotel, I need to enter a PIN sent via text to my phone. Microsoft’s risk-rating mechanism is even smart enough to recognize that I’m a frequent traveler, so I don’t get asked for the second-factor PIN all the time now -- only when I’m in high-risk areas or if I’ve traveled very far, very quickly from my last logon location.”

OK, so, per #3 above, I doubt that many CISOs at patient care organizations would—or should—subscribe to commercial services that scan password databases whose scans were illegally obtained, to see whether their staff members’ passwords are in them. But, setting that rather extreme thought aside, do Grimes’s recommendations make sense in healthcare?

Largely, yes. Now, one important thing to note is that the use of key fobs can be very problematic, given how mobile many healthcare professionals are, most particularly physicians, who may have privileges at several hospitals, and who may be scurrying in between multiple clinic sites as well. But, Grimes’s recommendations on shorter passwords, combined with “risk-based, multifactor authentication challenges,” makes a lot of sense. All of us as consumers are used to putting into a system a series of answers to questions, pieces of information that no one but family members or very close friends would know the answers to, such as mother’s maiden name, grandmother’s maiden name, father’s middle name, first pet’s name, name of elementary school, etc., etc. Those authentication challenge-based pieces of information, stored securely (and of course, that is another huge issue), could potentially help a lot, as physicians and other clinician end-users in particular, tire of having to make up long, complex passwords every month, in many different places.

Now, one important thing to keep in mind in all this is that healthcare is in many ways a unique industry—or at the very least, certainly an unusual one, compared to others. A bank teller, for example, will largely be working in one place 90 percent of the time; and even most people who work in manufacturing have only a small number of physical locations they need to log into. In contrast, physicians, nurses, and many other clinicians and healthcare professionals are almost constantly on the move, and as absolutely vital as data security is, the exceptional mobility of clinician end-users in particular always has to be kept in mind.

Also, given the hacking and other threats that are intensifying by the day in healthcare, there’s no question that all of these issues will continue to remain top-of-mind for CIOs, CISOs, CMIOs, and everyone else who bears any responsibility for helping to manage the immense complexity of data security management in healthcare, with the almost unique reality of end-users in our industry being nearly pervasive sources of security vulnerability.

In that regard, what about getting physicians, nurses, and other clinicians more involved in (relatively brief, discrete) discussions about password management? After all, clinicians are the ones most impacted, day to day, but whatever password rules, policies, and other norms are established and maintained in patient care organizations. And they so often feel oppressed by all the different log-in and identity management regimens that they’re asked to comply with. Now, obviously, very few physicians and other clinicians in practice are genuinely experts in identity management; even most CMIOs would acknowledge that they are not. But what could prove quite valuable, in my view, is to get a sense from clinicians, and especially from practicing physicians in any organization, what their biggest day-to-day challenges are with identity management, and to try to craft both a new or revised set of policies, as well as a new or revised set of identity management practices, around an understanding of those challenges.

And, given all the challenges facing healthcare IT leaders in the present operating environment, and all the changes to the current landscape that could emerge in the next few years, certainly, it would behoove the IT leaders at all patient care organizations to take a good, long look at their organizations’ identity management policies and practices, and work to refresh them both to enhance data and IT security in today’s operating environment as it evolves forward, and to make it easier for clinicians and other end-users to help support best practices in this area, understanding that the two concepts are not inherently opposed.


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Targeting Third Party Risk: Leading CISOs Detail Efforts to Secure the Healthcare Supply Chain

December 18, 2018
by Heather Landi, Associate Editor
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Healthcare information security leaders are faced with the dauting challenge of securing information systems and data at a time when the cyber threat landscape is evolving rapidly and becomingly increasingly complex.

Most patient care organizations’ supply chains are filled with third parties who support the care delivery process and require access to patient information. Properly vetting and monitoring these third parties is a major challenge, and in some cases, insurmountable for many organizations who simply don’t have the expertise or resources, according to healthcare IT security leaders.

Many healthcare chief information security officers (CISOs) have found that effectively assessing the security posture up and down the supply chain is expensive given the complexity of the risks posed by privacy and security concerns, as well as an everchanging regulatory landscape. Currently, the process of managing third-party risk is often inefficient and time-consuming, for both vendors and providers, while still leaving organizations vulnerable to security threats.

During a recent webinar, sponsored by HITRUST, focused on healthcare cybersecurity and managing third party risk, John Houston, vice president, privacy and information security at the 40-hospital UPMC health system in Pittsburgh, outlined a number of factors that have made third-party risk management increasingly challenging and complex.

“There has been a fundamental change in IT, and a rapid move to the cloud. At the same time, we all see an increasingly complex cyber threat landscape where the threats are more sophisticated, and the technology solutions are more sophisticated as our business requirements are changing. It’s an increasingly complex landscape,” Houston said.


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He further noted, “As a result, there is a lot of confusion about how we best ensure our information is secure and available, and what is reasonable in terms of trying to achieve that. And finally, we are all worried about risk, and the biggest risk is patient safety. We worry about the cost of litigation and penalties, but first and foremost, we need to think about ensuring that we are able to deliver the best care to our patients.”

The stakes are changing, Houston noted, as federal regulators are investigating and penalizing organizations for failure to monitor third parties’ security practices, and hackers are increasingly targeting medical devices, he said.

“From a CISO perspective, we need to ensure that we are applying proper oversight over all of this. We can’t assume third parties are doing the right thing,” he said.

What’s more, healthcare organizations are increasingly reliant on cloud technology. A year ago, Nuance Communications, a provider of voice and language tools, was knocked offline when the company was hit with the Petya ransomware virus.

“I was around during Y2K, and about 95 percent of all our applications at UPMC, we ran within the data center, on premise. About 95 percent of newly acquired applications were run on on-premise, there was little on the cloud. In that environment, it falls upon the entity to secure data within its possession,” he said.

Contrast that with today’s environment, as Houston noted that “very little of what we acquire today runs on-premise. In some way, shape or form, at least one copy of the data is in the cloud.”

Studies have estimated that by 2023 no more than 25 percent of applications will be run on-premise in an organization’s data center, with about 75 percent run in the cloud, Houston said. “Many copies of our data end up in the cloud, and it’s not just one cloud provider. We get services from a lot of different vendors, all of which are in the cloud. That speaks to the fact we, as CISOs, can no longer directly secure our own information. We are dependent upon third parties to secure our data for us. We can’t simply trust that they are going to adequately secure that information.”

From a healthcare CISO’s perspective, a vendor’s IT and data security practices should be at least as effective as the provider’s security posture, Houston said. “I should expect nothing less. As soon as I expect less, that’s a sign of defeat.”

Across the healthcare industry, ineffective security, compliance and assurance methods drive cost and confusion within organizations and across third parties.

While most healthcare organizations are taking the right steps to monitor and screen vendors and their products and services during the pre-selection and on-boarding phases and are also conducting security risk assessments, it’s still not enough to protect IT systems, data, and, most importantly, patients, said Taylor Lehmann, CISO at Wellforce, the Burlington, Mass.-based health system that includes Tufts Medical Center and Floating Hospital for Children. “We are still seeing breaches, and the breaches are still coming after we do all this screening,” he said.

“We’re not being effective and it’s difficult to be effective with the current paradigm,” Houston added.

From the CISO’s perspective, there are inefficiencies in the third-party supply chain ecosystem. Suppliers are commonly required by their customers to respond to unique questionnaires or other assessment requests relating to their risk management posture. Vendors often must fill out questionnaires with 300-plus questions. What’s more, there’s no assurance or audit of the information the vendor provides, and the process is completely inefficient for suppliers who are audited 100 times annually on the same topics, but just different questions, And, the security assessment often occurs too late in the process.

“We’re creating a lot of waste; we’re taking time away from our organizations and we’re taking time away from suppliers,” he said. “The current way we’re doing supply chain risk management, it doesn’t work, and it doesn’t scale, and there is an opportunity to improve.”

To address these issues, a group of CISOs from a number of healthcare organizations established the Provider Third Party Risk Management (TPRM) Initiative to develop a standardized method to assess the risk management posture of third-party suppliers to healthcare firms. Launched this past August, the founding member organizations for the Provider TPRM Council include Allegheny Health Network, Cleveland Clinic, University of Rochester Medical Center, UPMC, Vanderbilt University Medical Center and Wellforce/Tufts University. Working with HITRUST and PwC, the Council aims to bring uniformity and consistency to the process while also reducing the burden on providers and third parties.

The healthcare industry, as a whole, will benefit from a common set of information security requirements with a standardized assessment and reporting process, Lehmann noted.

In the past four months, the governing members have been expanded to include Nuance, The Mayo Clinic, Multicare, Indiana University Health, Children’s Health Dallas, Phoenix Children’s Hospital, and Banner Health.

The Provider TPRM initiative is increasing membership and gaining momentum as security leaders from both healthcare providers and their suppliers embrace the unified approach, Lehmann said.

One of the goals for the Council is to address the inefficiencies found in the third-party supply chain ecosystem. By reducing the multiple audits and questionnaires, the financial savings will allow business partners to invest in substantive risk reduction efforts and not redundant assessments, the Council leaders say.

“By reducing wasted effort and duplication, suppliers will find their products and services will be acquired more quickly by healthcare providers. This will also reduce the complexity of contracts and provide third parties with better visibility regarding the requirements to do business with providers,” said Omar Khawaja, VP and CISO of Allegheny Health Network and Highmark Health. Khawaja’s organization is a founding participant and governing member of the Provider TPRM initiative.

As part of this initiative, going forward, provider organizations that join the effort will require third-party vendors to become HITRUST CSF Certified within the next two years, by September 2020. The HITRUST CSF Certification will serve as the standard for third parties providing services where they require access to patient or sensitive information and be accepted by all the Council’s organizations. HITRUST CSF is an industry privacy and security framework that is continuously evolving with the changing cyber landscape.

 “After September 1, 2020, third parties without certification cannot do business with participants,” Khawaja said.

Houston added, “We recognize that there are limitations in our current processes, and what we’re putting in place is at least as good or better than what we’re already doing. This will lead to faster onboarding, less waste, better transparency, and simpler compliance.”

By choosing to adopt a single comprehensive assessment and certification program, healthcare organizations represented by the council are prioritizing the safety, care, and privacy of their patients by providing clarity and adopting best practices that their vendors can also adopt, while providing vendors the expectation of what it takes to do business with their organizations.

“It provides transparency,” Houston said “It sends a message to suppliers that we’re an open book about what it takes to do business. That’s powerful.”

Moving forward, the Provider TPRM initiative will focus on adding business associates to the effort to increase membership and impact, Lehmann said. “The simple fact is, many of us are pushing this through our supply chain and there are organizations that may not have a process or low maturity process. But, through the efforts of council members, more suppliers will show up, which is means safer products are possible to purchase.”

Further, the program will likely develop additional requirements on vendors such as breach response and monitoring security threats and alerts observed as third-party vendors.

The Council also plans to focus on certification programs for smaller vendors. “A lot of innovation in healthcare is coming from smaller companies, and we understand there is a gap between what those companies can do with respect to cyber. We’re not lowering our standards, but we want to be thoughtful and create a certification program for those areas. We want to do business and we need a vehicle to bring them in in a safe and secure way,” Lehmann said.

“We want to build a community of health providers working together, business associates working together, to share information,” Lehmann said. “We want to better inform ourselves and align other programs, like cyber insurance, to enable more effective planning throughout the supply chain. The things we learn through these relationships can translate to other aspects of our organizations.”

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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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