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Congressional Leaders Call Out HHS Leaders on Healthcare Cybersecurity Center

June 7, 2018
by Heather Landi
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A bipartisan group of U.S. Senators and U.S. Representatives wrote a joint letter June 5 to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar voicing concerns and confusion about the status of the one-year-old Healthcare Cybersecurity and Communications Integration Center (HCCIC), and HHS’ overall cybersecurity capabilities.

The disorganization and drama around the fledging HCCIC goes back more than a year. The HCCIC was announced back in April 2017 by the then-HHS deputy Chief Information Security Officer, Leo Scanlon, and the center went live in June 2017. HCCIC was established to protect the nation’s healthcare system from cyber attack and was designed to focus its efforts on analyzing and disseminating cyberthreats across the healthcare industry in real time, according to HCCIC officials at the time.

However, since that time, there has been ongoing controversy over the reassignment of top cyber leaders at HHS and the work of the HCCIC. According to multiple media reports back in November, the fledging HCCIC became the center of a rumored investigation into contracting irregularities and possible fraud allegations. An anonymous complaint was lodged, alleging contracting improprieties. Scanlon was put on administrative leave back in September, and the center’s director, Maggie Amato, has since resigned. Chris Wlaschin then stepped in to the HHS CISO role, but stepped down March 31 and was replaced with Janet Vogel, previously the deputy chief information officer at the Centers for Medicare & Medicaid Services (CMS).

As previously reported by Healthcare Informatics, the controversy regarding top tech and cyber positions at HHS is a tangled web of personal and policy disputes, and, according to Scanlon in a published statement provided by his attorney back in March, the net effect of the reassignments has been that “the HCCIC initiative, which played such an important and promising role during the WannaCry incident, has been derailed.” Further, Scanlon states that “the Critical Infrastructure Protection Program of HHS once again lacks a cybersecurity component, and the NH-ISAC [National Health Information Sharing and Analysis Center] has no functioning partners in the agency.”

It seems Congressional leaders are also concerned about the current role and status of HCCIC. In the five-page letter, members of the House Energy and Commerce Committee and the Senate Committee on Health, Education, Labor and Pensions noted that when the HCCIC was announced a year ago, there were few details provided, “offering little clarity on how HCCIC would fit into the larger healthcare cybersecurity picture and raising concerns that HCCIC could duplicate work by entities such as the National Health-Information Sharing and Analysis Center (NH-ISAC).”

And, the lawmakers cited the leadership changes, specifically the reassignment of senior officials responsible for the day-to-day operation of the HCCIC, as one of their top concerns. “HHS’s removal of senior HCCIC personnel has had undeniable impacts on HCCIC and HHS’s cybersecurity capabilities.”

In the same week that the letter was sent to Azar, the House Energy and Commerce health subcommittee held a hearing on the reauthorization of the Pandemic and All-Hazards Preparedness Act, legislation that seeks to enhance the nation’s ability to prepare for and respond to health threats from infectious diseases, bioterrorism, chemical attacks, radiological emergencies and cybersecurity incidents. The bill proposes moving the HCCIC from the HHS’s Office of the Chief Information Officer to the Assistant Secretary for Preparedness and Response (ASPR), also within HHS.

During that hearing, Erik Decker, CISO and chief privacy officer at the University of Chicago Medicine, testified that there’s confusion about the status of HCCIC as well as the cybersecurity roles of various agencies at HHS, and the confusion is hindering many healthcare organizations from participating in cyber intelligence sharing,

The letter, signed by Sens. Patty Murray, D-Wash., and Lamar Alexander, R-Tenn., along with Reps. Frank Pallone, D-N.J., and Greg Walden, R- Ore., also noted, “Stakeholders have informed our staffs that they no longer understand whether the HCCIC still exists, who is running it, or what capabilities and responsibilities it has. Responses to committee requests to HHS for clarification on these questions remain vague at best, and the lack of documentation provided continues to undermine HHS’s efforts to address the HCCIC’s status.”

And, and lawmakers wrote, “HHS’s private and public representation of the HCCIC as central to its cybersecurity efforts has confounded efforts to understand how HHS meets its obligations related to cybersecurity given the HCCIC’s instability.”

The lawmakers are also concerned that HHS has failed to provide a Cyber Threat Preparedness Report as required by the Cybersecurity Information Sharing Act of 2015. The HCCIC developments and the lack of a CTPR “raises concerns about HHS’s ability to address the growing number and severity of cyber threats facing the health care sector,” the lawmakers wrote.

Congressional leaders are demanding an updated CTPR with a detailed explanation of the HCCIC, its roles and responsibilities, how its work and operations intersect with the NCCIC and NH-ISAC and how it fits into HHS’s broader cybersecurity capabilities and responsibilities.

In a broader sense, the lawmakers also raised concerns about HHS operating as both a regulator of the healthcare sector and the Sector Specific Agency (SSA) responsible for leading and providing guidance under the national critical infrastructure protection model. “HHS must make it clear how it plans to carry this dual role and clearly communicate to stakeholders, who must balance the need for support from HHS during cybersecurity incidents with the perceived risk that seeking support could lead to regulatory enforcement actions,” the lawmakers wrote.

Congressional leaders are asking for HHS leaders to clarify how it plans to differentiate those dual roles, regulator and SSA for healthcare, and how it plans to transition between the two roles.

 

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Assessing the New Cybersecurity Practices Publication: Why Small and Medium-Sized Care Organizations Have Reason to Rejoice

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A new set of voluntary cybersecurity practices just released by HHS offers practical advice and conceptual supports that fill information gaps
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How helpful will the new set of voluntary cybersecurity practices that the Department of Health and Human Services (HHS) released in late December, be, to the leaders of patient care organizations? Only time will tell, as part of the value of the release will only be made manifest as the leaders of patient care organizations move forward to implement some of those practices, and the potential success of such implementations is in some way measured and benchmarked.

But the release is a first start, at least. As Healthcare Informatics Associate Editor Heather Landi reported on January 2, HHS released the set of practices in the form of a publication “that marks the culmination of a two-year effort that brought together over 150 cybersecurity and healthcare experts from industry and the government under the Healthcare and Public Health (HPH) Sector Critical Infrastructure Security and Resilience Public-Private Partnership.”

“Cybersecurity is everyone’s responsibility. It is the responsibility of every organization working in healthcare and public health.  In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively,” Janet Vogel, HHS Acting Chief Information Security Officer (CISO), said in a statement published with the release of the new publication.

Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients (HICP), the primary publication of the Cybersecurity Act of 2015, Section 405(d) Task Group, aims to raise awareness, provide vetted cybersecurity practices, and move organizations towards consistency in mitigating the current most pertinent cybersecurity threats to the sector,” HHS officials stated. “It seeks to aid healthcare and public health organizations to develop meaningful cybersecurity objectives and outcomes. The publication includes a main document, two technical volumes, and resources and templates.”

The overall publication consists of several sections, the first being the HICP, which “examines cybersecurity threats and vulnerabilities that affect the healthcare industry. It explores five current threats and presents 10 practices to mitigate those threats; “Technical Volume 1: Cybersecurity Practices for Small Health Care Organizations,” which offers cybersecurity practices for small healthcare organizations; “Technical Volume 2: Cybersecurity Practices for Medium and Large Health Care Organizations”; the “Resources and Templates” portion, which “includes a variety of cybersecurity resources and templates for end users to reference”; and a Cybersecurity Practices Assessments Toolkit, which “helps organizations prioritize their cyber threats and develop their own action plans using the assessment methodology outlined in the Resources and Templates volume”—that last section being still under development as of Jan. 2.

As Landi reported, “The HICP publication aims to provide cybersecurity practices for this vast, diverse, and open sector to ultimately improve the security and safety of patients. The main document of the publication explores the five most relevant and current threats to the industry. It also recommends 10 cybersecurity practices to help mitigate these threats.”

What’s more, she wrote, “The main document presents real-life events and statistics that demonstrate the financial and patient care impacts of cyber incidents.  It also lays out a call to action for all industry stakeholders, from C-suite executives and healthcare practitioners to IT security professionals, that protective and preventive measures must be taken now. The publication also includes two technical volumes geared for IT and IT security professionals, one focusing on cybersecurity practices for small healthcare organizations, and one focused on practices for medium and large healthcare organizations.”

Among the salient statistics reported in the HICP:

  • Fifty-eight percent of malware attack victims are small businesses.
  • In 2017, cyber-attacks cost small and medium-sized businesses an average of $2.2 million.
  • Sixty of small businesses go out of business within six months of an attack.
  • And, 90 percent of small businesses do not use any data protection at all for company and customer information.

How does that translate into impacts on smaller healthcare organizations? Among other incidents, the HICP notes that:

  • A popular orthopedic practice announced that its computer system was hacked via breach of a software vendor’s log-in credentials. This breach put just under a half-million people at risk of identity theft. Of those, 500 patient profiles appeared for sale on the dark web. The information for sale included names, addresses, social security numbers, and other personally identifiable information (PII). Although not posted for sale, pertinent PHI such as X-ray results and medical diagnoses were also stolen.

 

  • A rural hospital had to replace its entire computer network after a ransomware cyber-attack froze the hospital’s electronic health record (EHR) system. Doctors were unable to review their patients’ medical histories or transmit laboratory and pharmacy orders. Officials were unable to restore essential services and could not pay the ransom for the return of their system. After consultations with the Federal Bureau of Investigation and cybersecurity experts, hospital officials made the difficult decision to replace the entire system.
  •  

Of particular practicality is some of the very basic advice given to the leaders of smaller healthcare organizations. To wit: “Doctors and nurses know that hand sanitizing is critical to prevent the spread of germs. That does not mean health care workers wash up as often as they should. Similarly, we know that cybersecurity practices reduce the risk of cyber-attacks and data breaches. Just as we are able to protect our patients from infection, we should all work towards protecting patient data to allow physicians and caregivers to trust the data and systems that enable quality health care. Just as health care professionals must wash their hands before caring for patients, health care organizations must practice good ‘cyber hygiene’ in today’s digital world, including it as a part of daily universal precautions,” the HICP notes. “Like the simple act of hand-washing, a culture of cyber-awareness does not have to be complicated or expensive for a small organization. It must simply be effective at enabling organization members to protect information that is critical to the organization’s patients and operations. Your organization’s vigilance against cyber-attacks will increase concurrently with your and your workforce’s knowledge of cybersecurity. This knowledge will enable you to advance to the next series of cybersecurity Practices, expanding your organization’s awareness of and ability to thwart cyber threats.”

Meanwhile, both smaller and larger patient care organizations will benefit from the technical supports, including a Security Risk Assessment Tool, a set of recommendations on medical devices and cybersecurity, and an incident response risk management handbook.

What this set of resources does is to fill a gap between theory and technical practice in a key area. Will it shift the entire landscape of cybersecurity for patient care organizations? No, that would be a far-too-ambitious goal. But the healthcare IT leaders of smaller and medium-sized patient care organizations in particular, will welcome practice advice and supports, as they move forward in their journeys around cybersecurity. Any such journey is inherently challenging, and federal publications and resources like these will be of real value in moving patient care organization HIT leaders forward.

 

 

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HHS Releases Voluntary Healthcare Cybersecurity Practices

January 2, 2019
by Heather Landi, Associate Editor
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In late December, the Department of Health and Human Services (HHS) released voluntary cybersecurity practices to the healthcare industry with the aim of providing practice guidelines to cost-effectively reduce cybersecurity risks.

The “Health Industry Cybersecurity Practices (HICP): Managing Threats and Protecting Patients” publication aims to provide guidance to healthcare organizations of all types and sizes, ranging from local clinics to large hospital systems.

The industry-led effort was in response to a mandate set forth by the Cybersecurity Act of 2015 Section 405(d), to develop practical cybersecurity guidelines to cost-effectively reduce cybersecurity risks for the healthcare industry.

According to HHS, the publication marks the culmination of a two-year effort that brought together over 150 cybersecurity and healthcare experts from industry and the government under the Healthcare and Public Health (HPH) Sector Critical Infrastructure Security and Resilience Public-Private Partnership.

“Cybersecurity is everyone’s responsibility. It is the responsibility of every organization working in healthcare and public health.  In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively,” Janet Vogel, HHS Acting Chief Information Security Officer (CISO), said in a statement.

While technologies are vital to the healthcare industry and help provide life-saving treatments and improve patient care, these same technologies are vulnerable to myriad attacks from adversaries, ranging from criminals and hacktivists to nation-states, according to HHS. These technologies can be exploited to gain access to personal patient data or render entire hospital systems inoperable. Recent cyber-attacks against the nation’s healthcare industry continue to highlight the importance of ensuring these technologies are safe and secure.

“The healthcare industry is truly a varied digital ecosystem. We heard loud and clear through this process that providers need actionable and practical advice, tailored to their needs, to manage modern cyber threats. That is exactly what this resource delivers; recommendations stratified by the size of the organization, written for both the clinician as well as the IT subject matter expert,” Erik Decker, industry co-lead and Chief Information Security and Privacy Officer for the University of Chicago Medicine, said in a statement.

The HICP publication aims to provide cybersecurity practices for this vast, diverse, and open sector to ultimately improve the security and safety of patients. The main document of the publication explores the five most relevant and current threats to the industry. It also recommends 10 cybersecurity practices to help mitigate these threats.

The main document presents real-life events and statistics that demonstrate the financial and patient care impacts of cyber incidents.  It also lays out a call to action for all industry stakeholders, from C-suite executives and healthcare practitioners to IT security professionals, that protective and preventive measures must be taken now. The publication also includes two technical volumes geared for IT and IT security professionals, one focusing on cybersecurity practices for small healthcare organizations, and one focused on practices for medium and large healthcare organizations.

 

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CynergisTek, Protenus Partner on Privacy Monitoring Programs

December 26, 2018
by Heather Landi, Associate Editor
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CynergisTek, Inc., an Austin, Texas-based healthcare cybersecurity firm, is partnering with Protenus, a healthcare compliance analytics company, to combine the companies’ technology tools and services with a focus on patient privacy monitoring programs.

The partnership will grant health systems access to Protenus’ analytics platform that leverages artificial intelligence to gather data related to potential patient privacy risks, along with CynergisTek’s patient privacy monitoring services.

According to the Protenus research, insider incidents accounted for 23 percent of all breaches that occurred at health systems in Q3 2018. This figure will only continue increasing, indicating that now more than ever, health systems need a cost-effective solution to meet the daily challenges of managing patient privacy.

To address this need, CynergisTek and Protenus formed a preferred partnership to combine CynergisTek’s healthcare consulting experience and privacy programs with Protenus’ healthcare analytics technology to offer health systems both the people, processes, and technology components of a strong patient privacy monitoring program, according to the companies.

“As health systems face mounting challenges in creating and maintaining robust patient privacy monitoring programs, we identified a need to partner with a company offering complementary services so that health systems can act on the insights uncovered by our analytics,” Nick Culbertson, CEO and co-founder of Protenus, said in a statement.

 “Data privacy is evolving as a dominate theme in conversations, both in healthcare and other industries, and health systems need to take an end-to-end approach to patient privacy to truly address this complex and mission-critical challenge,” Mac McMillan, CEO and president of CynergisTek, said in a statement.

 

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