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HHS Task Force Report: Healthcare Cybersecurity is in Critical Condition

June 5, 2017
by Heather Landi
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The Department of Health and Human Services (HHS) Health Care Industry Cybersecurity Task Force, which was formed last year following passage of the Cybersecurity Act of 2015, issued its final report to Congress June 2 with a number of recommendations to improve cybersecurity across the industry.

The report states that “healthcare cybersecurity is in critical condition,” citing a severe lack of security talent, legacy equipment that runs on old, unsupported and vulnerable operating systems, vulnerabilities that impact patient care and an epidemic of known vulnerabilities. The report, developed by Task Force members comprised of government and private industry leaders, also cited “premature and over-connectivity” as an issue contributing to the critical state of cybersecurity. “Meaningful Use requirements drove hyper-connectivity without secure design and implementation,” the report authors wrote.

The Task Force is composed of 21 private and government leaders considered experts in healthcare cybersecurity. The Task Force held public meetings and consulted with other experts over the past year in order to develop recommendations to address the growing challenge posed by cyberattacks.

In the report issued to Congress, the Task Force emphasized that healthcare cybersecurity issues as patient safety issues, and the findings call for a collaborative public and private sector effort to protect the healthcare system and patients from cyber threats.

The Health Information Trust Alliance (HITRUST) a issued a statement praising the HHS Health Care Industry Cybersecurity Task Force’s report for bringing attention to security issues within the healthcare industry.

“The report makes clear that there are many steps which public and private partners must take to continue this progress. An important first step is to leverage the work HITRUST has done in developing a healthcare specific security and privacy framework (the HITRUST CSF) and fully support the work the Healthcare and Public Health Sector Coordinating Council (HPH-SCC) has completed (with HITRUST) in developing a healthcare specific implementation guide of the NIST Framework,” the organization stated.

Further, HITRUST wrote, “While the report highlights a number of shortfalls in the industry, the fact remains that companies must continue to invest in security and risk management and move from a compliance to risk management mindset.”

The Task Force report sets out six imperatives to improve cybersecurity, including improving information sharing of industry, threats, risks and mitigations and increasing health care industry readiness through improved cybersecurity awareness and education.

With regard to improving information sharing, the Task Force recommends streamlining information sharing for quick and efficient consumption, especially for small and medium-size organizations and providing security clearance for more members of the health care community to gain access to threat information.

The report also calls for defining and streamlining leadership, governance and expectations for health care industry cybersecurity. To this end, the Task Force recommends creating a cybersecurity leader role within HHS to align industry-facing efforts for health care cybersecurity as well as establishing a consistent, consensus-based healthcare-specific Cybersecurity Framework.

The report authors wrote, “Although NIST (National Institute of Standards and Technology) has developed a generic framework, health care (like other sectors) has many unique aspects such as its diverse resource capabilities, legacy systems that will persist for years, and the burden of the need to have low barriers for sharing of data that is essential for collaborative patient-oriented care. The framework should build upon the minimum standard of security required by the NIST Cybersecurity Framework and the HIPAA Security Rule to promote a single lexicon for health care sector as well as standards, guidelines, and best practices. The complex environment requires certain basic standards that all stakeholders must meet and guidelines that allow flexibility for select issues. Without this framework, any of the countless constituents may pose a risk to the health care ecosystem.”

The Task Force also calls for increasing the security and resilience of medical devices and health IT, with more specific recommendations including securing legacy systems, improving manufacturing and development transparency among developers and users and increasing adoption and rigor of the secure development lifecycle (SDL) in the development of medical devices and electronic health records (EHRs).

The Task Force also calls for establishing a Medical Computer Emergency Readiness Team (MedCERT) to coordinate medical device-specific responses to cybersecurity incidents and vulnerability disclosures.

The Task Force report findings also address healthcare cybersecurity workforce issues as one of the six imperatives is to develop the healthcare workforce capacity necessary to prioritize and ensure cybersecurity awareness and technical capabilities. To this end, the Task Force recommends that every organization identify the cybersecurity leadership role for driving more robust cybersecurity policies, processes and functions with clear engagement from executives. And, the Task Force suggests establishing a model for adequately resourcing the cybersecurity workforce with qualified individuals.

“The prospect of supplying even one dedicated resource per organization currently looks daunting; however, managed services and contracted external resources/partners can enhance cybersecurity capability and services,” the report authors wrote, citing the example of the state of California starting the first safe patient ratio staffing system for registered nurses. That program evolved from a critical need to protect patients, nurses and health delivery organizations. “We find ourselves in a similar situation regarding cybersecurity,” the report authors wrote. “There is a need to determine a similar acceptable ratio of health care cybersecurity expertise to the size of the organization, complexity of care, degree of interconnectedness with other organizations, etc. The larger the organization, the more security professionals are required.”

To address the workforce gap, the Task Force also advises examining the impact of the Stark Law and Anti-Kickback regulations as well as leveraging managed security service providers (MSSPs) to develop a business and security model.

One of the six imperatives is to identify mechanisms to protect R&D efforts and intellectual property from attacks and exposure.

In a blog post, Steve Curren, director of the division of resilience in the Office of the Assistant Secretary for Preparedness and Response’s (ASPR) Office of Emergency Management, wrote about the Task Force report, “Today, much of healthcare is delivered by smaller practices and rural hospitals that may not have the resources to protect against these threats. Unfortunately, these organizations often do not possess the infrastructure to identify and track threats, lack the technical capacity to analyze the threat data they receive in order to quickly translate it into actionable information, and lack the capability to act on that information.

Further, Curren wrote, “The Office of the Assistant Secretary for Preparedness and Response understands that healthcare facilities are facing these challenges right now and we have developed a collection of peer-reviewed resources on cybersecurity to help healthcare industry stakeholders better protect against, mitigate, respond to, and recover from cyber threats, in order to better defend patient safety and operational continuity. 

“As called for by the Cybersecurity Information Sharing Act of 2015 the HHS Secretary is sharing educational materials on cybersecurity, including the Task Force’s report and appendix, with industry stakeholders to improve preparedness for and response to cybersecurity threats. The Health Care Industry Cybersecurity Task Force’s report contains valuable recommendations to help improve cybersecurity throughout the healthcare sector that ultimately could better protect patient care and public health,” Curren wrote.

 

 

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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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