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Report: Exposed Medical Devices, Supply Chain Attacks Pose Major Cyber Risks

April 5, 2018
by Heather Landi
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This coming May marks the anniversary of the WannaCry attack, yet, a year later, researchers found that the scare of ransomware may not have resulted in more secure healthcare environments, rather the attack surface has only expanded. 

In a new report, “Securing Connected Hospitals,” researchers with Trend Micro, a global cloud security solutions company with U.S. headquarters in Los Angeles, took a deep dive into the threats and areas of exposure within healthcare networks. The report, which provides research on exposed medical systems and supply chain risks, was released in collaboration with HITRUST.

“As hospitals and other healthcare facilities adopt new technology, add new devices, and embrace new partnerships, patients get better and more efficient services — but the digital attack surface expands as well. The more connected they get, the more attractive they become as lucrative targets to threat actors,” researchers wrote in a recent report.

Although the research report is extensive, the report highlights two aspects of healthcare networks that researchers feel IT teams need to consider as part of their overall security strategy—exposed medical devices and the supply chain.

Using Shodan, a search engine for internet-connected devices, the researchers looked for healthcare-related cyber assets and found that a large number of hospital systems are exposed on the internet. The researchers discovered exposed medical systems, healthcare software interfaces and even misconfigured hospital networks, that should not be viewable publicly. While a device or system being exposed does not necessarily mean that it is vulnerable, exposed devices can potentially be leveraged by cybercriminals and other threat actors to penetrate into organizations, steal data, run botnet and install ransomware.

Specifically, researchers found that several Digital Imaging and Communications in Medicine (DICOM) servers were exposed, including those owned by 21 universities. “These DICOM servers should not be exposed online. Exposed medical systems potentially jeopardize critical data such as patients’ personally identifiable information (PII) and medical records,” the researchers wrote in the report.

“Altogether we found a surprisingly high number of exposed servers that process and store medical images such as computed tomography (CT) and magnetic resonance imaging (MRI) scans and X-rays through Shodan. Along with medical systems were exposed ports, databases, and we even identified misconfigured hospital networks,” the researchers wrote in the report.

Researchers also found a handful of exposed electronic health record (EHR) system interfaces. “Perpetrators can, with additional effort, disrupt hospital, clinic, and pharmacy operations by corrupting sensitive data, issuing incorrect device commands, infecting systems with ransomware, and so on,” the report states.

Additionally, using threat risk assessment models, the researchers found determined DDoS attacks to be the most serious overall threat to healthcare organizations.

Aside from the risks brought on by unsecured medical devices and systems online, healthcare IT teams should also develop a plan of action for another oft-neglected mechanism of hospital operations— the supply chain, the report notes. Weaknesses in the supply chain have led to high-profile breaches in other industries such as retail.

Supply chain threats are potential risks associated with the suppliers of goods and services to healthcare organizations where a perpetrator can exfiltrate confidential or sensitive information, introduce an unwanted function or design, disrupt daily operations, manipulate data, install malicious software, introduce counterfeit devices, and affect business continuity.

“Given the fluid and unique nature of the partnerships hospitals form with each and every third-party vendor or contractor, healthcare IT teams must closely study their networks for supply chain weaknesses, which could lead to a cyberattack,” the report states.

The researchers specifically identified a number of vectors that pose potential risks:

Device firmware attacks—Threat actors can access and modify a medical device’s firmware source code to add malicious functionality or install a backdoor.

mHealth mobile app compromise—mHealth mobile apps can be compromised to change functionality, deliver fatal-level dosages, expose personal health data, penetrate other hospital systems, and cause HIPAA violations.

Source code compromise during manufacturing—Perpetrators can access and modify software source code via backdoor installation or device rooting.

Insider threats from hospital and vendor staff—Fueled by a desire for revenge or sometimes through sheer negligence, staff may abuse access privileges, leading to a breach.

Website, EHR, and internal portal compromise—Perpetrators can attempt to compromise hospital websites, EHR software, and internal portals used by hospital staff and vendors.

Spear phishing from trusted email accounts—Threat actors can gain control of vendor credentials and send clients

While healthcare IT teams have competing priorities, the report recommends a number of technical solutions as a baseline: Network segmentation; firewalls; next-generation firewalls/Unified Threat Management (UTM) gateways; anti-malware solutions; anti-phishing solutions; breach detection systems (BDS); Intrusion Prevention/Detection Systems (IPSs/IDSs); encryption technologies; patch management (physical or virtual); vulnerability scanners; deception technologies; and Shodan scanning.

The human aspect is also a crucial element of the overall security strategy. IT teams must conduct regular social engineering drills and provide training for all employees and relevant third-party partners, the report states. What’s more, an incident response protocol and team, consisting of people from different hospital departments, should be established.

The researchers also offer a number of supply-chain-specific recommendations. Healthcare IT teams should perform vulnerability assessments of new medical devices. Bring your own device (BYOD) programs should include authentication using Network Access Control (NAC) before allowing network access.

Healthcare organizations should purchase medical devices from manufacturers who go through rigorous security assessments of products during design and manufacture. And, healthcare IT teams should develop a plan for patching and updating code or firmware for devices implanted in patients and hospital medical equipment. Healthcare IT leaders should perform risk assessments of all suppliers and vendors in the supply chain, and should identify third-party vendor software and perform security and vulnerability testing to ensure they are safe from hackers. Penetration testing of the hospital network by professional pen-testing companies is highly recommended.

 

 

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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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