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Survey: 75 Percent of Healthcare Orgs Saw a Significant Security Incident Last Year

March 13, 2018
by Heather Landi
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A recent cybersecurity survey conducted by the Health Information and Management Systems Society (HIMSS) found that 75 percent of healthcare organizations experienced a significant security incident in the past 12 months. And, while more organizations view cybersecurity as a business priority, most healthcare organizations’ cybersecurity programs have room for improvement.

The 2018 HIMSS Cybersecurity Survey, based on the feedback from 239 health information security professionals, provides insight into what healthcare organizations are doing to protect their information and assets, in light of increasing cyber-attacks and compromises impacting the healthcare and public health sector.

“Significant security incidents at healthcare organizations have not slowed down by any means. If anything, it is projected that significant security incidents will continue to grow in number, complexity, and impact,” the report stated.

The survey found that 75.7 percent of healthcare organizations experienced a significant security incident in the past 12 months. While 21 percent said they did not have a recent significant security incident in the past year, 3 percent said they did not know.

What’s more, almost all respondents (96 percent) who said their organizations had experience a significant threat were able to characterize the threat actor. The top threat actor was the online scam artist involved in activities such as phishing and spear phishing (30 percent). Sixteen percent of respondents said negligent insiders were responsible for the most significant security incident, and another 16 percent identified hackers as the top threat actor.

Malicious insiders (4 percent), social engineers (3.7 percent, hacktivists (3 percent), and nation state actors (2 percent) also were identified as threat actors.

The majority of respondents (61.4 percent) indicated that the initial point of compromise was via e-mail (e.g., phishing e-mail). Yet others indicated that the initial point of compromise was in the “other” category (12.7 percent). For the “other” category, the initial point of compromise ranged from web application attacks, compromised customer networks, weak passwords, misconfigured cloud servers, and human error.

A minority of respondents (about 3 percent or less) indicated that the initial point of compromise was by way of a compromised organizational website (3.2 percent), hardware or software infected with malware “off the shelf” (3.2 percent), infected or compromised mobile device or medical device (each 2.1 percent), third party websites (1.6 percent), or a compromised cloud provider/service (1.6 percent).

 When looking at time to discovery of a security incident, the majority of respondents (47 percent) said it took less than 24 hours for their organization to discover the attack; 13 percent said it took one to two days and 7 percent said it took three to seven days.

The HIMSS Cybersecurity report findings also yielded a few notable themes. Healthcare organizations with cybersecurity programs are making positive efforts towards improvement. More resources are dedicated to cybersecurity programs, the report stated. The vast majority of respondents (84.3 percent) indicated that their organizations’ use of resources to address cybersecurity concerns has increased. Yet others indicated that there has not been a change in resources since last year (11 percent). Still others indicated that their organizations’ use of resources has decreased (3.3 percent).

In the 2015 and 2016 HIMSS Cybersecurity Surveys, the majority of respondents indicated that cybersecurity was a business priority for their respective organizations. In the 2017 survey, 60 percent of respondents indicated that their organization employs a senior information security leader.

More than half of respondents (55 percent) said their organizations have a dedicated or defined amount of the current IT budget allocated for cybersecurity. However, a fair amount of respondents (26.5 percent) have no specific carve out of cybersecurity within the IT budget (but, money is spent on cybersecurity).

According to the survey report, another finding is that proactive measures are being taken as a result of regular risk assessments. Penetration testing and security awareness training are regularly conducted, the report stated. A little less than half of respondents (45 percent) said risk assessments are conducted once a year.

One positive trend is that 70 percent of respondents said cybersecurity assessments were conducted as part of their organization’s due diligence analysis when acquiring a product or service for their organizations. While this is a positive trend, 26 percent of respondents said their organizations don’t do these kinds of cybersecurity assessments as part of due diligence.

According to the survey, most healthcare organizations’ cybersecurity programs have room for improvement.” Significant barriers exist for remediating and mitigating security incident, namely, personnel and financial resources. Some organizations do not yet have formal insider threat management programs. Risk assessments widely vary from organization to organization,” the report states. Almost 20 percent of respondents (16.9 percent) said no security framework, such as NIST or HITRUST, had been implemented at their respective organizations at all.

Looking to the future, healthcare organizations have certain concerns and priorities which will shape the direction of healthcare cybersecurity. “Healthcare cybersecurity is advancing with some noted improvements. However, there is always room for growth. But, cybersecurity programs cannot advance alone. Indeed, barriers such as lack of cybersecurity personnel and financial resources still persist. Accordingly, healthcare organizations (and their leaders) need to take proactive steps by instilling positive change and making cybersecurity a genuine priority. It is only then that we can move forward instead of taking one step forward and two steps back,” the report stated.

 

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Minnesota DHS Acknowledges Increase in Targeted Phishing Attacks

October 15, 2018
by Rajiv Leventhal, Managing Editor
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Two phishing attacks on employees at the Minnesota Department of Human Services (DHS) resulted in the possible leakage of about 21,000 Minnesotans’ personal information.

The state health agency issued a notice last week that explained over the last several months, several phishing campaigns have targeted Minnesota’s executive agencies, including DHS. Two of these attacks were deemed “successful,” in that hackers—once in June and another time in July—were able to gain access to the state email accounts of two DHS employees, using these accounts to send out spam emails. The agency’s IT department didn’t find out about the attacks until August, officials said.

According to DHS, the two email accounts contained information about some people who have interacted with DHS, including the Minnesota citizens who were notified. Examples of the type of information found in the email accounts at the time they were compromised include: first and last names, dates of birth, Social Security numbers, addresses, telephone numbers, medical information, educational records, employment records, and/or financial information, officials noted.

The agency did add in its notice, “We currently have no evidence that this information was actually viewed, downloaded, or misused.”

According to a report in the Minnesota Star Tribune, this is just the latest cyberattack on Minnesota’s state agencies, “which fend off about 3 million hacking attempts daily, state officials have said. In fact, attacks are increasing, said Aaron Call, the chief information security officer for Minnesota IT Services, which provides technology services to state executive agencies,” according to that report.

In fact, in just the past nine months, “more than 700 security incidents have been reported affecting state agencies, Call said, adding that the attacks are becoming ‘more pervasive and more sophisticated,’” according to the Star Tribune report.

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CISOs, CIOs Not Confident in Their Medical Device Security Strategy, New KLAS Research Finds

October 9, 2018
by Heather Landi, Associate Editor
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According to a survey of CIOs and CISOs, healthcare organizations have an average of 10,000 connected medical devices
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The healthcare industry continues to be bombarded with security attacks, and these cyber attacks are continuously evolving and become more sophisticated over time. At the same time, the healthcare ecosystem has become more connected with the increasing use of Internet of Things (IoT) medical devices, and these medical devices introduce vulnerabilities into healthcare organizations.

Unsecured and poorly secured medical devices put patients at risk of great harm if those devices are hacked, while also posing a threat to the security and privacy of patients’ protected health information (PHI). A recent medical device security report, the result of a collaborative effort between the College of Healthcare Information Management Executives (CHIME), the Association for Executives in Healthcare Information Security (AEHIS), and the Orem, Utah-based KLAS Research, sheds light on the current state of the medical device security industry. For the report, KLAS interviewed 148 CIOs, chief information security officers (CISOs), chief technology officers (CTOs) and other professionals at provider organizations to gauge their level of confidence in their medical device security strategies, the most common challenges they face, their perceptions of the security and transparency of major medical device manufacturers, and the best practices they leverage to overcome medical device security challenges.

The author of the report, Dan Czech, director, market analysis, cybersecurity at KLAS Research, will provide an in-depth overview of this report and medical device security trends during Healthcare Informatics’ Seattle Health IT Summit Oct. 22-23 at the Grand Hyatt Seattle.

The sheer number of connected medical devices that the average healthcare provider is trying to manage speaks to the tremendous challenge IT security leaders face, says Czech. “We spoke to organizations ranging from small to mid-sized clinics all the way to large multi-hospital IDNs (integrated delivery networks), and everyone in between, and the average number of connected medical devices was just under 10,000 medical devices. You think of the enormity of that problem, for an organization to wrap their arms around the problem of managing 10,000 devices,” he says.

What’s more, respondents reported that, among the thousands of connected medical devices that their organizations are managing, about one-third (33 percent) of those devices are “unpatchable.”

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According to the research, 18 percent of provider organizations had medical devices impacted by malware or ransomware in the last 18 months, although few of these incidents resulted in compromised PHI or an audit by the Office for Civil Rights, U.S. Department of Health and Human Services (HHS OCR).

Czech notes that there have not been any patient safety events, to date, as a result of a medical device security issue; however, respondents cite patient safety as a top concern. “Let’s take an infusion pump,” he says. “The ability for a bad actor to gain access to that pump and change the dosage of the medication that’s being injected into a human, that is the kind of patient safety issue that we are concerned about.”

Czech continues, “Another way medical device security affects patient safety is if a device is on Windows XP, and WannaCry ransomware hits; if something like that happens, that device is taken out of production. You may have an oncology patient who needs consistent treatment with a medical device, and if you take that out of production, it disrupts patient care and impacts patient safety.”

The report found that most respondents are either neutral about or not confident in their current medical device security strategy, with CISOs and CIOs more likely to report concern. Only 39 percent of respondents said they were very confident or confident that their current strategy protects patient safety and prevents disruptions in care. Thirty-one percent said they were unconfident or very unconfident, and another 30 percent were neutral. About one-fifth of respondents feel that the inherent risks of medical devices—several of which are outside of their control—will prevent them from ever feeling confident.

Those healthcare leaders who expressed confidence most often point to their security processes and policies, including access limitations, network segmentation and regular device monitoring and risk assessment, as the source of their confidence, followed by strong technology. To support these processes and policies, many leverage security technologies, such as access controls, asset tracking, firewalls, and medical device monitoring. Strong executive support (financial and organizational) and cross-department collaboration also drive confidence, as evidenced by the fact that large IDNs, who more commonly have greater financial resources, are more likely to be confident in their strategies, according to the report.

“Respondents who report they are more confident also are those that have a clear line of ownership, not a shared responsibility,” Czech notes.

Those respondents that lacked confidence in their medical device security cited lack of manufacturer support as the top reason. Almost as common are internal issues related to basic—but hard-to-master—security tasks, such as understanding what assets exist in their organization, which have been patched, which are connected to their network, and what systems those devices are talking to. “Asset and inventory visibility is the basic blocking and tackling of medical device security strategy—you can’t protect what you don’t know. They are looking for tools and processes that they can put in place that will help them understand all the devices they have, what’s connected to their networks, and some cases, what software is on the devices” Czech says.

What’s more, 76 percent of provider organizations report that their resources are insufficient or too strained to adequately secure their medical devices.

More Manufacturer Support and Collaboration Needed

Taking a deep dive into the root causes of medical device security struggles, the report finds that interviewed organizations are almost unanimous in citing manufacturer-related factors as a cause of their medical device security issues. Most provider organization see this issue as one of shared responsibility. As one CISO explained in the report, “I think there needs to be a coordinated effort between the manufacturers, the provider sites, and the regulators. I wish there were some other way for us to address this issue, but without that three-way partnership, I just don’t see how things will work out.”

According to Czech, the research findings indicate there is a gap between how long organizations expect to be able to use a device and how long vendors feel they can keep a device up to date and secure. As a result, nearly all interviewed organizations (93 percent) have struggled with out-of-date operating systems or the inability to patch a device throughout its expected life cycle. Currently, many manufacturers do not allow customers to patch devices themselves, or void warranties if they do.

Insufficient security controls, insufficient encryption, and hardcoded passwords are each cited as manufacturer-caused issues by about half of respondents. Adding to provider organizations’ frustration, on average, almost one-third of medical device vendors decline to offer contract provisions favorable to security.

However, the industry is beginning to shift, Czech notes. "Many provider organizations have drawn a line in the sand to say all contracts now and going forward will include standardized security contract language," he says. "This trend has been led by forward-thinking provider organizations and it also has benefited smaller organizations that may not have the legal teams or the cybersecurity teams that bigger organizations have, but they can use that standardized language in their contracts as well."

What’s interesting, Czech notes, is that many respondents spontaneously brought up frustrations regarding the role of the U.S. Food and Drug Administration (FDA) in medical device security, though KLAS did not specifically ask respondents about it. “It gets back to shared responsibility,” he says. “Respondents feel that manufacturers have a stake in this, they have a stake in this, but so does the FDA. Predominantly, the concern that they shared was that their manufacturer would hide behind their perceptions of the FDA regulations."

Almost two-thirds of respondents said manufacturers blame FDA policies, claiming the policies prevent them from making devices more secure. About a third said FDA policies are unclear, giving manufacturers ways to skirt around responsibility and a third said that even when policies are clear, the FDA doesn’t hold manufacturers accountable, according to the report.

Cybersecurity Programs Advancing Forward

According to the research, organizations are increasingly adopting a number of best practices to strengthen medical device security. There are foundational best practices that organization should implement, such as performing risk assessments, ensuring the inclusion of security provisions in their contracts, and ensuring they receive a software bill of materials, Czech notes. Organizations also report using the most common and basic defense techniques such as network segmentation, antivirus software, and vulnerability scanning to ameliorate security risk.

With regards to organizations’ patching strategies, many provider organizations have begun requesting that vendors use contract language that clearly outlines patching responsibilities and timelines.

Providers also are leveraging third-party solutions to improve medical device security, with nearly 75 percent of respondents currently using or planning to use third-party software or services, according to the report. Network access control (NAC) is most often used to segment networks and approve/deny access. To reduce costs and clearly define ownership, other organizations outsource their clinical engineering as well.

Looking at overall cybersecurity trends, the report indicates that organizations are investing more resources, both operationally and financially, in their cybersecurity programs. Almost 70 percent of organizations (68 percent) report having a VP or C-level leader in charge of the security program, and that’s up from only 42 percent in 2017, representing a 26-percent increase.

“Large IDNs are definitely leading the way with CISO leadership, as about 80 percent of their organizations have a CISO in charge, whereas if you look at clinics and community hospitals, those would be hospitals under 200 beds, only less than 10 percent have a CISO in charge,” Czech says. “Many of those smaller organizations have a CIO that wears two hats—an IT hat and a security hat.”

Organizations also reported improvements to security programs compared to a year ago. Twenty-seven percent considered their security programs to be fully functional and 47 percent said they were developed or starting to function in 2018, compared to 16 percent and 41 percent, respectively, in 2017.   

More than half of organizations (57 percent) report that security is an agenda item at board meetings monthly or quarterly. In addition, 83 percent of organizations have increased their security budget in the last two years, and, on average, budgets increased by 85 percent, according to the report.

 


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Aspire Health Suffers Email Breach from Phishing Attack

September 28, 2018
by Heather Landi, Associate Editor
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Aspire Health, a Nashville-based in-home healthcare provider, was hacked Sept. 3 as a result of a phishing attack and “lost” some protected health information (PHI), according to a report by the Tennessean.com.

The hack was disclosed for the first time in federal court records filed on Tuesday, according to the media report. The company suffered a phishing attack on Sept. 3 which gained access to Aspires internal email system. The Tennessean article cites information in the court records that indicates the hacker then forwarded 124 emails to an external email account, including emails that contained “confidential and proprietary information and files” and “protected health information.”

“No other information about the contents of the hacked emails have been made public, so it is unclear how many patients have been exposed and what kind of information was leaked. Aspire has issued a statement saying it has already alerted a ‘small handful’ of patients who ‘may have been impacted’ by the email breach,” the article stated.

According to an email sent to the Tennessean from Cory Brown, a chief compliance officer for Aspire, the company immediately locked the compromised email account after discovering the phishing attack.

Brown added that it is unknown if the stolen emails were actually opened by the hacker.

In a statement to the local News4 station about the cyber attack, Aspire Health said:Aspire takes the security of its data and the personal information of its patients very seriously. Aspire recently learned one of its employees was the victim of an international phishing attack. Aspire’s information security team quickly discovered the attack and immediately took action to lock the employee’s account. Aspire is now working through the legal process to determine if any Aspire information was ultimately accessed by a third-party. Out of an abundance of caution, Aspire has already alerted the small handful of customers who may have been impacted by this event.”

According to the article, Aspire Health was founded in 2013 by former Sen. Bill Frist and current CEO Brad Smith. The company offers house-call physicians offering palliative care for advanced cancer and other serious illnesses.

“In the court records filed on Tuesday, Aspire has said it has tried to identify the hacker but so far has been unable to do so. The phishing attack originated from a website with an IP address in Eastern Europe for which Google is the registrar,” the article stated.

Court records detail Aspire Health's effort to subpoena Google and identify the hacker, according to media reports. The hacking attack was revealed Tuesday as Aspire filed a federal court motion seeking to subpoena Google for more information on the unknown hacker. Aspire attorney James Haltom said in the court motion that Google’s internal records should be able to identify the culprit – currently known only as John Doe 1, the Tennessean reported.

Haltom wrote in court records that Aspire has requested the information from Google “informally,” but Google said Aspire would need to get a subpoena, the article stated.

“The proposed subpoena to Google should provide information showing who has accessed and/or maintains the phishing website and the subscriber of the e-mail account that John Doe 1 used in the phishing attack,” Haltom wrote. “This information will likely allow Aspire to uncover and locate John Doe 1.”

 

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