Healthcare Resources - Keeping Security Strategy Healthy

As the healthcare industry constantly evolves, every component of operational support must evolve as well. Security is one critical area that must strive to keep pace with industry changes, stay current with regulatory compliance mandates and utilize data to stay ahead of the curve. When intelligence is culled, analyzed and viewed as a source of continuous improvement, proactive security programs are the result.

What trends and data do healthcare security professionals need to assess?

Trade Associations: The International Association for Healthcare Security & Safety (IAHSS) and ASIS are key drivers in establishing protocol to assess measure and implement healthcare security strategy; and provide information and resources.

National Resources: Workplace violence in healthcare is a growing concern. According to the Bureau of Labor Statistics, nearly 60 percent of all nonfatal assaults and violent acts in the workplace occurred in the healthcare and social assistance industry. The Occupational Safety and Health Administration (OSHA) offers Workplace Violence Safety and Health Topics Page with information that can help security professionals effectively evaluate their workplace.

Regulatory Agencies: An effective healthcare security program must be in-tune with and apply the direction of a variety of accrediting bodies including OSHA, The Joint Commission, CMS, DNV, and NFPA, as well as state and local regulators.

Local Data: Analysis of what is happening in the community is essential. Crime statistics, population trends, community events, and anticipated weather events can help the facility’s security team be more prepared.

On-site Trends: Ongoing review of security trends can aid in the evolution of security strategy and security officer deployment that is predictive, rather than reactive. Frequent incidents in particular area of a hospital could be addressed with a change in procedure or staffing.

Security Best Practices: In addition to industry benchmarks, information and best practices shared among peers creates additional opportunities for continuous improvement and success.

A data-driven approach to security must be comprehensive and cognizant of the evolving nature of the industry and the facility. Review and then ask yourself… what additional information do I need to continue to move my security program forward?

Social Engineering in HealthCare

The weakest link in an information security program is people. Hackers have known this for a long time and have refined the art of social engineering. By convincing someone to do something that isn’t in their best interest, malicious individuals are able to launch devastating attacks on organizations.

One method in which the hackers prey on their victims is through phishing. This attack vector utilizes electronic communication that appears to be trustworthy. Through this vehicle, hackers attempt to obtain sensitive information about their victims such as credentials, credit card information, and even more coveted protected health information.

The healthcare industry has always been about helping people; however, when it comes to privacy and security, being too helpful isn’t always a good thing. Partners Healthcare realized this when a group of their employees fell victim to phishing emails. Hackers were able to convince some of Partners’ employees to engage with them through an email on November 25, 2014 allowing the hackers to gain access to the employees’ email accounts. This eventually led to the compromise of approximately 3,300 patient records.

In another unfortunate example, Texas-based Seton Healthcare Family, a part of Ascension Health System, became a victim of a compromise of protected health information on 39,000 patients when an employee opened an email that turned out to be a phishing scam. This wasn’t the first time Seton Healthcare had been breached; in 2013 the health system reported the theft of an unencrypted laptop. Since 2007, they had two additional breaches: one again involving a stolen laptop affecting 10,300 patients and a breach by a third-party vendor involving more than 500 patients where member cards were sent out to the wrong members.

St. Vincent Medical Group fell victim to a phishing attack targeting employees. A statement posted on their website indicated that they discovered an employee’s email account had been compromised around December 3, 2014. As of March 12, 2015, they uncovered the compromised email account that contained personal health information on approximately 760 patients.

With the ease of phishing and the high returns that can be achieved by using this technique, security professionals fear that these types of threats will increase in 2015. With health data becoming more valuable to hackers on the black market and the belief that the healthcare industry is not ‘up to par’ with security as other industries, the healthcare industry will continue to see an increase in attacks. 

Protecting Patient Records in an App-Happy Healthcare World

Medical identity theft is the fastest growing type of identity theft. It is more lucrative from the bad guy's point of view, and it's also very hard to detect.  Detection is a growing problem for those IT and security operations centers working within healthcare organizations. By law, they must protect patients' and providers' electronic records. At the same time, there's growing pressure to expand the security architecture to accommodate more access to on-demand services.  This is particularly true when it comes to mobile devices, where a loss or theft can carry serious consequences.

Healthcare IT, in general, is typically slower to adopt new platforms to support emerging technologies, in part because potential disruptions in services could mean life or death. They also have a highly fluid user base. But the proliferation of on-demand patient portals, healthcare exchanges, fitness-related wearable technologies and health-oriented mobile applications are pressing forward, with or without IT's blessings.

The whole issue with security portals and making sure we have the appropriate security around them is absolutely paramount.  All regulated industries struggle continually to meet consumer demands and compliance mandates.

Medical records are under more intense scrutiny today in part because of two recent breaches: Anthem, the largest for-profit managed care company in the Blue Cross Blue Shield portfolio; and Premara Blue Cross, headquartered in Washington. Between the two, almost 100 million customers are now at risk of identity theft.

A stolen record may be worth $1 on the black market, whereas a stolen health record may fetch $5. Why?  It's got all the information on someone to steal their identity and use it to get at a lot of other areas.

Like many other security issues, education and awareness are key to improving the security posture of any organization. For health IT, helping patients, caregivers and providers understand mobile device security best practices is a good start. Consider training and requiring users on the following safeguards to minimize risks:

Authentication. As a policy, users should set up multi-factor authentication to access apps holding personal health information and credentials. Make sure those who use PINs or passwords are set up to mask the codes as they are entered to reduce the chance of visual hacking.

Encryption. Show mobile users how to install encryption to protect healthcare and financial data stored on their smartphones, tablets and laptops.

Enable Remote wipe. If the device is company-owned, consider installing technology to remotely erase data or disable an app if you believe it is at substantial risk of a compromise.

Block downloads. This is a little tougher for healthcare organizations, which may need to share files for legitimate purposes. But consider as a policy disabling non-essential applications to narrow the risk of exposure.

Install security software. Many consumers realize the need on their desktops or laptops but fail to install antimalware software, firewalls, VPNs or other security basics on their mobile phones. A little encouragement can go a long way. So does accepting security updates when a request pops up on their phones or tablets.

Discourage public Wi-Fi use.  Password-protect a facility's wireless network and warn people to avoid accessing, receiving or transmitting private patient data in places with unsecured Wi-Fi. Similarly, if you are in a public setting or where there's public access, a screen shield will keep private patient health data away from prying eyes.

Lock the device when not in use. And use automatic log-off.   For many years, I used to tell my people, You are in healthcare. You aren't working for IBM or Symantec. At the end of that server or PC is someone's life, and that changes their whole perspective.

Raising Cyber Security Awareness for Healthcare Professionals

A large percentage of the reported breaches can be traced back to human error. Physical security controls break down because a door is left open. Technical controls break down because a user ID or password is posted via a sticky note on a computer monitor or because account credentials are shared and the task at hand absolutely positively need to be done right now.

Professionals working in the healthcare industry possess a zeal for protecting the health of their patients and improving how that support is provided. No legitimate employee wants to intentionally do something to adversely impact the health of a patient.

Health IT is about promoting the use of IT to support the healthcare mission. Health IT is all about providing high-quality care more efficiently, faster and cost effectively by using software and hardware technologies that have transformed countless other industries. However, these technologies cannot be deployed without considering the potential new cyber risks introduced to an organization.

An obvious manifestation of healthcare IT is the continuing transition from paper-based records to digital health records. But it does not end there, as wireless technologies have enabled medical devices to become extended diagnostic and reporting nodes on an increasingly networked IT infrastructure that shares patient medical records, billing records, financial records and burgeoning software applications—all accessing databases housed in common server structures.

How can this extended enterprise be protected? One approach can be extracted from the "Stop. Think. Connect" campaign administered by the U.S. Department of Homeland Security (DHS). The intent is not to make everyone a cyber security expert or to unduly raise fear, uncertainty and doubt—the intent is to bring some sense of awareness of cyber security to the general population. The goal of this campaign is to make someone think—even for half a second—before they take action online.

Do you have a secure connection to the server where you are about to input your credit card information? Are you authorized to access the data records you are about to request? Should you post personal information online for anyone to see? Simply hesitating to consider your actions before blindly clicking on that link can help prevent obvious human errors from occurring.

The board of directors of a healthcare organization has a myriad of concerns—providing sound patient care, maintaining financial viability and leveraging IT to enhance their operations. Just like healthcare professionals run their departments, the IT infrastructure should utilize cyber security experts cognizant of the constantly evolving threats and mitigating the resultant risks to the organization. As there is never enough budget or staff to throw at a non- mission essential, yet critical, area such as cyber security—how can the board cope?

Raise the cyber security awareness of the overall organization with role-appropriate cognizance of the consequences of individual actions and how easily one click on an inappropriate link can compromise an entire network—ultimately leading to the compromise of personal health records.

What is one effective way to overcome this challenge? Establish a cyber security awareness program.

Creating and operating a cyber security awareness program to have individuals realize that they play key roles in protecting the digital health of patients—just as they play direct roles in protecting the physical health of patients. 

What will it take to prioritize security in HealthCare?

With security breaches dominating news headlines daily, those responsible for securing our systems, networks, and devices are struggling to keep pace with the evolving threat landscape. Perhaps some of the most concerning potential breach data comes from the healthcare industry where we entrust our most personal information—social security number, birth date, medical history—as well as our immediate family members’ sensitive information to medical care providers. Further, medical devices rely on secure IT networks to function properly and deliver continuous, critical care to patients with heart conditions, diabetes, and other ailments. In the event of a security breach, the malfunction of devices could have potentially life-threatening consequences.

So what can we do to create a more secure environment for protected health information and equip healthcare IT staff with the security skills they need to fulfill this task?

First, we must start with a level of awareness. Calling attention to the alarming number of data breaches in today’s healthcare industry certainly helps the cause. According to Redspin’s Breach Report 2013 – Protected Health Information (PHI), the number of PHI breaches were up 138 percent from 2012, with 199 incidents reported to the U.S. Department of Health and Human Services (HHS), impacting over 7 million patient records. HHS even has a “wall of shame” webpage for the world to see lists of U.S. healthcare organizations that have had a security breach of protected health information affecting more than 500 individuals.

Part of the problem with security awareness lies in current processes, which don’t take into account how to mitigate fraud or medical identity theft.  If a patient’s healthcare record is compromised by someone who stole the identity to receive care and consequently had false information entered into that patient’s electronic health record, there’s no process in place that allows medical providers to go in and fix the record because it’s considered a legal document. Right now, we’re still at the awareness level for security and what has to be done is to help hospitals and other healthcare organizations recognize when an instance of medical identity theft has occurred so they can improve processes to protect patients.

Medical records are more susceptible to identity theft because the online systems for medical records and the networks on which they operate are not as locked down and sophisticated as other industries. We must also realize that healthcare is one of the last industries to move data from paper to online systems. Many physicians still use paper records for their patients. And others are only beginning the process of transitioning patient records to digital systems.

When it comes to educating healthcare IT staff, they need the resources, experience, and continuous drive to ensure they possess the latest knowledge and skills required to secure protected health information.  Many stressed the lack of security even at the basic awareness level in their organizations.

Let’s face it, making security a priority for the healthcare industry won’t happen overnight. It will require a concerted effort that begins with security awareness, followed by education and training of healthcare IT staff, and finally adoption and acceptance from the healthcare industry to create a secure digital environment for protected health information.

Healthcare Security

Following recent healthcare data breach, data security is back in the national spotlight. Healthcare data breaches not only create financial vulnerabilities for companies and consumers, but they can also pose serious medical threats due to tampered medical histories of affected patients.

While healthcare data breaches have not received as much media attention as the hacks against the national retailers, healthcare breaches could potentially have much greater personal affect than hacks perpetrated in other industries.

What Makes Healthcare Data so Vulnerable?

Although data breaches in any industry pose great threats, healthcare data breaches have the potential to inflict greater financial and personal consequences on clients and companies. Here are some of the main concerns when it comes to healthcare breaches.

1. Health companies face unique challenges in transferring health records securely.

Many healthcare companies are still inexperienced in upholding and maintaining the secure transfers of their Electronic Health Records (EHRs), and subsequently their records may be more vulnerable. While these healthcare companies may have the necessary technology to create secure records, others are still inexperienced in the necessary security practices to withstand trained hackers.

2. Healthcare companies need to refocus their infrastructure to protect against breaches.

Many healthcare companies are still learning how to protect and prevent against data breaches. Unlike credit card companies and banks that have established measures of quickly recognizing fraudulent activity and putting a stop to it, healthcare companies can take months to notice errors—if they notice them at all.

“Cybercriminals tend to think of healthcare organizations as soft targets. Historically, they haven’t invested much in IT, and security specifically.  Knowing that healthcare companies are seen as easier targets should give these companies the necessary motivation to improve their security practices.

3. The consequences of healthcare breaches are much more severe.

While the consequences of identity theft can be expensive and frightening, the impact of healthcare data breaches are often more expensive and may even have the potential to be lethal. In addition to the financial threat, many hackers of healthcare records are tampering with these medical records in order to make a higher profit (mostly through the reselling of prescription drugs). While the consequences of hacks related to accessing and selling drugs seem obvious, there is also potential for these hacks to lead to life-threatening changes on medical records (including past surgeries, allergies, and drug interactions) posing a great threat to your medical care in an emergency.

What Can Healthcare Providers Do?

Healthcare companies have sometimes neglected to deploy even the most basic enterprise security measures. Without proper security checkpoints, these companies make themselves more vulnerable to hacks and potentially put their clients’ most important data (social security numbers, medical records, credit card information) at great risk. However, in order to avoid these attacks in the future, healthcare organizations must take this opportunity to begin prioritizing better security practices and improve the face of healthcare security from here on out.

The Human Factor and Healthcare Privacy and Security

An organization can have all the necessary healthcare privacy and security measures in place, but without comprehensive employee training, the facility could still fall victim to a data breach or violate HIPAA regulations.  That is just one of several issues the healthcare industry is facing in 2015.  The human factor is critical for any healthcare organization, and a lack of knowledge about HIPAA could be harmful.

Accessing healthcare information is also a critical aspect of securing that data because organizations must ensure that the users who are accessing the information are authorized to do so.  Covered entities have to define what information needs to be accessed by what users. They also want to define what processes need to be in place to ensure that the appropriate level of access is granted to the users.

Essentially, healthcare organizations need to take a look at what information they actually have, how that information is stored, and for what purposes it needs to be used for. Once those three elements are in place, facilities can then define what their provisioning processes should be based upon users’ need and the duty they need to perform.

You have to keep in mind that all the users that have access to that data have a role or responsibility, and are using that information for a specific purpose.  So it’s up to those users to make sure that they follow the necessary processes, procedures and policies in place for the disclosure of that information.

Additionally, that access has to be in accordance with all regulatory requirements, such as the HIPAA Privacy Rule and Security Rule. Finding that balance is a challenge that healthcare organizations of all sizes are working to overcome.

It’s a lot easier for practices, covered entities, and hospitals to grant access to all employees and feel like they will only use the information that they’re supposed to,” he said. “However, that’s not always the case.

This is where comprehensive training and education will come into play. Employees need to be aware of what the Privacy and Security Rules are about and then what their obligations as staff members are. From there, covered entities need to teach employees how to tie those obligations back to existing practices within their particular organization.

Another key tool to strengthening the human factor in healthcare privacy and security is conducting regular audits and reviews of what employees are actually able to access. For example, an individual who works in the billing office doesn’t necessarily need to have access to clinical information, such as a patient’s medical record. Comparatively, a nurse will need access to clinical information, but will likely not need to see a patient’s demographic information or their financial data.

You have to understand what information you have in your system and how grantable your system can be in order to determine what level of access is appropriate for your employees, recalling the “minimum necessary” required in HIPAA. “Granting all access to everybody would not be in compliance, and would not be standard with the security requirements.”