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The Downside of Interoperability

Posted on May 2, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s hard to argue that achieving health data interoperability is not important — but it comes with risks. And I’ve seen little discussion of the fact that interoperability may actually increase the chance that a major attack could hit a wide swath of healthcare providers. It might be extreme to suggest that we put off such efforts until we step up the industry’s security status, but the problem shouldn’t be ignored either.

Sure, data interoperability is a critical goal for healthcare providers of all stripes. While there’s room to argue about how it should be accomplished, particularly over whether providers or patients should drive health data management, there’s no question it needs to get done. There’s little doubt that most efforts to coordinate care will fall flat if providers are operating with incomplete information.

And what’s more, with the demand for interoperability baked into MACRA, we pretty much have no choice but to make it happen anyway. To my knowledge, HHS has proposed neither carrot nor stick to convince providers to come on board – nor has it defined “widespread” interoperability to my knowledge — but the agency has to achieve something by 2018, and that means change will come.

That being said, I’m struck by how little industry concern there seems to be about the extent to which interoperability can multiply the possibility of a breach occurring. Unfortunately, security is only as good is the weakest link in the chain, and data sharing increases the length of the chain exponentially. Of course, the risk varies a great deal depending on who or what the data-sharing intermediary is, but the fact remains that a connected network is a connected network.

The problem only gets worse if interoperability is achieved by integrating applications. I’m no software engineer, but I’m pretty sure that the more integrated providers’ infrastructure is, the more vulnerabilities they share. To be fair, hospitals theoretically vet their partners, but that defeats the purpose of universal data sharing, doesn’t it?

And even if every provider in the universal data sharing network practices good security hygiene, they can still get attacked. So it’s not a matter of requiring participants to comply with some network security standard, or meet some certification criteria. Given the massive incentives these have to steal health data (and lock it up with ransomware), nobody can hold out forever.

The bottom line is that I believe we should discuss the matter of security in a fully-connected health data sharing network more often.

Yes, we almost certainly need to press ahead and simply find a way to contain the risks. We simply can’t afford our fragmented healthcare system, and data interoperability offers perhaps the best possible chance of pulling it back together.

But before we plunge into the fray, it only makes sense to stop and consider all of the risks involved and how they should be addressed. After all, universal interconnection exposes a virtually infinite number of potential points of failure to cybercrooks. Let’s put some solutions on the table before it’s too late.

Medical Device Security At A Crossroads

Posted on April 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As anyone reading this knows, connected medical devices are vulnerable to attacks from outside malware. Security researchers have been warning healthcare IT leaders for years that network-connected medical devices had poor security in place, ranging from image repository backups with no passwords to CT scanners with easily-changed configuration files, but far too many problems haven’t been addressed.

So why haven’t providers addressed the security problems? It may be because neither medical device manufacturers nor hospitals are set up to address these issues. “The reality is both sides — providers and manufacturers — do not understand how much the other side does not know,” said John Gomez, CEO of cybersecurity firm Sensato. “When I talk with manufacturers, they understand the need to do something, but they have never had to deal with cyber security before. It’s not a part of their DNA. And on the hospital side, they’re realizing that they’ve never had to lock these things down. In fact, medical devices have not even been part of the IT group and hospitals.

Gomez, who spoke with Healthcare IT News, runs one of two companies backing a new initiative dedicated to securing medical devices and health organizations. (The other coordinating company is healthcare security firm Divurgent.)

Together, the two have launched the Medical Device Cybersecurity Task Force, which brings together a grab bag of industry players including hospitals, hospital technologists, medical device manufacturers, cyber security researchers and IT leaders. “We continually get asked by clients with the best practices for securing medical devices,” Gomez told Healthcare IT News. “There is little guidance and a lot of misinformation.“

The task force includes 15 health systems and hospitals, including Children’s Hospital of Atlanta, Lehigh Valley Health Network, Beebe Healthcare and Intermountain, along with tech vendors Renovo Solutions, VMware Inc. and AirWatch.

I mention this initiative not because I think it’s huge news, but rather, as a reminder that the time to act on medical device vulnerabilities is more than nigh. There’s a reason why the Federal Trade Commission, and the HHS Office of Inspector General, along with the IEEE, have launched their own initiatives to help medical device manufacturers boost cybersecurity. I believe we’re at a crossroads; on one side lies renewed faith in medical devices, and on the other nothing less than patient privacy violations, harm and even death.

It’s good to hear that the Task Force plans to create a set of best practices for both healthcare providers and medical device makers which will help get their cybersecurity practices up to snuff. Another interesting effort they have underway in the creation of an app which will help healthcare providers evaluate medical devices, while feeding a database that members can access to studying the market.

But reading about their efforts also hammered home to me how much ground we have to cover in securing medical devices. Well-intentioned, even relatively effective, grassroots efforts are good, but they’re only a drop in the bucket. What we need is nothing less than a continuous knowledge feed between medical device makers, hospitals, clinics and clinicians.

And why not start by taking the obvious step of integrating the medical device and IT departments to some degree? That seems like a no-brainer. But unfortunately, the rest of the work to be done will take a lot of thought.

The Need for Speed (In Breach Protection)

Posted on April 26, 2016 I Written By

The following is a guest blog post by Robert Lord, Co-founder and CEO of Protenus.
Robert Protenus
The speed at which a hospital can detect a privacy breach could mean the difference between a brief, no-penalty notification and a multi-million dollar lawsuit.  This month it was reported that health information from 2,000 patients was exposed when a Texas hospital took four months to identify a data breach caused by an independent healthcare provider.  A health system in New York similarly took two months to determine that 2,500 patient records may have been exposed as a result of a phishing scam and potential breach reported two months prior.

The rise in reported breaches this year, from phishing scams to stolen patient information, only underscores the risk of lag times between breach detection and resolution. Why are lags of months and even years so common? And what can hospitals do to better prepare against threats that may reach the EHR layer?

Traditional compliance and breach detection tools are not nearly as effective as they need to be. The most widely used methods of detection involve either infrequent random audits or extensive manual searches through records following a patient complaint. For example, if a patient suspects that his medical record has been inappropriately accessed, a compliance officer must first review EMR data from the various systems involved.  Armed with a highlighter (or a large excel spreadsheet), the officer must then analyze thousands of rows of access data, and cross-reference this information with the officer’s implicit knowledge about the types of people who have permission to view that patient’s records. Finding an inconsistency – a person who accessed the records without permission – can take dozens of hours of menial work per case.  Another issue with investigating breaches based on complaints is that there is often no evidence that the breach actually occurred. Nonetheless, the hospital is legally required to investigate all claims in a timely manner, and such investigations are costly and time-consuming.

According to a study by the Ponemon Institute, it takes an average of 87 days from the time a breach occurs to the time the officer becomes aware of the problem, and, given the arduous task at hand, it then takes another 105 days for the officer to resolve the issue. In total, it takes approximately 6 months from the time a breach occurs to the time the issue is resolved. Additionally, if a data breach occurs but a patient does not notice, it could take months – or even years – for someone to discover the problem. And of course, the longer it takes the hospital to identify a problem, the higher the cost of identifying how the breach occurred and remediating the situation.

In 2013, Rouge Valley Centenary Hospital in Scarborough, Canada, revealed that the contact information of approximately 8,300 new mothers had been inappropriately accessed by two employees. Since 2009, the two employees had been selling the contact information of new mothers to a private company specializing in Registered Education Savings Plans (RESPs). Some of the patients later reported that days after coming home from the hospital with their newborn child, they started receiving calls from sales representatives at the private RESP company. Marketing representatives were extremely aggressive, and seemed to know the exact date of when their child had been born.

The most terrifying aspect of this story is how the hospital was able to find out about the data breach: remorse and human error! One employee voluntarily turned himself in, while the other accidentally left patient records on a printer. Had these two events not happened, the scam could have continued for much longer than the four years it did before it was finally discovered.

Rouge Valley Hospital is currently facing a $412 million dollar lawsuit over this breach of privacy. Arguably even more damaging, is that they have lost the trust of their patients who relied on the hospital for care and confidentiality of their medical treatments.

As exemplified by the ramifications of the Rouge Valley Hospital breach and the new breaches discovered almost weekly in hospitals around the world, the current tools used to detect privacy breaches in electronic health records are not sufficient. A system needs to have the ability to detect when employees are accessing information outside their clinical and administrative responsibilities. Had the Scarborough hospital known about the inappropriately viewed records the first time they had been accessed, they could have investigated earlier and protected the privacy of thousands of new mothers.

Every person seeks a hospital’s care has the right to privacy and the protection of their medical information. However, due to the sheer volume of patient records accessed each day, it is impossible for compliance officers to efficiently detect breaches without new and practical tools. Current rule-based analytical systems often overburden the officers with alerts, and are only a minor improvement from manual detection methods.

We are in the midst of a paradigm shift with hospitals taking a more proactive and layered approach to health data security. New technology that uses machine learning and big data science to review each access to medical records will replace traditional compliance technology and streamline threat detection and resolution cycles from months to a matter of minutes. Making identifying a privacy breach or violation as simple and fast as the action that may have caused it in the first place.  Understanding how to select and implement these next-generation tools will be a new and important challenge for the compliance officers of the future, but one that they can no longer afford to delay.

Protenus is a health data security platform that protects patient data in electronic medical records for some of the nation’s top-ranked hospitals. Using data science and machine learning, Protenus technology uniquely understands the clinical behavior and context of each user that is accessing patient data to determine the appropriateness of each action, elevating only true threats to patient privacy and health data security.

Patient Portal Security Is A Tricky Issue

Posted on April 25, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Much of the discussion around securing health data on computers revolves around enterprise networks, particularly internal devices. But it doesn’t hurt to look elsewhere in assessing your overall vulnerabilities. And unfortunately, that includes gaps that can be exposed by patients, whose security practices you can’t control.

One vulnerability that gets too little attention is the potential for a cyber attack accessing the provider’s patient portal, according to security consultant Keith Fricke of tw-Security in Overland Park, Kan. Fricke, who spoke with Information Management, noted that cyber criminals can access portal data relatively easily.

For example, they can insert malicious code into frequently visited websites, which the patient may inadvertently download. Then, if your patient’s device or computer isn’t secure, you may have big problems. When the patient accesses a hospital or clinic’s patient portal, the attacker can conceivably get access to the health data available there.

Not only does such an attack give the criminal access to the portal, it may also offer the them access to many other patients’ computers, and the opportunity to send malware to those computers. So one patient’s security breach can become a victim of infection for countless patients.

When patients access the portal via mobile device, it raises another set of security issues, as the threat to such devices is growing over time. In a recent survey by Ponemon Institute and CounterTack, 80% of respondents reported that their mobile endpoints have been the target of malware the past year. And there’s little doubt that the attacks via mobile device will more sophisticated over time.

Given how predictable such vulnerabilities are, you’d think that it would be fairly easy to lock the portals down. But the truth is, patient portals have to strike a particularly delicate balance between usability and security. While you can demand almost anything from employees, you don’t want to frustrate patients, who may become discouraged if too much is expected from them when they log in. And if they aren’t going to use it, why build a patient portal at all?

For example, requiring a patient to change your password or login data frequently may simply be too taxing for users to handle. Other barriers include demanding that a patient use only one specific browser to access the portal, or requiring them to use digits rather than an alphanumeric name that they can remember. And insisting that a patient use a long, computer-generated password can be a hassle that patients won’t tolerate.

At this point, it would be great if I could say “here’s the perfect solution to this problem.” But the truth is, as you already know, that there’s no one solution that will work for every provider and every IT department. That being said, in looking at this issue, I do get the sense that providers and IT execs spend too little time on user-testing their portals. There’s lots of room for improvement there.

It seems to me that to strike the right balance between portal security and usability, it makes more sense to bring user feedback into the equation as early in the game as possible. That way, at least, you’ll be making informed choices when you establish your security protocols. Otherwise, you may end up with a white elephant, and nobody wants to see that happen.

Are Ransomware Attacks A HIPAA Issue, Or Just Our Fault?

Posted on April 18, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

With ransomware attacks hitting hospitals in growing numbers, it’s growing more urgent for healthcare organizations to have a routine and effective response to such attacks. While over the short term, providers are focused mostly on survival, eventually they’ll have to consider big-picture implications — and one of the biggest is whether a ransomware intrusion can be called a “breach” under federal law.

As readers know, providers must report any sizable breach to the HHS Office for Civil Rights. So far, though, it seems that the feds haven’t issued any guidance as to how they see this issue. However, people in the know have been talking about this, and here’s what they have to say.

David Holtzman, a former OCR official who now serves as vice president of compliance strategies at security firm CynergisTek, told Health Data Management that as long as the data was never compromised, a provider may be in the clear. If an organization can show OCR proof that no data was accessed, it may be able to avoid having the incident classed as a breach.

And some legal experts agree. Attorney David Harlow, who focuses on healthcare issues, told Forbes: “We need to remember that HIPAA is narrowly drawn and data breaches defined as the unauthorized ‘access, acquisition, use or disclosure’ of PHI. [And] in many cases, ransomware “wraps” PHI rather than breaches it.”

But as I see it, ransomware attacks should give health IT security pros pause even if they don’t have to report a breach to the federal government. After all, as Holtzman notes, the HIPAA security rule requires that providers put appropriate safeguards in place to ensure the confidentiality, the integrity and availability of ePHI. And fairly or not, any form of malware intrusion that succeeds raises questions about providers’ security policies and approaches.

What’s more, ransomware attacks may point to underlying weaknesses in the organization’s overall systems architecture. “Why is the operating system allowing this application to access this data?” asked one reader in comments on a related EMR and HIPAA post. “There should be no possible way for a database that is only read/write for specified applications to be modified by a foreign encryption application,” the reader noted. “The database should refuse the instruction, the OS should deny access, and the security system should lock the encryption application out.”

To be fair, not all intrusions are someone’s “fault.” Ransomware creators are innovating rapidly, and are arguably equipped to find new vectors of infection more quickly than security experts can track them. In fact, easy-to-deploy ransomware as a service is emerging, making it comparatively simple for less-skilled criminals to use. And they have a substantial incentive to do so. According to one report, one particularly sophisticated ransomware strain has brought $325 million in profits to groups deploying it.

Besides, downloading actual data is so five years ago. If you’re attacking a provider, extorting payment through ransomware is much easier than attempting to resell stolen healthcare data. Why go to all that trouble when you can get your cash up front?

Still, the reality is that healthcare organizations must be particularly careful when it comes to protecting patient privacy, both for ethical and regulatory reasons. Perhaps ransomware will be the jolt that pushes lagging players to step up and invest in security, as it creates a unique form of havoc that could easily put patient care at risk. I certainly hope so.

Breach Affecting 2.2M Patients Highlights New Health Data Threats

Posted on April 4, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A Fort Myers, FL-based cancer care organization is paying a massive price for a health data breach that exposed personal information on 2.2 million patients late last year. This incident is also shedding light on the growing vulnerability of non-hospital healthcare data, as you’ll see below.

Recently, 21st Century Oncology was forced to warn patients that an “unauthorized third party” had broken into one of its databases. Officials said that they had no evidence that medical records were accessed, but conceded that breached information may have included patient names Social Security numbers, insurance information and diagnosis and treatment data.

Notably, the cancer care chain — which operates on hundred and 45 centers in 17 states — didn’t learn about the breach until the FBI informed the company that it had happened.

Since that time, 21st Century has been faced with a broad range of legal consequences. Three lawsuits related to the breach have been filed against the company. All are alleging that the breach exposed them to a great possibility of harm.  Patient indignation seems to have been stoked, in part, because they did not learn about the breach until five months after it happened, allegedly at the request of investigating FBI officials.

“While more than 2.2 million 21st Century Oncology victims have sought out and/or pay for medical care from the company, thieves have been hard at work, stealing and using their hard-to-change Social Security numbers and highly sensitive medical information,” said plaintiff Rona Polovoy in her lawsuit.

Polovoy’s suit also contends that the company should have been better prepared for such breaches, given that it suffered a similar security lapse between October 2011 and August 2012, when an employee used patient names Social Security numbers and dates of birth to file fraudulent tax refund claims. She claims that the current lapse demonstrates that the company did little to clean up its cybersecurity act.

Another plaintiff, John Dickman, says that the breach has filled his life with needless anxiety. In his legal filings he says that he “now must engage in stringent monitoring of, among other things, his financial accounts, tax filings, and health insurance claims.”

All of this may be grimly entertaining if you aren’t the one whose data was exposed, but there’s more to this case than meets the eye. According to a cybersecurity specialist quoted in Infosecurity Magazine, the 21st Century network intrusion highlights how exposed healthcare organizations outside the hospital world are to data breaches.

I can’t help but agree with TrapX Security executive vice president Carl Wright, who told the magazine that skilled nursing facilities, dialysis centers, imaging centers, diagnostic labs, surgical centers and cancer treatment facilities like 21st are all in network intruders’ crosshairs. Not only that, he notes that large extended healthcare networks such as accountable care organizations are vulnerable.

And that’s a really scary thought. While he doesn’t say so specifically, it’s logical to assume that the more unrelated partners you weld together across disparate networks, it multiplies the number of security-related points of failure. Isn’t it lovely how security threats emerge to meet every advance in healthcare?

This Time, It’s Personal: Virus Hits My Local Hospital

Posted on March 30, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In about two weeks, I am scheduled to have a cardiac ablation to address a long-standing arrhythmia. I was feeling pretty good about this — after all, the procedure is safe at my age and is known to have a very high success rate — until I scanned my Twitter feed yesterday.

It was then that I found out that what was probably a ransomware virus had forced a medical data shutdown at Washington, D.C.-based MedStar Health. And while the community hospital where my procedure will be done is not part of the MedStar network, the cardiac electrophysiologist who will perform the ablation is affiliated with the chain.

During my pre-procedure visit with the doctor, a very pleasant guy who made me feel very safe, we devolved to talking shop about EMR issues after the clinical discussion was over. At the time he shared that his practice ran on GE Centricity which, he understandably complained, was not interoperable with the Epic system at one community chain, MedStar’s enterprise system or even the imaging platforms he uses. Under those circumstances, it’s hard to imagine that my data was affected by this breach. But as you can imagine, I still wonder what’s up.

While there’s been no official public statement saying this virus was part of a ransomware attack, some form of virus has definitely wreaked havoc at MedStar, according to a report by the Washington Post. (As a side note, it’s worth pointing out that if this is a ransomware attack, health system officials have done an admirable job of keeping the amount demanded for data return out of the press. However, some users have commented about ransomware on their individual computers.)

As the news report notes, MedStar has soldiered on in the face of the attack, keeping all of its clinical facilities open. However, a hospital spokesperson told the newspaper that the chain has decided to take down all system interfaces to prevent the spread of the virus. And as has happened with other hospital ransomware incursions, staffers have had to revert to using paper-based records.

And here’s where it might affect me personally. Even though my procedure is being done at a non-MedStar hospital, it’s possible that the virus driven delay in appointments and surgeries will affect my doctor, which could of course affect me.

Meanwhile, imagine how the employees at MedStar facilities feel: “Even the lowest-level staff can’t communicate with anyone. You can’t schedule patients, you can’t access records, you can’t do anything,” an anonymous staffer told the Post. Even if such a breach had little impact on patients, it’s obviously bad for employee morale. And that can’t be good for me either.

Again, it’s possible I’m in the clear, but the fact that the FUD surrounding this episode affects even a trained observer like myself plays right into the virus makers’ hands. Now, so far I haven’t dignified the attack by calling the doctor’s office to ask how it will affect me, but if I keep reading about problems with MedStar systems I’ll have to follow up soon.

Worse, when I’m being anesthetized for the procedure next month, I know I’ll be wondering when the next virus will hit.

Cyber Breach Insurance May Be Useless If You’re Negligent

Posted on March 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Ideally, your healthcare organization will never see a major data breach. But realistically, given how valuable healthcare data is these days — and the extent to which many healthcare firms neglect data security — it’s safer to assume that you will have to cope with a breach at some point.

In fact, it might be wise to assume that some form of costly breach is inevitable. After all, as one infographic points out, 55 healthcare organizations reported network attacks resulting in data breaches last year, which resulted in 111,809,322 individuals’ health record information being compromised. (If you haven’t done the math in your head, that’s a staggering 35% of the US population.)

The capper: if things don’t get better, the US healthcare industry stands to lose $305 billion in cumulative lifetime patient revenue due to cyberattacks likely to take place over the next five years.

So, by all means, protect yourself by any means available. However, as a recent legal battle suggests, simply buying cyber security insurance isn’t a one-step solution. In fact, your policy may not be worth much if you don’t do your due diligence when it comes to network and Internet security.

The lawsuit, Columbia Casualty Company v. Cottage Health System, shows what happens when a healthcare organization (allegedly) relies on its cyber insurance policy to protect it against breach costs rather than working hard to prevent such slips.

Back in December 2013, the three-hospital Cottage Health System notified 32,755 of its patients that their PHI had been compromised. The breach occurred when the health system and one of its vendors, InSync, stored unencrypted medical records on an Internet accessible system.

It later came out that the breach was probably caused by careless FTP settings on both systems servers which permitted anonymous user access, essentially opening up access to patient health records to anyone who could use Google. (Wow. If true that’s really embarrassing. I doubt a sharp 13-year-old script kiddie would make that mistake.)

Anyway, a group of presumably ticked off patients filed a class action suit against Cottage asking for $4.125 million. At first, cyber breach insurer Columbia Casualty paid out the $4.125 million and settled the case. Now, however, the insurer is suing Cottage, asking the health system to pay it back for the money it paid out to the class action members. It argues that Cottage was negligent due to:

  • a failure to continuously implement the procedures and risk controls identified in the application, including, but not limited to, its failure to replace factory default settings and its failure to ensure that its information security systems were securely configured; and
  • a failure to regularly check and maintain security patches on its systems, its failure to regularly re-assess its information security exposure and enhance risk controls, its failure to have a system in place to detect unauthorized access or attempts to access sensitive information stored on its servers and its failure to control and track all changes to its network to ensure it remains secure.

Not only that, Columbia Casualty asserts, Cottage lied about following a minimum set of security practices known as a “Risk Control Self Assessment” required as part of the cyber insurance application.

Now, if the cyber insurer’s allegations are true, Cottage’s behavior may have been particularly egregious. And no one has proven anything yet, as the case is still in the early stages, but this dispute should still stand as a warning to all healthcare organizations. If you neglect security, then try to get an insurance company to cover your behind when breaches occur, you might be out of luck.

To Improve Health Data Security, Get Your Staff On Board

Posted on February 2, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As most readers know, last year was a pretty lousy one for healthcare data security. For one thing, there was the spectacular attack on health insurer Anthem Inc., which exposed personal information on nearly 80 million people. But that was just the headline event. During 2015, the HHS Office for Civil Rights logged more than 100 breaches affecting 500 or more individuals, including four of the five largest breaches in its database.

But will this year be better? Sadly, as things currently stand, I think the best guess is “no.” When you combine the increased awareness among hackers of health data’s value with the modest amounts many healthcare organizations spend on security, it seems like the problem will actually get worse.

Of course, HIT leaders aren’t just sitting on their hands. According to a HIMSS estimate, hospitals and medical practices will spend about $1 billion on cybersecurity this year. And recent HIMSS survey of healthcare executives found that information security had become a top business priority for 90% of respondents.

But it will take more than a round of new technical investments to truly shore up healthcare security. I’d argue that until the culture around healthcare security changes — and executives outside of the IT department take these threats seriously — it’ll be tough for the industry to make any real security progress.

In my opinion, the changes should include following:

  • Boost security education:  While your staff may have had the best HIPAA training possible, that doesn’t mean they’re prepared for growing threat cyber-strikes pose. They need to know that these days, the data they’re protecting might as well be money itself, and they the bankers who must keep an eye on the vault. Health leaders must make them understand the threat on a visceral level.
  • Make it easy to report security threats: While readers of this publication may be highly IT-savvy, most workers aren’t. If you haven’t done so already, create a hotline to report security concerns (anonymously if callers wish), staffed by someone who will listen patiently to non-techies struggling to explain their misgivings. If you wait for people who are threatened by Windows to call the scary IT department, you’ll miss many legit security questions, especially if the staffer isn’t confident that anything is wrong.
  • Reward non-IT staffers for showing security awareness: Not only should organizations encourage staffers to report possible security issues — even if it’s a matter of something “just not feeling right” — they should acknowledge it when staffers make a good catch, perhaps with a gift card or maybe just a certificate. It’s pretty straightforward: reward behavior and you’ll get more of it.
  • Use security reports to refine staff training: Certainly, the HIT department may benefit from alerts passed on by the rest of the staff. But the feedback this process produces can be put to broader use.  Once a quarter or so, if not more often, analyze the security issues staffers are bringing to light. Then, have brown bag lunches or other types of training meetings in which you educate staffers on issues that have turned up regularly in their reports. This benefits everyone involved.

Of course, I’m not suggesting that security awareness among non-techies is sufficient to prevent data breaches. But I do believe that healthcare organizations could prevent many a breach by taking advantage of their staff’s instincts and observational skills.

NIST Goes After Infusion Pump Security Vulnerabilities

Posted on January 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As useful as networked medical devices are, it’s become increasingly apparent that they pose major security risks.  Not only could intruders manipulate networked devices in ways that could harm patients, they could use them as a gateway to sensitive patient health information and financial data.

To make a start at taming this issue, the National Institute of Standards and Technology has kicked off a project focused on boosting the security of wireless infusion pumps (Side Note: I wonder if this is in response to Blackberry’s live hack of an infusion pump). In an effort to be sure researchers understand the hospital environment and how the pumps are deployed, NIST’s National Cybersecurity Center of Excellence (NCCoE) plans to work with vendors in this space. The NCCoE will also collaborate on the effort with the Technological Leadership Institute at the University of Minnesota.

NCCoE researchers will examine the full lifecycle of wireless infusion pumps in hospitals, including purchase, onboarding of the asset, training for use, configuration, use, maintenance, decontamination and decommissioning of the pumps. This makes a great deal of sense. After all, points of network connection are becoming so decentralized that every touchpoint is suspect.

The team will also look at what types of infrastructure interconnect with the pumps, including the pump server, alarm manager, electronic medication administration record system, point of care medication, pharmacy system, CPOE system, drug library, wireless networks and even the hospital’s biomedical engineering department. (It’s sobering to consider the length of this list, but necessary. After all, more or less any of them could conceivably be vulnerable if a pump is compromised.)

Wisely, the researchers also plan to look at the way a wide range of people engage with the pumps, including patients, healthcare professionals, pharmacists, pump vendor engineers, biomedical engineers, IT network risk managers, IT security engineers, IT network engineers, central supply workers and patient visitors — as well as hackers. This data should provide useful workflow information that can be used even beyond cybersecurity fixes.

While the NCCoE and University of Minnesota teams may expand the list of security challenges as they go forward, they’re starting with looking at access codes, wireless access point/wireless network configuration, alarms, asset management and monitoring, authentication and credentialing, maintenance and updates, pump variability, use and emergency use.

Over time, NIST and the U of M will work with vendors to create a lab environment where collaborators can identify, evaluate and test security tools and controls for the pumps. Ultimately, the project’s goal is to create a multi-part practice guide which will help providers evaluate how secure their own wireless infusion pumps are. The guide should be available late this year.

In the mean time, if you want to take a broader look at how secure your facility’s networked medical devices are, you might want to take a look at the FDA’s guidance on the subject, “Cybersecurity for Networked Medical Devices Containing Off-the-Shelf Software.” The guidance doc, which was issued last summer, is aimed at device vendors, but the agency also offers a companion document offering information on the topic for healthcare organizations.

If this topic interests you, you may also want to watch this video interview talking about medical device security with Tony Giandomenico, a security expert at Fortinet.