Cloud Computing in Healthcare

OCR Publishes New Resources for MHealth App Developers and Cloud Services Providers

The Department of Health and Human Services’ Office for Civil Rights has announced it has published additional resources for mobile health app developers and has updated and renamed its Health App Developer Portal.

The portal – Resources for Mobile Health Apps Developers – provides guidance for mobile health app developers on the HIPAA Privacy, Security, and Breach Notification Rules and how they apply to mobile health apps and application programming interfaces (APIs).

The portal includes a guidance document on Health App Use Scenarios and HIPAA, which explains when mHealth applications must comply with the HIPAA Rules and if an app developer will be classed as a business associate.

“Building privacy and security protections into technology products enhances their value by providing some assurance to users that the information is secure and will be used and disclosed only as approved or expected,” explained OCR. “Such protections are sometimes required by federal and state laws, including the HIPAA Privacy, Security, and Breach Notification Rules.”

The portal provides access to the Mobile Health Apps Interactive Tool developed by the Federal Trade Commission (FTC) in conjunction with the HHS’ Office of the National Coordinator for Health IT (ONC) and the Food and Drug Administration (FDA). The Tool can be used by the developers of health-related apps to determine what federal rules are likely to apply to their apps. By answering questions about the nature of the apps, developers will discover which federal rules apply and will be directed to resources providing more detailed information about each federal regulation.

The portal also includes information on patient access rights under HIPAA, how they apply to the data collected, stored, processed, or transmitted through mobile health apps, and how the HIPAA Rules apply to application programming interfaces (APIs).

The update to the portal comes a few months after the ONC’s final rule that called for health IT developers to establish a secure, standards-based API that providers could use to support patient access to the data stored in their electronic health records. While it is important for patients to be able to have easy access to their health data to allow them to check for errors, make corrections, and share their health data for research purposes, there is concern that sending data to third-party applications, which may not be covered by HIPAA, is a privacy risk.

OCR has previously confirmed that once healthcare providers have shared a patients’ health data with a third-party app, as directed by the patient, the data will no longer be covered by HIPAA if the app developer is not a business associate of the healthcare provider. Healthcare providers will not be liable for any subsequent use or disclosure of any electronic protected health information shared with the app developer.

A FAQ is also available on the portal that explains how HIPAA applies to Health IT and a guidance document explaining how HIPAA applies to cloud computing to help cloud services providers (CSPs) understand their responsibilities under HIPAA.

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AI Company Exposed 2.5 Million Patient Records Over the Internet

The personal and health information of more than 2.5 million patients has been exposed online, according to technology and security consultant Jeremiah Fowler.

The records were discovered on July 7, 2020 in two folders that were publicly accessible over the Internet and required no passwords to access data. The folders were labeled as “staging data” and had been hosted by an artificial intelligence company called Cense AI, a company that provides SaaS-based intelligent process automation management solutions. The folders were hosted on the same IP address as the Cense website and could be accessed by removing the port from the IP address, which could be done by anyone with an Internet connection. The data could have been viewed, altered, or downloaded during the time it was accessible.

An analysis of the data suggests it was collected from insurance companies and relate to individuals who had been involved in automobile accidents and had been referred for treatment for neck and spinal injuries. The data was quite detailed and included patient names, addresses, dates of birth, policy numbers, claim numbers, diagnosis notes, payment records, date of accident, and other information. The majority of individuals in the data set appeared to come from New York. In total, there were 2,594,261 records exposed across the two folders.

Fowler identified extremely uncommon names and performed a Google search to verify those individuals were real, checking the name, region and demographic data. Fowler was satisfied that this was a real data set and not dummy data. Fowler made contact with Cense via email and while no response was received, the data was no longer accessible on July 8, 2020.

Fowler suspects that the data had been temporarily loaded into a storage repository prior to being loaded into Cense’s management or AI system. There was no way of determining how long the data had been exposed.

Currently, there is no breach notice on the Cense website and the incident has not appeared on the HHS’ Office for Civil Rights website. Fowler said he only accessed a limited amount of data for verification purposes and did not download any patient information; however, during the time the folders were exposed, it is possible that other individuals may have found and downloaded the data.

Data leaks such as this are all too common. Misconfigurations of cloud resources such as S3 buckets and Elasticsearch instances frequently leave sensitive data exposed. Cybercriminals are constantly searching for exposed data and it does not take long for data to be found. Once study conducted by Comparitech showed that it takes just a few hours for exposed Elasticsearch instances to be found.

Cloud services offer many advantages over on-premises solutions, but it is essential for protections to be put in place to secure any cloud data and for policies and procedures to be implemented to allow misconfigurations to be rapidly identified and corrected.

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Healthcare Data Leaks on GitHub: Credentials, Corporate Data and the PHI of 150,000+ Patients Exposed

A new report has revealed the personal and protected health information of patients and other sensitive data are being exposed online without the knowledge of covered entities and business associates through public GitHub repositories.

Jelle Ursem, a security researcher from the Netherlands, discovered at least 9 entities in the United States – including HIPAA-covered entities and business associates – have been leaking sensitive data via GitHub. The 9 leaks – which involve between 150,000 and 200,000 patient records – may just be the tip of the iceberg. The search for exposed data was halted to ensure the entities concerned could be contacted and to produce the report to highlight the risks to the healthcare community.

Even if your organization does not use GitHub, that does not necessarily mean that you will not be affected. The actions of a single employee or third-party contracted developer may have opened the door and allowed unauthorized individuals to gain access to sensitive data.

Exposed PII and PHI in Public GitHub Repositories

Jelle Ursem is an ethical security researcher who has previously identified many data leaks on GitHub, including by Fortune 500 firms, publicly traded companies, and government organizations. Ursem decided to conduct a search to find out if any medical data had been leaked on GitHub. It took just 10 minutes to confirm that it had, but it soon became clear that this was far from an isolated case.

Ursem conducted searches such as “companyname password” and “medicaid password FTP” and discovered several hard-coded usernames and passwords could be found in code uploaded to GitHub. Those usernames and passwords allowed him to login to Microsoft Office 365 and Google G Suite accounts and gain access to a wide range of sensitive information such as user data, contracts, agendas, internal documents, team chats, and the protected health information of patients.

“GitHub search is the most dangerous hacking tool out there,” said Ursem. Why go to the trouble of hacking a company when it is leaking data that can be found with a simple search on GitHub?

Ursem attempted to make contact with the companies concerned to alert them to the exposure of their data and ensure the information was secured, but making contact with those organizations and getting the data secured proved problematic, so Ursem contacted databreaches.net for assistance.

Together, Dissent Doe of DataBreaches.net and Ursem worked together to contact the organizations concerned and get the data secured. In some cases, they succeeded – with considerable effort – but even after several months of attempts at contacting the companies concerned, explaining the severity of the situation, and offering help to address the problems that led to the exposure of data, some of that data is still accessible.

9 Leaks Identified but There are Likely to be Others

The report details 9 leaks that affected U.S. entities – namely Xybion, MedPro Billing, Texas Physician House Calls, VirMedica, MaineCare, Waystar, Shields Health Care Group, AccQData – and one unnamed entity: Unnamed because the data is still accessible.

The most common causes of GitHub data leaks were developers who had embedded hard-coded credentials into code that had been uploaded into public GitHub repositories, the use of public repositories instead of private repositories, and developers who had abandoned repositories when they were no longer required, rather than securely deleting them.

For example, Ursem found that a developer at Xybion – a software, services and consulting company with a presence in workplace health issues – had left code in a public GitHub repository in February 2020. The code included hard-coded credentials for a system user that, in connection with other code, allowed Ursem to access billing back-office systems that contained the PHI of 7,000 patients, together with more than 11,000 insurance claims dating back to October 31, 2018.

It was a similar story with MaineCare – a state- and federally-funded program that provides healthcare coverage to Maine residents. In that case, hard-coded credentials gave Ursem administrative access to the entire website, access to the internal server infrastructure of MaineCare / Molina Health, MaineCare SQL data sources, and the PHI of 75,000 individuals.

The Typhoid Mary of Data Leaks

The report highlights one developer, who has worked with a large number of healthcare organizations, whose GitHub practices have led to the exposure of many credentials and the PHI of an estimated 200,000 clients. That individual has been called the “Typhoid Mary of Data Leaks”.

The developer made many mistakes that allowed client data to be exposed, including leaking the credentials of 5 employers on GitHub and leaving repositories fully accessible after work had been completed. In one case, the actions of that developer had allowed access to the central telephone system of a large entity in debt collection, and in another credentials allowed access to highly sensitive records for people with a history of substance abuse.

While it was not possible to contact that individual directly, it appears that the work of DataBreaches.net and Ursem has gotten the message through to the developer. The repositories have now been removed or made private, but not before the data was cloned by at least one third party.

This was just one example of several outsourced or contracted developers who were being used by HIPAA-covered entities and business associates, whose practices exposed data unbeknownst to the CEs and BAs.

“No matter how big or small you are, there’s a real chance that one of your employees has thrown the front door key under the doormat and has forgotten that the doormat is transparent,” explained Dissent Doe of DataBreaches.net. Regardless of whether your organization uses GitHub, HIPAA Journal believes the report to be essential reading.

The collaborative report from Jelle Ursem and DataBreaches.net explains how the leaks occurred, why they have gone undetected for so long, and details several recommendations on how data breaches on GitHub can be prevented – and detected and addressed quickly in the event that mistakes are made. You can download the full PDF report on this link.

Many thanks to Dissent Doe for notifying HIPAA Journal, to Jelle Ursem for discovering the data leaks, and for the hard work of both parties investigating the leaks, contacting the entities concerned, and highlighting the problem to help HIPAA-covered entities and their business associates take steps to prevent GitHub data breaches moving forward.

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70% of Companies Have Suffered a Public Cloud Data Breach in the Past Year

A recent study conducted by Sophos has revealed 96% of companies are concerned about the state of their public cloud security. There appears to be a valid cause for that concern, as 70% of companies that host data or workloads in the cloud have experienced a breach of their public cloud environment in the past year. The most common attack types were malware (34%), followed by exposed data (29%), ransomware (28%), account compromises (25%), and cryptojacking (17%).

Data for the study came from a survey conducted by Vanson Bourne on 3,521 IT managers in 26 countries including the United States, Canada, France, Germany, India, and the United Kingdom. More than 10 industry sectors were represented.  Respondents used one or more public clouds from Azure, Oracle Cloud, AWS, VMWare Cloud on AWS, Alibaba Cloud, Google Cloud and IBM Cloud. The findings of the survey were published in the Sophos report: The State of Cloud Security 2020.

The biggest areas of concern are data loss, detection and response and multi-cloud management. Companies that use two or more public cloud providers experienced more security incidents than companies with just one cloud service provider. Up to twice as many breaches were experienced by companies using multiple clouds compared to those just using one public cloud provider.

India was the worst affected country with 93% of organizations experiencing a cloud security breach, with Italy the least affected with 45% of organizations experiencing a breach. 68% of organizations in the United States reported experiencing a public cloud data breach in the past 12 months. Sophos suggests the relatively low number of cloud security incidents in the United States is due to US organizations having a much better understanding about where the responsibilities for security lie. 90% of respondents from organizations in the United States understood that while the cloud service provider ensures the platform is secure, security is also the responsibility of each cloud customer. “Cloud security is a shared responsibility and organisations need to carefully manage and monitor cloud environments in order to stay one step ahead of determined attackers,” explained Sophos’ principal research scientist Chester Wisniewski. Organizations in the United States also have greater visibility into their public cloud environment. 85% of respondents from organizations in the US said they were fully aware of all of their cloud assets, which is 17% more than the global average.

The most common cause of public cloud security breaches were system misconfigurations and flaws in firewall applications, which were exploited in 66% of public cloud security incidents and allowed cybercriminals to gain access to sensitive data over the internet. 44% of attacks involved misconfigured web application firewalls and 22% were due to cloud resource misconfigurations. 33% of attacks involved the theft of account credentials. In the United States, 75% of successful breaches were due to misconfigurations and 23% involved the use of stolen credentials.

As companies introduce more cloud services and increase the number of clouds they use, complexity increases, the attack surface grows, and there is greater potential for misconfigurations. It is therefore important for organizations to have the right tools to provide full visibility into their cloud environments and to have staff with expertise in cloud security. Despite the high number of public cloud data breaches, only one in four organizations was concerned about a lack of staff expertise, suggesting many organizations undervalue the skills required to create a good cloud security posture.

Organizations need to continuously monitor their cloud resource configurations to identify misconfigured cloud services. A recent study conducted by Comparitech showed cybercriminals are conducting automatic scans to identify misconfigured cloud services and unsecured resources are rapidly found and attacked. In the Comparitech study, which used an exposed Elasticsearch honeypot, the first attempt to access data came within 9 hours of the resource being created.

Organizations also need to proactively manage cloud access. The Sophos survey revealed 91% of respondents had over-privileged identity and access management roles. By ensuring users only have access to the cloud resources they need, harm can be minimized in the event of a breach.

The increase in remote working due to COVID-19 has also presented new opportunities for cybercriminals. Remote workers should be provided with VPNs to ensure they can access cloud resources securely and access attempts should be monitored.  It is also important to set up multi-factor authentication. Even though multi-factor can prevent data breaches, 98% of respondents had disabled MFA on their cloud provider accounts.

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Webinar Today: A Practitioner’s Guide to Cloud Security and Compliance Processes

Many organizations find it difficult to keep their cloud environments secure and compliant with data protection standards as cloud usage grows. While they had effective security processes for their on-premises infrastructure, they do not always translate to the cloud and fail to mitigate risks associated with decentralized cloud usage.

Ensuring security processes are in place that are effective at identifying cloud misconfigurations that could be exploited by threat actors to gain access to cloud data is essential, but if those processes are not implemented, security becomes an impossible task.

One of the problems is that while standalone configurations may be correct, they can combine with other configurations which can potentially allow unauthorized access to sensitive data. These complex violation chains can be difficult to identify and are a common cause of cloud security breaches. Creating security policies to address risks can cause problems, as security policies can easily have an impact on productivity.

The creation of effective security policies that do not negatively affect the organization is a challenge, but one that can be easily overcome by adopting the right strategies.

The Cloud Security Alliance is running a webinar on Tuesday July 7, 2020 to help organizations scale their cloud usage while also improving their security posture. The CSA will be highlighting proven strategies that also empower teams to take full advantage of the agility benefits of the cloud.

The webinar will cover some of the most common security vulnerabilities and threats that increase security and compliance risks, how it is possible to ensure governance while maintaining the flexibility required for developer productivity, explain key steps that can be taken to improve your security posture, and cover lessons that have been learned from scaling these processes to support a growing cloud environment

The Cloud Security Alliance will be joined by Kolby Allen, Senior Architect at Zipwhip, and Jason Needham, Senior Director of Cloud Security at VMware.

Webinar Details

A Practitioner’s Guide to Cloud Security and Compliance Processes

Tuesday July 7, 2020

10 am PT / 1 pm ET

Click here to register for the webinar

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Windows CMS Hosting Specialist ServerSide Acquired by Liquid Web

The Lansing, MI-based managed hosting and managed application service provider, Liquid Web LLC, has announced it has acquired the leading Microsoft Windows CMS hosting provider ServerSide for an undisclosed sum.

In 2019, Liquid Web launched its managed private cloud powered by VMware and NetApp. The new offering provided small- and medium-sized businesses with the features and functions of a managed private cloud that are usually only available to enterprises.

The acquisition of ServerSide will expand Liquid Web’s SMB offerings further, adding proven experience in hosting leading Microsoft Content Management solutions to Liquid Web’s portfolio, accelerating the company’s move into the Progress Sitefinity, Kentico, and Sitecore hosting market. ServerSide joins Nexcess, iThemes, and InterWorx in the Liquid Web Group of companies, which together serve more than 45,000 customers in 150 countries, managing more than 1.5 million sites.

ServerSide founder and CEO, Steve Oren, has joined the Liquid Web team and is spearheading Liquid Web’s drive to migrate customers to the Liquid Web platform.

“The acquisition of ServerSide supports Liquid Web’s mission to power leading content management platforms. With ServerSide, we are excited about building upon the relationships ServerSide had with Sitefinity, Kentico, and Sitecore and their ecosystem partners”, said Liquid Web CEO, Joe Oesterling.

“We are excited about joining the Liquid Web team. We’ve successfully migrated our customers to Liquid Web’s platform, and we are working hand and hand to deploy our VMware architecture more broadly within Liquid Web”, said Oren. “We look forward to using Liquid Web’s scale to be a bigger player in the leading Windows CMS ecosystems.”

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CloudHealth by VMware Platform Added to Microsoft Azure Marketplace

VMware has announced it has deepened its collaboration with Microsoft and has now added the CloudHealth multi-cloud management platform to the Microsoft Azure Marketplace.

The CloudHealth platform helps organizations quantify, understand, optimize and automate cloud infrastructure and provides full visibility into an organization’s entire multi-cloud or hybrid cloud environment. The platform unites discreet data from essential cloud tools and services to give a holistic perspective of the cloud ecosystem. The increased visibility helps with organizational governance, shows cloud usage, provides recommendations for optimization to improve resource utilization and greatly reduce wastage, resulting in significant cost savings.

“Having CloudHealth on the Azure Marketplace both strengthens and deepens our collaboration with Microsoft,” said Tom Axbey, GM, Cloud Management at VMware. “Moreover, it enables us to deliver on the promise of helping customers innovate at cloud speed, which has always been core to our DNA and serves as the foundation for all new CloudHealth features and enhancements.”

The CloudHealth platform can be used by enterprises to improve governance and control of their cloud resources, regardless of their progress on their cloud journey. Whether organizations are just developing a cloud strategy or have an advanced Cloud Center of Excellence, the CloudHealth platform will help drive accountability, improve cross-organizational collaboration, and help reduce cloud bills.

The Azure Marketplace includes a range of software solutions that have been optimized and certified for use on Microsoft Azure and makes those solutions more accessible to cloud users. Azure customers will now have easy access to the CloudHealth platform and can use it to optimize their cloud resources and enable secure and efficient cloud operations across their multi-cloud and hybrid environments.

“Microsoft Azure Marketplace lets customers worldwide discover, try, and deploy software solutions that are certified and optimized to run on Azure. Azure Marketplace helps solutions like CloudHealth by VMware reach more customers and markets,” said Sajan Parihar, Senior Director, Microsoft Azure Platform at Microsoft Corp.

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CloudHealth by VMware Platform Added to Microsoft Azure Marketplace

VMware has announced it has deepened its collaboration with Microsoft and has now added the CloudHealth multi-cloud management platform to the Microsoft Azure Marketplace.

The CloudHealth platform helps organizations quantify, understand, optimize and automate cloud infrastructure and provides full visibility into an organization’s entire multi-cloud or hybrid cloud environment. The platform unites discreet data from essential cloud tools and services to give a holistic perspective of the cloud ecosystem. The increased visibility helps with organizational governance, shows cloud usage, provides recommendations for optimization to improve resource utilization and greatly reduce wastage, resulting in significant cost savings.

“Having CloudHealth on the Azure Marketplace both strengthens and deepens our collaboration with Microsoft,” said Tom Axbey, GM, Cloud Management at VMware. “Moreover, it enables us to deliver on the promise of helping customers innovate at cloud speed, which has always been core to our DNA and serves as the foundation for all new CloudHealth features and enhancements.”

The CloudHealth platform can be used by enterprises to improve governance and control of their cloud resources, regardless of their progress on their cloud journey. Whether organizations are just developing a cloud strategy or have an advanced Cloud Center of Excellence, the CloudHealth platform will help drive accountability, improve cross-organizational collaboration, and help reduce cloud bills.

The Azure Marketplace includes a range of software solutions that have been optimized and certified for use on Microsoft Azure and makes those solutions more accessible to cloud users. Azure customers will now have easy access to the CloudHealth platform and can use it to optimize their cloud resources and enable secure and efficient cloud operations across their multi-cloud and hybrid environments.

“Microsoft Azure Marketplace lets customers worldwide discover, try, and deploy software solutions that are certified and optimized to run on Azure. Azure Marketplace helps solutions like CloudHealth by VMware reach more customers and markets,” said Sajan Parihar, Senior Director, Microsoft Azure Platform at Microsoft Corp.

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Lack of Visibility and Poor Access Management are Major Contributors to Cloud Data Breaches

More companies are now completing their digital transformations and are taking advantage of the flexibility, scalability, and cost savings provided by public cloud environments, but securing public clouds can be a major challenge.

One of the main factors that has stopped companies from taking advantage of the public cloud has been security. Security teams often feel protecting an on-premise data center is much easier than protecting data in public clouds, although many are now being won over and understand that public clouds can be protected just as easily.

Public cloud providers now offer a range of security tools that can help companies secure their cloud environments. While these offerings can certainly make cloud security more straightforward, organizations must still ensure that their cloud services are configured correctly, identities and access rights are correctly managed, and they have full visibility into all of their cloud workloads.

Cloud security vendor Ermetic recently commissioned IDC to conduct a survey of CISOs to explore the challenges associated with cloud security and see how well organizations were faring at securing their public clouds. More than 300 CISOs and IT decision makers took part in the survey.

79% of respondents said they had experienced a cloud data breach in the past 18 months, and 43% of respondents said they had experienced 10 or more cloud data breaches during that time, strongly suggesting they are finding securing their public cloud environments something of a challenge.

When asked about the biggest security risks, 67% said they were concerned about security misconfigurations, 64% said a lack of visibility into access settings and activities was a key factor contributing to cloud data breaches, and 61% said access management and permission errors were a major breach risk.

The complexity of public cloud environments makes security challenging. The flexibility of the cloud means it is easy to quickly provision more resources on demand, but what often happens is cloud deployments become a maze of interconnected machines, users, applications, services, and containers. If organizations do not have complete visibility into their public cloud environments, it is difficult to ensure appropriate permissions are and the principle of least privilege is correctly applied.

Setting and managing access policies is a major challenge. Access policies need to be adjusted frequently, yet 80% of respondents said they could not effectively manage excessive data access for IaaS and PaaS. Excessive permissions are frequently abused by cybercriminals, who use them for a range of malicious activities such as data theft, data deletion, and delivering malware or ransomware.

“Some of the most high-profile cybersecurity incidents in recent years were the direct result of customers failing to properly configure their cloud environments, or granting excessive or inappropriate access permissions to cloud services, rather than a failure of the cloud provider in fulfilling its responsibilities,” explained Ermetic.

When asked about the main cloud security priorities, 78% of respondents said compliance monitoring, 75% said authorization and permission management, and 73% said security configuration management (73%). One of the biggest concerns was detection of excessive permissions, which was rated important or very important by 71% of respondents; however, only 20% of respondents said they were able to identify situations when employees had been given excessive permissions.

“An overworked security or IT admin may fail to identify and remove such permissions and create a significant vulnerability that may only be detected after the fact. Furthermore, early detection doesn’t necessarily guarantee prevention; more than 13% of respondents that detected excessive permissions reported that they were unable to mitigate the risks before data was exposed,” explained Ermetic in the report.

The survey confirmed that excessive permissions are a major problem in healthcare. 31.25% of healthcare organizations said they had identified a situation where employees had been given excessive permissions.

There have been many cases where security misconfigurations have lead to the exposure of sensitive data, with misconfigured Elasticsearch instances and AWS S3 buckets a common reason for data breaches, but it is also important to ensure that identities and permissions are properly managed.

Ensuring users, applications, and services can access only the cloud data and cloud resources that are necessary for their legitimate purposes was cited as the biggest cloud data protection challenge by respondents to the survey.

“Even though most of the companies surveyed are already using IAM, data loss prevention, data classification and privileged account management products, more than half claimed these were not adequate for protecting cloud environments,” said Ermetic CEO Shai Morag. “In fact, two thirds cited cloud native capabilities for authorization and permission management, and security configuration as either a high or an essential priority.”

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