Healthcare Data Security

Ponemon Study Reveals Impact of Data Breaches on Organizations’ Reputation

Posted by HIPAA Journal

Organizations that experience data breaches can expect many negative repercussions such as loss of reputation, loss of customers and fall of share value. The impact of a data breach on a company’s reputation and share value has recently been studied by the Ponemon Institute.

The Centrify-sponsored survey was conducted on IT operations and information security professionals, senior level marketers, communications professionals and consumers. 31% of the 446 IT practitioners said they had experienced a data breach of more than 1,000 sensitive records in the past two years, while 62% of the 549 consumers surveyed said they had been notified by companies or government agencies that their data had been exposed as a result of a data breach in the past 24 months.

Data breaches are to be expected; however, the study suggests that the C-Suite and boards of directors do not fully appreciate the negative impact data breaches can have on companies’ reputations. The effect can be considerable. The Ponemon Institute tracked the share value of 113 publicly traded companies for 30 days prior to a data breach and for 90 days following the breach. On average, share value dropped by 5% following the disclosure of a data breach.

However, it is possible to stop a decline in share value following a breach, provided companies are able to respond quickly. Companies that had self-declared their security posture to be superior prior to a breach, and were able to respond quickly the security incident, regained stock value after an average of 7 days.

Companies that had a poor security posture and failed to respond quickly saw a stock price decline that lasted an average of 90 days. Organizations with a poor security posture and slow response were also more likely to lose customers as a result of the breach.

The potential for loss of customers is considerable. 31% of consumers said they discontinued their relationships with the breached entity following a data breach, while 65% said they lost trust in the organization after being affected by one or more breaches. The average losses reported by organizations with a low customer loss rate (less than 2%) was $2.67 million. A customer loss rate of 5% resulted in average revenue losses of £3.94 million.

The study also revealed that healthcare organizations are trusted the most when it comes to keeping sensitive information secure. 80% of consumers said they trusted their healthcare providers to protect their sensitive information with the industry ranking highest in terms of consumer trust, even though healthcare organizations experience 34% of all data breaches.

Aside from banking institutions, which were trusted by 77% of consumers, trust in financial institutions was far lower. Only 26% of consumers trusted their credit card company to protect data, even though credit and financial institutions account for just 4.8% of data breaches.

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Microsoft Patches Two Critical, Actively Exploited Vulnerabilities

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Microsoft released a slew of updates this Patch Tuesday, including patches for two critical vulnerabilities that are being actively exploited in the wild. In total, 95 vulnerabilities were addressed yesterday, eighteen of which have been rated critical and 76 as important.

The two actively exploited vulnerabilities are of most concern, in fact one is so serious that Microsoft took the decision to issue a patch for Windows XP, even though extended support for the outdated operating system ended in April 2014. As with the emergency patch issued last month shortly after the WannaCry ransomware attacks, the vulnerability was considered so severe it warranted a patch.

Adrienne Hall, general manager of Microsoft’s Cyber Defense Operations Center, explained the decision to issue a patch for Windows XP saying, “Due to the elevated risk for destructive cyberattacks at this time, we made the decision to take this action because applying these updates provides further protection against potential attacks with characteristics similar to WannaCrypt.”

The flaw – CVE-2017-8543 – exists in the Windows Server Message Block (SMB) service. It was also a SMB service vulnerability that was exploited in the recent WannaCry ransomware attacks that spread to more than 300,000 devices in 150 countries on May 12.

CVE-2017-8543 could similarly be exploited by cybercriminals to install malware with wormlike capabilities, allowing infections to spread rapidly across a network. The flaw exists in most Windows versions, including Windows XP, Windows 7, Windows 8.1 and Windows 10, as well as Microsoft Server 2003, 2008, 2012 and 2016. Microsoft has also issued a patch for Microsoft Server 2003.

As with the WannaCry attacks, the vulnerability could be exploited without any user interaction required. A remote unauthenticated user could trigger the vulnerability via a SMB connection. If exploited, the attacker could take control of the infected device. Since this vulnerability is being actively exploited in the wild, it is essential that the patch is applied promptly.

The other critical – and actively exploited – flaw is CVE-2017-8464: A LNK remote code execution vulnerability. This vulnerability can be exploited using a specially crafted shortcut file.

While not believed to be exploited at present, a memory corruption vulnerability in Outlook (CVE-2017-8507) is of particular concern. An attacker could exploit the vulnerability simply by sending a specially crafted message to an Outlook user. The vulnerability would be triggered when the user views the message, giving the attacker full control of their computer. No attachment would need to be opened in order for the vulnerability to be exploited.

CVE-2017-8527 could also potentially be exploited with little user interaction required. A user would only be required to visit a website with specially crafted fonts.

Patches have also been issued for remote code execution vulnerabilities in Microsoft Edge and Internet Explorer. These flaws are not being actively exploited at present, although the flaws have been publicly disclosed so it is only a matter of time before attacks occur.

In addition to the patches released by Microsoft, Adobe has similarly issued a round of updates. In total, 21 vulnerabilities have been addressed, 15 of which have been rated critical. Four products have been updated – Flash, Shockwave, Captivate and Adobe Digital Editions.

While Microsoft has now issued patches for unsupported operating systems on two occasions in the past 30 days, this should not be taken as a sign that flaws will continue to be addressed. Any organization still using unsupported operating systems should ensure those systems are upgraded to supported Windows versions as soon as possible. Further flaws are likely to be discovered, but Microsoft is unlikely to continue to release patches.

Eric Doerr, general manager of the Microsoft Security Response Center said, “Our decision today to release these security updates for platforms not in extended support should not be viewed as a departure from our standard servicing policies.”

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Data Breach Risk From Out of Date Operating Systems and Web Browsers Quantified

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The recent WannaCry ransomware attacks have highlighted the risks from failing to apply patches and update software promptly; however, a new study conducted by BitSight sought to quantify the level of risk that tardy updates introduce.

For the study, BitSight analyzed the correlation between data breaches and the continued to use old operating systems such as Windows 7, Windows Vista and Windows XP and old versions of web browsers.

Operating systems and browsers used by approximately 35,000 companies from 20 industries were assessed as part of the study. BitSight checked Apple OS and Microsoft Windows operating systems and Chrome, Internet Explorer, Safari, and Firefox web browsers.

2,000 of the companies studied (6%) had out of date operating systems on more than half of their computers. BitSight said 8,500 companies were discovered to be using out of date web browsers.

BitSight used its risk platform to study computer compromises and identified operating system and browser versions at those companies. BitSight was able to determine that organizations running out of date operating systems were three times more likely to suffer a data breach than those running newer operating systems. Organizations with out of date web browsers were two times more likely to experience a data breach.

The analysis did not confirm whether the data breaches occurred as a direct result of running outdated browsers and operating systems. The outdated software was only an indicator in the risk profile of those companies.

BitSight research scientist Dan Dahlberg said it is common knowledge that using outdated software and operating systems increases risk, but the big surprise from the study was the number of companies that were taking such big risks. For instance, prior to the WannaCry attacks, 20% of computers analyzed during the study were still running Windows XP.

The healthcare industry fared better than other industry sectors with 85% of organizations using up to date browsers and operating systems. However, 15% were taking risks by failing to update their browsers promptly and upgrade their operating systems.

Unsurprisingly, government organizations were some of the worst offenders, with more than a quarter of computers running on old operating systems and using out-of-date browsers.

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WannaCry Ransomware Continues to Cause Problems for U.S. Hospitals

Posted by HIPAA Journal

The Department of Health and Human Services (HHS) has issued a cyber notice to alert healthcare organizations of the continuing problems caused by the WannaCry ransomware attacks on May 12, 2017.

Following the attacks, the United States Department of Homeland Security (DHS) issued a statement saying the U.S. had suffered ‘limited attacks’ with only a small number of companies affected. However, the problems caused by those attacks have been considerable. The HHS says two large, multi-state hospital systems are still facing significant challenges to operations as a result of the May 12 attacks.

The Windows SMB vulnerability (MS17-010) exploited by the threat actors was addressed by Microsoft in a March 14, 2017 update, with an emergency patch released for unsupported Windows versions shortly after the attacks took place. The patches will prevent the MS17-010 vulnerability from being exploited and thus prevent WannaCry from being downloaded.

The encryption routine used by the WannaCry malware was deactivated quickly following the discovery of a kill switch. While the encryption process has been blocked, that does not stop infection. Vulnerable devices could still be infected if the patch has not been applied.

Further, if a device has already been infected prior to the patch being applied, the malware will still be present on the infected system. The HHS likens the patch to quarantining a patient. While that action will prevent the spread of the infection to other individuals, simply placing a patient in quarantine will not remove the infection in that patient.

While the ransomware component of the malware is not active, the presence of the malware on computer systems will have some effects. Those are dependent on the Windows version installed.

If the malware is present, it will be capable of scanning the network for other vulnerable devices and spreading to those devices.

The HHS says that if a device has been infected with WannaCry, reimaging and applying the patch will remove the virus and prevent it from being installed again. However, HHS explains that while the patch addresses a vulnerability in the Windows Server Message Block version 1 (SMBv1) protocol, that may not be the only vulnerability that is exploited to download WannaCry. Even patched systems may still be infected if the threat actors exploit a different vulnerability to introduce the malware. Patches must therefore be applied promptly after they have been issued to prevent future WannaCry – and other – malware attacks.

If you have been affected by WannaCry, the HHS recommends contacting your FBI Field Office Cyber Task Force or the US Secret Service Electronic Crimes Task Force to report the incident and request assistance.

The HHS also recommends contacting the FDA’s 24/7 emergency line at 1-866-300-4374 if a suspected cyberattack affects medical devices.

HHS has issued the following advice to healthcare organizations on mitigating the risk of WannaCry infection:

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Final Healthcare Cybersecurity Task Force Report Details 6 Imperatives to Improve Security

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The Health Care Industry Cybersecurity (HCIC) Task Force was formed by Congress, as required by the Cybersecurity Act of 2015. The purpose of the HCIC Task Force is to address the cybersecurity challenges faced by the healthcare industry and help the healthcare industry improve cybersecurity defenses and prevent security breaches.

The Cybersecurity Information Sharing Act of 2016 required the Health Care Industry Cybersecurity Task Force to issue a report detailing improvements that can be made to improve cybersecurity in the healthcare industry. The final version of the report was released on Friday June 2.

The HCIC Task Force explains in the report that the high number of hacking incidents, ransomware attacks and data breaches reported to the Department of Health and Human Services’ Office for Civil Rights in recent years clearly show the healthcare industry is struggling to secure networks and data.

The HCIC Task Force says many healthcare organizations believe cybersecurity vulnerability is low. Recent breaches and ransomware attacks have shown that assumption is false. While recent data breaches have highlighted the very real risk of security incidents and data breaches, addressing vulnerabilities and improving security is a major challenge.

Most healthcare organizations have extremely limited budgets and lack highly skilled cybersecurity personnel.  Infrastructures make it difficult to identity and track threats and a lack of skilled staff means many healthcare organizations cannot easily translate threat data into actionable information. Even if threat information can be turned into actionable information, many organizations do not have the capability to act on that information.

However, these cybersecurity threats place the safety of patients at risk. Recent ransomware attacks have shown that access to patient data can be blocked, while vulnerabilities in medical devices could be exploited to cause patients serious harm. The report says, “health care cybersecurity is a key public health concern that needs immediate and aggressive attention.”

Prior to writing the report, the HCIC Task Force consulted experts from other critical infrastructure sectors and received briefings on strategies and safeguards that could be implemented to address key cybersecurity threats. The Task Force also spoke with stakeholders on the challenges faced by the healthcare industry.

One of the key problems identified in those discussions is severe budgetary constraints. That means healthcare organizations are faced with a choice of purchasing cybersecurity technologies to secure networks and data or buying new, much needed medical equipment or paying staff costs.

However, if vulnerabilities are not addressed and action not taken to improve security the safety of patients will be placed at risk.

In a recent blog post, Steve Curren, Director of the Division of Resilience in ASPR’s Office of Emergency Management, said “The Office of the Assistant Secretary for Preparedness and Response understands that healthcare facilities are facing these challenges right now and we have developed a collection of peer-reviewed resources on cybersecurity to help healthcare industry stakeholders better protect against, mitigate, respond to, and recover from cyber threats, in order to better defend patient safety and operational continuity.“

Task Force Co-Chairs Emery Csulak and Theresa Meadows explained that “While much of what we recommend will require hard work, difficult decisions, and commitment of resources, we will be encouraged and unified by our shared values as health care industry professionals and our commitment to providing safe, high quality care.”

In the report, the HCIC Task Force made several recommendations to improve healthcare cybersecurity and detailed six high-level imperatives:

 

The authors say, “The successful implementation of these recommendations will require adequate resources and coordination across the public and private sector. Once implemented, the recommendations will increase security for the health care industry’s organizations, networks, and associated medical devices.”

The report has changed little from the pre-release version released early last month. The final version of the 88-page report can be viewed on this link.

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Recent Employee Snooping Incidents Highlight Need for Access Controls and Alerts

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Ransomware, malware and unaddressed software vulnerabilities threaten the confidentiality, integrity and availability of PHI, although healthcare organizations should take steps to deal with the threat from within. This year has seen numerous cases of employees snooping and accessing medical records without authorization.

The HIPAA Security Rule 45 CFR §164.312(b) requires covered entities to “Implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information,” while 45 CFR §164.308(a)(1)(ii)(D) requires covered entities to “Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.”

Logs create an audit trail that can be followed in the event of a data breach or privacy incident. Those logs can be checked to discover which records have been accessed without authorization.

If those logs are monitored continuously, privacy breaches can be identified quickly and action taken to limit harm. However, recent incidents have shown that while access logs are kept, they are not being regularly checked. There have been numerous recent examples of employees who have improperly accessed patients’ medical records over a period of several years.

A few days ago, Beacon Health announced an employee had been discovered to have improperly accessed the medical records of 1,200 patients without any legitimate work reason for doing so. That employee had been snooping on medical records for three years.

In March, Chadron Community Hospital and Health Services in Nevada discovered an employee had accessed the medical records of 700 patients over a period of five years and St. Charles Health System in central Oregon discovered an employee had accessed medical records without authorization over a 27 month period.

Also in March, Trios Health discovered an employee had improperly accessed the medical records of 570 patients. The improper access occurred over a period of 41 months.

Rapid detection of internal privacy breaches is essential. Even when snooping is discovered relatively quickly, the privacy of many thousands of patients may have already been violated. In January, Covenant HealthCare notified 6,197 patients of a privacy breach after an employee was discovered to have improperly accessed medical records over a period of 9 months, while a Berkeley Medical Center employee accessed the ePHI of 7,400 patients over a period of 10 months.

Healthcare organizations may not feel it is appropriate to restrict access to patients’ PHI, but a system can be implemented that will alert staff to improper access promptly. Software solutions can be used to detect improper access and alert appropriate members of staff in near real-time. If such systems are not implemented, regular audits of ePHI access logs should be conducted. Regular checks of ePHI access logs will allow organizations to prevent large-scale breaches, reduce legal liability and reduce the harm caused by rogue employees.

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Seton Healthcare Family Hospitals Targeted by Cybercriminals

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Ascension Health, which runs the Seton Healthcare Family hospital network in Austin, TX, announced earlier this week that a computer virus had been discovered on its computer network. The hospital network was alerted to a potential cyberattack on Sunday when ‘suspicious activity’ was detected on the network.

In response to the suspected cyberattack, Seton Healthcare shut down around 3,600 devices as a precautionary measure while the incident was investigated. The suspicious activity was attributed to a virus, although no details have been released on the nature of the malware.

IT teams worked quickly to remove the virus and secure its network. The computer systems used by Dell Seton Medical Center and Dell Children’s Medical Center were quickly restored, although Seton Medical Center Williamson and Seton Medical Center Hays continued to be impacted by the incident until Wednesday, May 31. The Seton Smithville Regional Clinic and Seton Shoal Creek facility were unaffected.

The fast response by Seton Healthcare reduced the impact of the cyberattack. Staff had been drilled to expect incidents such as this and policies and procedures could be quickly implemented in case of malware, ransomware or hacking incidents. As this incident shows, healthcare organizations need to be prepared for security incidents and have the capability to respond rapidly.

A statement about the incident was issued earlier this week by Ascension Health confirming there were “no patient safety issues” and “no devices have been reported as encrypted by ransomware.” Systems were shut down as a safety precaution, with staff members moving to paper records while systems were down and the virus was removed. Ascension Health said “The attempt was unsuccessful, so no data was encrypted or lost.”

Out of an abundance of caution, emergency medical services were instructed to redirect some patients to other hospitals during the seven hours that the systems were down on Sunday night out of safety concerns. Additional members of staff were also called in to ensure patient safety was not affected.

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OCR Reminds Covered Entities of Security Incident Definition and Notification Requirements

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The ransomware attacks and high number of healthcare IT security incidents last month has prompted the Department of Health and Human Services’ Office for Civil Rights to issue a reminder to covered entities about HIPAA Rules covering security breaches.

In its May 2017 Cyber Newsletter, OCR explains what constitutes a HIPAA security incident, preparing for such an incident and how to respond when perimeters are breached.

HIPAA requires all covered entities to implement technical controls to safeguard the confidentiality, integrity and availability of electronic protected health information (ePHI). However, even when covered entities have sophisticated, layered cybersecurity defenses and are fully compliant with HIPAA Security Rule requirements, cyber-incidents may still occur. Cybersecurity defenses are unlikely to be 100% effective, 100% of the time.

Prior to the publication of OCR guidance on ransomware attacks last year, there was some confusion about what constituted a security incident and reportable HIPAA breach. Many healthcare organizations had experienced ransomware attacks, yet failed to report those incidents to OCR or notify patients that their ePHI may have been accessed.

OCR has reminded covered entities in its newsletter of the HIPAA definition of a security incident. The HIPAA Security Rule (45 CFR 164.304) describes a security incident as “an attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.”

OCR has taken the opportunity to remind covered entities that they need to prepare for those incidents. Policies and procedures should be developed that kick into action immediately following the discovery of a security incident or data breach.

If covered entities react quickly to security incidents and data breaches it is possible to minimize the impact and reduce legal liability and operational and reputational harm. Contingency plans should exist for a range of security incidents and emergency situations. OCR says “policies, procedures, and plans should provide a roadmap for implementing the entity’s incident response capabilities.”

When a breach occurs, the HIPAA Breach Notification Rule requirements must be followed. The HIPAA Breach Notification Rule (45 CFR 164.402) requires OCR to be notified of a breach and notifications to be sent to patients in the event of “an impermissible acquisition, access, use, or disclosure under the HIPAA Privacy Rule that compromises the security or privacy of the protected health information.”

Each month, Databreaches.net tracks healthcare data breach incidents, with the Protenus Breach Barometer report showing the time taken for covered entities to report their breaches to OCR. The past few reports show some improvement, with covered entities reporting their breaches more promptly. That said, there have been several cases where data breach notifications have been submitted late and patients have had their notification letters delayed.

OCR reminds covered entities that the HIPAA deadline for reporting security incidents and sending notifications to patients/health plan members is 60 days* from the discovery of the breach.

This is a deadline, not a recommendation. Many covered entities delay issuing notifications until day 59. OCR points out that the HIPAA Breach Notification Rule requires notifications to be issued “without reasonable delay.”

If you missed the email newsletter, you can download a copy on this link: https://www.hhs.gov/sites/default/files/may-2017-ocr-cyber-newsletter.pdf

*Breaches impacting fewer than 500 individuals can be reported to OCR annually, with the deadline 60 days after the end of the year when the breach was discovered. Breaches impacting 500 or more individuals must be reported to OCR within 60 days of the discovery of the breach. Individuals must be notified of a breach of PHI or ePHI within 60 days of the discovery of the breach, regardless of how many individuals have been impacted by the breach.

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Study Uncovers More Than 8,000 Security Flaws in Pacemakers from Four Major Manufacturers

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Over the past 12 months, security vulnerabilities in implantable medical devices have attracted considerable attention due to the potential threat to patient safety.

Last year, MedSec conducted an analysis of pacemaker systems which revealed security vulnerabilities in the Merlin@home transmitter and the associated implantable cardiac devices manufactured by St. Jude Medical. Those vulnerabilities could potentially be exploited to cause device batteries to drain prematurely and the devices to malfunction.

A recent study of the pacemaker ecosystem has uncovered a plethora of security flaws in devices made by other major manufacturers. Those flaws could potentially be exploited to gain access to sensitive data and cause devices to malfunction.

Billy Rios and Jonathan Butts, PhD., of security research firm WhiteScope has recently published a white paper detailing the findings of the study.

The pair conducted an analysis of seven cardiac devices from four major device manufacturers. The researchers evaluated home monitoring devices, implantable cardiac devices and physician programmers, with most effort concentrated on four programmers with RF capabilities.

All of the devices under study were obtained from auction sites such as eBay, even though the devices are supposed to be controlled and returned to the manufacturer or hospital when no longer required. The report explained that all of the manufacturers under test had home monitoring equipment listed for sale on public auction sites. The researchers found security flaws existed on all pacemaker systems under study.

The filesystems used by the pacemaker systems were unencrypted, with data stored on removable media. Some of the devices stored highly sensitive data such as medical histories and Social Security numbers, yet the data were not encrypted to prevent unauthorized access.

The pacemaker systems allowed physicians to reprogram the devices without authentication and pacemaker programmers did not authenticate with pacemaker devices. The researchers explained that any pacemaker programmer could be used to reprogram any pacemaker from the same manufacturer.

The software used by the pacemaker systems was discovered to contain more than 8,000 known vulnerabilities in third-party libraries across all the devices. One vendor had 3,715 vulnerabilities in its third-party libraries. The researchers said it was clear there was “an industry wide issue associated with software security updates.”

The study also revealed firmware used by the devices was not cryptographically signed, therefore it would be possible to replace firmware with a custom firmware.

Rios and Butt said, “The findings are relatively consistent across the different vendors,” and recommended “vendors evaluate their respective implementations and validate that effective security controls are in place to protect against identified deficiencies that may lead to potential system compromise.”

The researchers did not disclose the specifics of the vulnerabilities, although they were passed to the Department of Homeland Security’s ICS-CERT, while a report has been submitted to “the appropriate agency” about the discovery of Social Security numbers and other sensitive data from a patient of a prominent east coast hospital.

The researchers now plan to evaluate the home monitoring systems associated with implantable cardiac devices.

The report – Security Evaluation of the Implantable Cardiac Device Ecosystem Architecture and Implementation Interdependencies – can viewed on this link.

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