By Ellen Messmer
Healthcare organizations feel under increasing attack from the Internet,
while security incidents involving insiders and disappearing laptops
with sensitive data are piling up. On top of that, there's now the
prospect of a surprise audit from the federal government agency in
charge of overseeing the Health Insurance Portability and Accountability
Act security and privacy rules.
Healthcare organizations are stepping up efforts to protect electronic
patient information as they witness increased attacks against hospital
networks, mindful how a data breach could hurt patients and their own
There is definitely an uptick in attacks, says Dr. John Halamka, CIO at
both Beth Israel Deaconess Medical Center and Harvard Medical School in
the Boston area. Privacy is the foundation of everything we do. We dont
want to be the TJX of healthcare. TJX is the Framingham, Mass-based
retailer which last year disclosed a massive data breach involving
Dr. Halamka, who this week announced a project in electronic health
records as an online service to the 300 doctors in the Beth Israel
Deaconess Physicians Organization, acknowledges computers in healthcare
are sometimes compromised as spam relays or to host unauthorized content
such as porn.
It gives attackers a means to distribute it, says Halamka. While he has
seen no evidence of attackers targeting healthcare networks to steal
patient data for financial gain, other security experts say that
dangerous trend is well underway.
Healthcare organizations store a lot of valuable personal, identifiable
information such as Social Security numbers, names, addresses, age, in
addition to banking and credit-card information, says Don Jackson,
researcher at Atlanta-based security services firm SecureWorks.
SecureWorks has recorded an 85% increase in the number of attempted
attacks directed toward its healthcare clientele by Internet hackers,
with these attempts jumping from 11,146 per healthcare client per day in
the first half of 2007 to an average of 20,630 per day in the last half
of last year through January of this year.
SecureWorks believes that some of the most sought-after information is
from patients who are members of preferred medical network plans, which
hackers turn around and sell as credentials to criminals specializing in
Credentials information is usually stolen via targeted cyber attacks,
says Jackson, adding hes seen several cases where health insurance
credentials were sold to criminals in the counterfeit document racket,
especially in Central and South America.
Insider attacks, too, are also a worry.
Tenet Healthcare, which owns more than 50 hospitals in a dozen states,
last month disclosed a security breach involving a former billing center
employee in Texas who pled guilty to stealing patient personal
information. He got nine months in jail.
And in an identity fraud case in Sarasota, Fla. last month, an office
cleaner who gained access to the patient files of an anesthesiologist
who rented an office at HealthSouth Ridgelake Hospital pled guilty to
fraud for ordering credit cards on the Internet with stolen patient
personal information. He got two years jail time.
Lost and stolen laptops have also been a problem, with disclosure of
missing personal information related to patients or employees at Duluth,
Minn.-based Memorial Blood Center; Mountain View, Calif.-based Health
Net; Sutter Lakeside Hospital at Lakeside, Calif.; and the West Penn
Allegheny Health System revealed just within the last three months.
The HIPAA surprise audit
Besides the loss of confidence such security incidents provoke, the
specter of government regulatory probes is looming related to the
federal security and privacy rules in HIPAA.
The U.S. Department of Health and Human Services (HHS), which oversees
HIPAA compliance, has contracted with the firm PricewaterhouseCoopers
(PWC) to conduct surprise audits of hospitals this year, says Gartner
analyst Barry Runyon.
Its complaint-driven, says Runyon, noting that Tony Trenkle, director of
the Centers for Medicare & Medicaid Services at HHS, last month publicly
said the first 10 or so reviews will be at hospitals where CMS received
complaints about security.
In visiting the healthcare organization, the government regulatory probe
will focus on security risks associated with remote access to data and
portable storage concerns, with security managers expected to answer a
lot of questions.
CMS plans to publish the results of these audits on its Web site but not
the organizations name, unless it uncovers major lapses, which could
result in fines or other penalties as defined under the HIPAA
guidelines. Last month, Atlantas Piedmont Hospital was revealed by HHS
to be the first unannounced HIPAA security audit.
Healthcare, heal thyself
Information-technology managers indicated theyre taking proactive steps
to secure external network access while also ensuring that authorized
network users are limited to seeing only what they rightfully should.
At Mount Sinai Medical Center in New York City, the policy there is very
strict about employees even looking at patient records without reason.
Its the curiosity factor, says Jack Nelson, CIO at Mt. Sinai, who notes
that employees are told when hired they can be fired for online peeking
-- and some have been.
Its one strike and youre out -- and thats [for] clinicians as well, says
Nelson, noting that the hospitals systems are generally role-based and
keep track of every single access to a record.
Nelson says his biggest concern is not hackers trying to break in but
sensitive data flying out over the network, including Mt. Sinais
voluminous clinical-lab test documentation. So Mt. Sinai recently
installed Symantec data-loss prevention software on client computers to
monitor outbound traffic.
HIPAA isnt the only set of security and privacy regulations that Mt.
Sinai cares about. When you have a data loss of about the magnitude of
10 patient records, you have to report that to the New York State Dept.
of Health, says Nelson. Thats a serious violation.
Like Mt. Sinai Medical Center, Miami-based health benefit company AvMed
Health Plans is also making use of data-loss prevention monitoring
equipment to make sure sensitive data related to health claims is
Some e-mail communications with physicians offices and hospitals must be
encrypted under the HIPAA guidelines, notes Charles Hibnick, chief
systems security architect at AvMed. The Palisade Systems PacketSure
monitoring equipment deployed since last October provides a way to
determine that policy is being followed since it flags errors that might
occasionally occur, such as someone forgetting to encrypt an e-mails
People sometimes say thank you when we catch this, says Hibnick. The
monitoring is increasingly important since about 80% of health claims at
AvMed are electronic, rather than predominantly fax, as they were just
five years ago.
The prospect of an unannounced HIPAA audit by the government is an event
that could shake anyone up, but in the final analysis, the federal
probes are probably good for the healthcare industry, says Mark Jacobs,
director of technology services in the data-center operations at
Pennsylvania-based WellSpan Health.
HIPAA did help in some regard, getting the health information community
to do audit, logging and secure messaging and encryption," Jacobs notes,
adding HIPAA has propelled his healthcare organization into new
practices, such as adopting a security governance framework, single
sign-on and password provisioning.
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