You are a group of healthcare personnel working for a healthcare organization. Your Director of Health Information just shared two reports on cybersecurity – one from the US and one from the UK (see attachment in GA folder). Upon reading the reports, your Director of Health Information is concerned about cybersecurity and its impact on your organization. Your Director of Health Information would like you and your team to develop a presentation and e-poster to share at the organization’s upcoming employee professional development day. The Director of Health Information has asked that cybersecurity be the main theme but focusing on risk management and the legality and ethics of digital healthcare. However, given that you and your team members work in different department of your campustype healthcare organization, you will also focus on specific practice areas of your expertise. Instructions: As a group, here are the instructions your Director of Health Information has provided: 1. Read the uploaded resources from HHS Cybersecurity Program and Panda Mediacenter via link https://www.pandasecurity.com/en/mediacenter/security/5-pillars-security-nhs/ 2. Identify one (1) practice area from your group members (family medicine, nursing, pharmacy, dentistry, physiotherapy, diagnostics etc) 3. Compare and contrast the content based on the US and UK resource 4. Create a PRESENTATION to with the following criteria: Page 1 of 4 i) Describe your Canadian campus-style healthcare provider ii) What findings are similar to your Canadian campus-style healthcare provider iii) What findings are different – if any – to your Canadian campus-style healthcare provider iv) Identify relationship to one (1) of your group members practice setting; ensure you identify the professional practitioner description of this practice setting. v) Based on the selection of the practice setting and professional practitioner, describe minimum two (2) risks associated of the findings that are similar vi) Based on the selection of the practice setting and professional practitioner, describe minimum two (2) risks associated of the findings that are different vii) Based on the selection of the practice setting and professional practitioner, describe the legalization/regulation challenges associated with each risks from (v) and (vi) viii) Based on the selection of the practice setting and professional practitioner, describe ethical issues that could be impacted by the risks from (v) and (vi) ix) With (v), (vi), and (vii) provide for each a minimum of two and maximum four strategies to mitigate these issues from occurring within the practice setting and professional practitioner chosen x) From the presentations by your two chosen organizations, how can Health Systems Management graduates mitigate the risk identified and legalization/regulation challenges. For this presentation, it is a synchronous presentation that must be minimum three (3) and maximum five (5) minutes. You can choose to facilitate the presentation or present a prerecorded presentation. NOTE – Due to size limitation of uploading presentations to FOL, you can post to YouTube to present and upload a link for grading and presentation. For this, you will share/upload your link to the submission folder/dropbox for grading and showcasing your presentation. 5. In addition to your presentation, you will create an e-poster with the critical items from your presentation which will be displayed within your organization during the professional development day. The requirements of the e-poster can be a flyer, brochure or handout format. You are to ensure you use a balance of text and images/graphics and appropriate headings to communicate your theme/purpose description, practice setting, professional practitioner, risk associated, legalization/regulation challenge, ethical issues, strategies for each, and HSY graduate support. 6. You are to have a minimum of five (5) references. Page 2 of 4 Unit 2/3 Presentation Rubric @ 15% CATEGORY Effectiveness 4 3 2 Project includes most Project includes all material needed to gain a material needed to gain a comfortable Project is missing more comfortable understanding understanding of the than two key elements. of the topic. material but is lacking one or two key elements. 1 Points Project is lacking several key elements and has inaccuracies. Sequencing of Information Information is organized in Most information is Some information is a clear, logical way. It is organized in a clear, logical logically sequenced. An There is no clear plan easy to anticipate the type way. One item of occasional item of for the organization of of material that might be information seems out of information seems out of information. next. place. place. Originality Presentation shows considerable originality and inventiveness. The content and ideas are presented in a unique and interesting way. Presentation shows some originality and Presentation shows an inventiveness. The content attempt at originality and ideas are presented in and inventiveness. an interesting way. Presentation is a rehash of other people’s ideas and/or graphics and shows very little attempt at original thought. Spelling and Grammar Presentation has no misspellings or grammatical errors. Presentation has 1-2 misspellings, but no grammatical errors. Presentation has 1-2 grammatical errors but no misspellings. Presentation has more than 2 grammatical and/or spelling errors. Use of Graphics All graphics are attractive (size and colors) and support the theme/content of the presentation. A few graphics are not attractive but all support the theme/content of the presentation. All graphics are attractive Several graphics are but a few do not seem to unattractive AND support the detract from the theme/content of the content of the presentation. presentation. Sources (minimum 2) All sources (information All sources (information and graphics) are and graphics) are accurately documented, accurately documented in but one is not in the the desired format. desired format. All sources (information and graphics) are Some sources are not accurately documented, accurately but two or more are not documented. in the desired format. Description of campusstyle healthcare provider Findings – similar Findings – different Practice and Professional Practitioner Explanation Risk Associated Legalization/regulation challenge Ethical issue impacted Strategies HSY graduates support Total Score /60 Page 3 of 4 Unit 2/3 ePoster Rubric @ 5% Detailed Scoring Evaluation for Rubric 4 = Excellent/ Exemplary Area Organization 3 = Good/Proficient 2 = Fair/Partially Proficient 1 = Poor/ Incomplete Assignment Each required criteria providedRequirement – as per guideline and CLEARLY found/seen/visual Mark Aligned and presented on e-poster Presentation and Graphics Grammar and Mechanics Content Information is organized and has some whitespace between sections; poster does not look cramped and draws attention to main message; logical order of content. Attractive in design, layout and neatness; easy to read; graphics and effects are relevant to service provider. Text is brief and focused; identified most important information; text is large enough to be visible from a distance; content is understandable whenillustrations briefly viewed. Used or graphics in simple but prominent fashion; colors don’t clash; flows well and identified important information first; avoided fonts that are difficult to read; used no more than three fonts. Capitalization and punctuation are correct throughout the poster; no grammatical errors; all pictures/graphs/graphics are captioned and labelled as required e-Poster has theme, (source). practitioner, practice setting, risk, legislation/regulation, ethical issues, strategies clearly identified Total Addendum to A136 Academic Integrity Policy – Pursuant to Fanshawe College’s A136 Academic Integrity policy, the Health Systems Management program does not permit the use of any unauthorized technology tools. Technology tools include, but are not limited to, calculators, textbooks, translation tools, course notes and resources, search engines (e.g. Google), and artificial intelligence applications (e.g. ChatGPT or any other similar/equivalent platform). The unauthorized use of these technology tools in any academic deliverable will result in the applicable penalties as per A136 Academic Integrity policy. This can be applied individually or group capacity, dependent on the offence identified and resulting investigation and verification. Page 4 of 4 /32 Electronic Medical Records in Healthcare 02/17/2022 TLP: WHITE, ID# 202202171300 Agenda • What Is an EMR, and How Is It Used in Healthcare? • Top EHR Software Used in Hospitals • Benefits & Risks of Using EMR/HER • Why EMRs/EHRs Are Valuable to Cyber Attackers • How Are EMR/EHRs Stored and Handled? • EMR Compromised, Healthcare & Critical Industries Hacked • Healthcare Industry Under Attack • Healthcare Industry Under Attack, Part II • Top Data Breaches of 2021 • Top Threats Against Electronic Medical & Health Records • Costs of Data Breach • Protecting EMR & EHR Data • References Slides Key: Non-Technical: Managerial, strategic and highlevel (general audience) Technical: Tactical / IOCs; requiring in-depth knowledge (sysadmins, IRT) 2 What Is an EMR and How Is It Used in Healthcare? EMR vs EHR Electronic medical records (EMRs) and electronic health records (EHRs) are often used interchangeably. An EMR allows the electronic entry, storage, and maintenance of digital medical data. EHR contains the patient’s records from doctors and includes demographics, test results, medical history, history of present illness (HPI), and medications. EMRs are part of EHRs and contain the following: • • • • Patient registration, billing, preventive screenings, or checkups Patient appointment and scheduling Tracking patient data over time Monitoring and improving overall quality of care Electronic healthcare record process diagram 3 Top EMR/EHR Software Systems Used in Hospitals Top 10 Inpatient EHR Vendors by Market Share Courtesy of Definitive Healthcare’s HospitalView. (June 2021) 4 Benefits and Risks of Using EMR/EHR Some benefits of using electronic medical records and electronic health records are: • Comprehensive patient-history records • Makes patient data shareable • Improved quality of care • Convenience and efficiency Some risks of using electronic medical records / electronic health records are: The risks to EHRs relate primarily to a range of factors that include user-related issues, financial issues and design flaws that create barriers to using them as an effective tool to deliver healthcare services. EMR is also a top target in healthcare breaches. Additional risks are as follows: • Security or privacy issues • Potentially vulnerable to hacking • Data can be lost or destroyed • Inaccurate paper-to-computer transmission • Cause of treatment error 5 Why EMRs/EHRs Are Valuable to Cyber Attackers EMR/EHRs are valuable to cyber attackers because of the Protected Health Information (PHI) it contains and the profit they can make on the dark web or black market. These 18 identifiers provide criminals with more information than any other breached record. Extortion, fraud, identity theft, data laundering, Hacktivist / Promoting Political Agenda and Sabotage are some ways cyber attackers use this data for profit. HIPAA Protected Health Identifiers (PHI) Names Dates, except year Telephone numbers Geographic data FAX numbers Social Security numbers Email addresses Medical record numbers Account numbers Health plan beneficiary numbers Certificate/license numbers Vehicle identifiers and serial numbers including license plates Web URLs Device identifiers and serial numbers Internet protocol (IP) addresses Full face photos and comparable images Biometric identifiers (i.e. retinal scan, fingerprints) Any unique identifying number or code 6 Why EMRs/EHRs Are Valuable to Cyber Attackers, Part II According to IBM, stolen healthcare data is the most valuable, as the graph below shows: 7 How EMRs/EHRs Are Stored and Handled EMR / EHR data is stored on dedicated servers in specific, known physical locations. 8 EMR Compromised, Healthcare & Critical Industries Hacked In 2020, at least 2,354 U.S. government, healthcare facilities and schools were impacted by a significant increase in ransomware. The cyber attacks caused significant disruption across the healthcare industry. Organizations impacted by these attacks are as follows: • 113 federal, state and municipal governments and agencies • 1,681 schools, colleges and universities • 560 healthcare facilities • Pennsylvania Health Services Company (operates 400 hospitals & healthcare facilities) 9 Healthcare Industry Under Attack Healthcare data breaches have increased significantly. According to the HIPAA Journal’s 2020 Healthcare Data Breach Report, the healthcare industry in 2020 had the third largest number of data breaches on record since 2009. 10 Healthcare Industry Under Attack, Part II Entities With the Most Data Breaches (per HIPAA Journal): 11 Top Data Breaches of 2021 In 2021, HHS received reports of data breaches from 578 healthcare organizations, impacting more than 41.45 million individuals. The following list is of organizations with the most individuals affected in 2021: • Florida Pediatric Health Pediatric Organization: 3.5 million • Florida Vision Care Provider: 3.25 million • Wisconsin Dermatologist: 2.41 million • Texas Health Network: 1.66 million • Indiana General Health Provider: 1.52 million • Ohio Pharmacy Network: 1.47 million • Georgia Health Network: 1.4 million • Nevada University Health Center: 1.3 million • New York Anesthesiologist: 1.27 million • New York Medical Management Solutions Provider: 1.21 million In January 2022, 38 organizations reported nearly 2 million individuals were impacted by data breaches. TLP: WHITE 12 Top Threats Against Electronic Medical & Health Records • Phishing Attacks • Malware & Ransomware Attacks • Encryption Blind Spots • Cloud Threats • Employees 13 Phishing Attacks A phishing attack is a type of social engineering attack where the threat actor pretends to be a trusted source and tricks their target into opening an email or clicking a link, revealing their login credentials and depositing malware. You can protect EMRs/EHRs by doing the following: • Educate healthcare professionals • Do not click links within an email that do not match, or has a TLD associated with suspicious sites • Physicians should verify all EHR file-share requests before sending any data 14 Malware and Ransomware Attacks Malware enters a healthcare system’s computer network through software vulnerabilities, encrypted traffic, downloads, and phishing attacks. The effect of each type of malware attack ranges from data theft to harming host computers and networks. Ransomware is a type of malware that locks users out of their network system or computer until the threat actor or hacker who launched the attack is paid for regained access to data, information, and files. This could be dangerous for hospitals, healthcare facilities, and others who rely on EHRs or EMRs for up-todate information to provide patient care. 15 Encryption Blind Spots Data encryption protects and secures EMR/EHR data while it is being transferred between on-site users and external cloud applications. Blind spots in encrypted traffic could pose a threat to IT healthcare because threat actors or hackers are able to use encrypted blind spots to avoid detection, hide, and execute their targeted attack. Also helps with HIPAA, FISMA, and Sarbanes-Oxley Act of 2002 compliance. 16 Cloud Threats More healthcare organizations are using Cloud services to improve patient care, so there is an increasing need to keep private data secure while complying with HIPAA. 17 Employees: Insider Threats Insider threats apply across industries, including the heath sector. It is recommended that your healthcare organization has a cybersecurity strategy and policy that’s not only understood but followed and enforced. An effective strategy involves: • • • • Educating all healthcare partners and staff Enhancing administrative controls Monitoring physical and system access Creating workstation usage policies o Auditing and monitoring system users o Employing device and media controls o Applying data encryption 18 Costs of Data Breach Data breaches targeting EMRs/EHRs have been costly for the healthcare industry. According to IBM, the average cost per incident in 2021 was $9.3 million, and there were 40 million patient records compromised. HIPAA developed four tiers of penalties for failure to protect PHI: First Tier: $100-$50K per incident (up to $1.5M) Second Tier: $1,000-$50K (up to $1.5M) Third Tier: $10,000-$50,000 (up to $1.5M) per incident Fourth Tier: at least $50,000 (up to $1.5M) per incident 19 Protecting EMR & EHR Data Here are a few strategies that healthcare leaders should consider to strengthen their organization’s cyber posture: • Evaluate risk before an attack • Use VPN with multifactor authentication (MFA) • Develop an endpoint hardening strategy • Endpoint Detection and Response (EDR) • Protect emails and patient health records • Engage Cyber Threat Hunters • Conduct red team / blue team exercises • Moving beyond prevention 20 Protecting EMR & EHR Data – Evaluate Risk Before an Attack Healthcare leaders should understand where operational vulnerabilities exist in their organization, from marketing all the way down to critical health records. By understanding the scope of the task at hand, management and other healthcare leaders can create a preparedness plan to address any weaknesses in digital infrastructure. 21 Protecting EMR & EHR Data – Use VPN with MFA Leaders in the healthcare industry should consider developing a strategy to combat ransomware that targets Remote Desktop Protocol (RDP) and other applications that face the Internet. Healthcare leaders should also consider adding a VPN with multifactor authentication to avoid exposing their RDP and prioritize patching for vulnerabilities in VPN platform and other applications. 22 Protecting EMR & EHR Data – Develop Endpoint Hardening Strategy with EDR Developing an endpoint hardening strategy allows healthcare leaders the ability to harden their digital infrastructure with multiple defense layers at various endpoints. This strategy also detects and contains an attack before it can reach patient medical records or other sensitive information. Endpoint Detection and Response (EDR) should also be added to detect and mitigate cyber threats. 23 Protecting EMR & EHR Data – Emails & Patient Health Records It is imperative that patient health records and emails are protected. In addition to threat actors using Remote Desktop Protocol (RDP) to gain access, HIVE ransomware attacks malicious files attached to phishing emails to gain access to health records and company systems. Email security software with URL filtering and attachment sandboxing is recommended as a mitigation strategy. 24 Protecting EMR & EHR Data – Engage Cyber Threat Hunters Threat hunting is a proactive practice that finds threat actors or hackers who have infiltrated a network’s initial endpoint security defenses. This type of human threat detection capability operates as an extension of the organization’s cyber team that will track, prevent, or even stop potential cyber attacks on an organization. 25 Protecting EMR & EHR Data – Conduct Red Team / Blue Team Exercises Red and blue team exercises are essentially a face-off between two teams of highly trained cybersecurity professionals: • • Red Team uses real-world adversary tradecraft to compromise the environment. Blue Team consists of incident responders who work within the security unit to identify, assess and respond to the intrusion. These exercises are imperative to understanding issues with an organization’s network, vulnerabilities and other possible security gaps. 26 Protecting EMR & EHR Data – Moving Beyond Prevention It is recommended that healthcare leaders shift their focus by moving beyond a prevention strategy and creating a proactive preparedness plan. This helps understand vulnerabilities in the current network landscape and provides guidance needed for framework that will be effective in identifying and preventing attacks, which is key to protecting EMRs/EHRs, along with access to vital patient data. 27 Reference Materials References • Duffin, Sonya. “Top 10 Cybersecurity Best Practices to Combat Ransomware,” Threat Post. November 12, 2021. https://threatpost.com/cybersecurity-best-practices-ransomware/176316/. • Green, Jeff. “Disadvantages of EHR systems – dispelling your fears,” EHR Knowledge Zone. August 15, 2019. https://www.ehrinpractice.com/ehr-system-disadvantages.html. • “What are the Consequences of a Medical Record Breach,” American Retrieval. September 22,2020. https://www.americanretrieval.com/medical-records-breach. • O’Connor, Stephen. “Top 5 Risks You May Encounter After an EHR Software Implementation,” Advanced Data Systems Corruption. January 31, 2017. https://www.adsc.com/blog/top-5-risks-you-may-encounterafter-an-ehr-software-implementation. • Marchesini,Kathryn;Massihi, Ali. “4 Ways Using the HHS Security Risk Assessment Tool Can Help Your Organization,” Health IT Buzz. October 30, 2019. https://www.healthit.gov/buzz-blog/privacy-and-securityof-ehrs/4-ways-using-the-hhs-security-risk-assessment-tool-can-help-your-organization. • “2020 Healthcare Data Breach Report: 25% Increase in Breaches in 2020,” HIPAA Journal. January 19, 2021. https://www.hipaajournal.com/2020-healthcare-data-breach-report-us/. • “Programs/Electronic Medical Records(EMR),” MedixOnline. May 21, 2021. https://medixonline.ca/programs/electronic-medical-records-emr/. • Luyer, Eric M. “Cybersecurity Risks in Medical Devices Are Real,” MedTech Intelligence. February 23, 2017. https://www.medtechintelligence.com/feature_article/cybersecurity-risks-medical-devices-real/. • Cepero, Robert. “How Hospitals Can Protect Their EMR Data,” Bleuwire. December 16, 2020. https://bleuwire.com/how-hospitals-can-protect-their-emr-data/. 29 References • Cepero, Robert. “How Hospitals Can Protect Their EMR Data,” Bleuwire. December 16, 2020. https://bleuwire.com/how-hospitals-can-protect-their-emr-data/. • Vaidya, Anuja.“5 ways U.S. hospitals can protect against ‘imminent’ ransomware threat,” MedCityNews. October 29, 2020. https://medcitynews.com/2020/10/5-ways-u-s-hospitals-can-protect-against-imminentransomware-threat/. “Understanding EMR vs. EHR,” NextGen Healthcare. July 19, 2019. https://nextgen.com/insights/emr-vsehr/emr-vs-ehr. • “Why is PHI Valuable to Criminals?,” Compliancy Group. November 16, 2020. https://compliancy-group.com/why-is-phi-valuable-to-criminals/. • • Taylor, Tori. “Hackers, Breaches, and the Value of Healthcare Data.” December 8, 2021. https://www.securelink.com/blog/healthcare-data-new-prize-hackers/. • Adams, Katie. “10 Biggest Patient Data Breaches in 2021,”Becker Hospital Review. December 7,2021. https://www.beckershospitalreview.com/cybersecurity/10-biggest-patient-data-breaches-in-2021.html. • “Costs of a Data Breach Report 2021,” IBM Security. July 28, 2021. https://www.ibm.com/downloads/cas/OJDVQGRY#:~:text=Healthcare%20organizations%20experienced%20th e%20highest,industries%2C%20and%20year%20over%20year. • Deford, Drex. “Under Siege: How Healthcare Organizations Can Fight Back,” CPO Magazine. November 25,2021. https://www.cpomagazine.com/cyber-security/under-siege-how-healthcare-organizations-can-fightback/. • Kumar, S.Rakesh, Gayathri,N. Muthuramalingam,S., Balamurugan, B, Ramesh,C., Nallakaruppan, M.K. “Medical Big Data Mining and Processing in e-Healthcare,” Internet of Things in BioMedical Engineering. November 1,2019. https://www.sciencedirect.com/topics/engineering/electronic-health-record . 30 References • “What Is An EMR? About EMR Systems – Electronic Medical Records,” Healthcare IT Skills. January 5, 2020. https://healthcareitskills.com/what-is-an-emr-ehr/. • “The 10 Most Common Inpatient EHR Systems by 2021 Market Share,” Definitive Healthcare https://www.mdhinsight.com/services/emr-data-extraction. • Zelinska, Solomija. “Which Types of EMR/EHR Systems are the Best for Your Business,”Empeek. March 5, 2021. https://empeek.com/which-types-of-emr-ehr-systems-are-the-best-for-your-business/ . 31 ? Questions Questions Upcoming Briefs • 3/3 – Healthcare Cybersecurity: 2021 Year-in-Review / A Look Forward to 2022 Product Evaluations Recipients of this and other Healthcare Sector Cybersecurity Coordination Center (HC3) Threat Intelligence products are highly encouraged to provide feedback. If you wish to provide feedback, please complete the HC3 Customer Feedback Survey. Requests for Information Need information on a specific cybersecurity topic? Send your request for information (RFI) to [email protected]. Disclaimer These recommendations are advisory and are not to be considered as Federal directives or standards. Representatives should review and apply the guidance based on their own requirements and discretion. HHS does not endorse any specific person, entity, product, service, or enterprise. 33 About Us HC3 works with private and public sector partners to improve cybersecurity throughout the Healthcare and Public Health (HPH) Sector Products Sector & Victim Notifications White Papers Threat Briefings & Webinar Direct communications to victims or potential victims of compromises, vulnerable equipment or PII/PHI theft, as well as general notifications to the HPH about current impacting threats via the HHS OIG. Document that provides in-depth information on a cybersecurity topic to increase comprehensive situational awareness and provide risk recommendations to a wide audience. Briefing presentations that provide actionable information on health sector cybersecurity threats and mitigations. Analysts present current cybersecurity topics, engage in discussions with participants on current threats, and highlight best practices and mitigation tactics. Need information on a specific cybersecurity topic, or want to join our Listserv? Send your request for information (RFI) to [email protected],or visit us at www.HHS.Gov/HC3. 34 Contact www.HHS.GOV/HC3 [email protected]
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