Is paying ransom going to become another part of providing health care?

Hollywood Presbyterian Medical Center, a Los Angeles hospital, paid a $17,000 ransom on February 15, 2016 to unencrypt its electronic health record system after it was taken hostage by hackers. Although the ransom payment was not the first of its kind, it represents another link in the increasingly complex chain of threats faced by health care providers.  The hospital gave in to criminal demands ten days after  the provider’s network was affected, noting that paying off the hackers was “the quickest and most efficient way” to restore the hospital’s electronic systems.

A new threat

The ransomware attack experienced at Hollywood Presbyterian is representative of a new kind of threat for health care providers (see Another hit for health IT—now hackers hold hospitals hostage?, February 23, 2016). Unfortunately, the ransomware attack wasn’t the first of its kind and the hospital’s response was not a novel approach either. Some reports suggest that entities may be the victim of such ransom demands more often than is publicized because some companies do not reveal when they fall victim to ransomware and similarly do not disclose when they have paid off the criminal attackers. Although, according to the Hollywood Presbyterian release, patient care was not compromised and neither patient nor employee information was subject to unauthorized access, the security breach was dramatic. The seriousness is only exaggerated by the fact that similar attacks may be going on without public notification.

Other threats

Cybercrime has become a persistent reality for health care providers. One estimate suggested that Health care-record hacking is rising at an exponential rate, shooting up 11,000 percent last year. The rise has impacted individuals. The toll last year was 100 million stolen health care records. Hackers take the records and sell them on the dark web with thinly veiled advertising claims like “you can use those profiles for normal fraud stuff or to get a brand new healthcare plan for yourself.” Some of the most recent breaches include a breach of Magnolia Health Corporation and a security breakdown in Washington’s Apple Health Medicaid program. While some data breaches, like the one impacting Apple Health, are relatively innocuous lapses in protocol, other incidents—like the Hollywood Presbyterian attack or the 2015 Anthem breach—are the product of intentional criminal activity.

Task Force

To address the growing problem, HHS recently announced the formation of the Health Care Industry Cybersecurity Task Force as mandated by the Consolidated Appropriations Act of 2015 (P.L. 114-113). HHS announced a call for nominations for membership on the task force, seeking individuals with experience in the health care and public health sector; knowledge of the technical, administrative, management, and/or legal aspects of health information security; and knowledge of major health information security policies, best practices, organizations, and trends. The first teleconference of the Task Force will be held on March 17, 2016.

Economics of hacking

From a preparation standpoint, according to a recent Ponemon Institute report, one secret to defeating cyber threats may be identifying how to make hacks too costly to pursue. Instead of building an impenetrable security wall that hackers cannot break through, the study recommended that entities build a strong security protocol that makes hackers shy away from a target because of the opportunity costs—namely, the time required to successfully hack the system.

Looking ahead

Cyber threats are changing as they grow. With the number of individuals being impacted and the number of ways they are being impacted rising, health information security is becoming increasingly important. Because there may be no absolute protection from cyber threats—short of following quixotic recommendations to revert back to paper—Providers must remain vigilant and aware of the threats so that they do not find themselves in the position of Hollywood Presbyterian, paying criminals as the “most efficient way” to return to business.

Another hit for health IT—now hackers hold hospitals hostage?

The nature of health care data security breaches is changing. Whereas the majority of lapses in health care information security were once caused by the loss and theft of devices, the greatest security threat to health care consumers and health care providers is now happening through large-scale hacks. The shift has left the industry exposed. The Institute for Critical Infrastructure Technology warns that among all of the nation’s critical infrastructures, the most vulnerable is the health care sector. The warnings aren’t empty, in January 2015, a breach of Anthem, Inc. allowed hackers access to the information of 80 million Americans. Three months later, another 11 million individuals had information stolen when health insurer Premera Blue Cross was hacked. Now, hackers have taken things one step stranger by shutting down a California hospital’s internal computer system for a ransom of almost $3.7 million.

New trend

According to the 2016 Health Care Breach Report from security company Bitglass, 98 percent of leaked healthcare records were exposed as a result of large-scale hacks, like the Anthem and Premera hacks. Although the enormity of those breaches might at first suggest that a few large breaches skewed the average results, the report also noted that even when the six largest breaches are excluded, hacking-related incidents still accounted for the majority of leaked health care data. The breach report explained that 111 million people were affected by data loss. Some of the data lost included names, addresses, dates of birth, social security numbers, and medical claims information. Why are hackers targeting health care data? The obvious answer: money. According to a Ponemon Institute report, in general, the average cost per lost or stolen record is $154, but when a record is stolen from a health care organization, the number rises to $363.

Ransomware

The trend is alarming, and the security threat does not appear to be stopping at conventional security hacks. The California hospital under ransom—Hollywood Presbyterian—was shut down by a type of malicious software known as ransomware. Like other malware, the software identifies weakness in a computer system and then encrypts data, which can only then be unencrypted with a key code. The hackers of Hollywood Presbyterian have placed a price on that keycode—9,000 bitcoin, worth about $3.7 million. According to the hospital, the hack has impacted the provider’s ability to deliver care by interrupting email and access to certain systems. According to the hospital, the hack has not compromised patient medical records. Ransomware has been used before. In fact, since its emergence in 2013, 56 types of ransomware have been used.

What is next?

Some commentators are calling hackers “cyber barbarians” and warning that hacks could result in the actual loss of life. Although the scope of the threat is debatable, there is no dispute that a very real change is happening in the world of health care information security. While security experts say that the threats are addressable and, in some cases, preventable, health care organizations are facing new challenges. Whether they are called hostage takers, barbarians, or criminals, hackers are posing a real threat to private and sensitive health data. The question now is two-fold: (1) what can be done to address and stop the current breaches? and (2) what will the hackers attack with next?