RisknCompliance Blog

Thoughts On Delivering Meaningful Outcomes in Security and Privacy

You don’t know what you don’t know – Do we have a "detection" problem with the healthcare data breach numbers?

Like some of you perhaps, I have been reading a few recent articles on Healthcare data breaches, especially the one from Dark Reading and a detailed analysis of the 2010-to-date breaches from HITRUST Alliance.

What stood out for me from these articles is something that is not necessarily highlighted in the articles and that is the very low number of breaches involving technology/people/process controls as opposed to physical losses.

These articles focused on the 119 or so breaches that have been reported to Department of Health and Human Services (HHS) or made public to date in 2010. From the HITRUST Alliance analysis, it is clear that an overwhelming majority of the breaches resulted from physical loss/theft of paper or electronic media, laptops etc.  Only two breaches resulted from hacking incidents.

I then went back to do a little bit of my own analysis of the 2010 data breach incidents covered in the Identity Theft Resource Center report available here. I came up with the following numbers for breaches other than those that involved physical loss, theft, burglary, improper disposal etc. :

  • Malware  infection -1
  • Unauthorized access to file share – 1
  • Database misconfiguration or vulnerability – 2
  • Website vulnerability – 1
  • Improper access or misuse by internal personnel – 6

As you can see, these account for less than 10% of the healthcare breaches known or reported so far this year.  Contrast this with the findings in 2010 Verizon Data Breach Investigation Report which attributes 38% of breaches to malware, 40% to hacking and 48% to misuse. It is pertinent to note that the Verizon report focused on 141 confirmed breaches from 2009 covering  a variety of industries,  but I think it is still good for a high level comparison to determine if we may be missing something in the healthcare breach data.

The comparison seems to suggest that the healthcare industry probably has much stronger safeguards  against malware, hacking, improper logical access etc.  I know from my own experience working with healthcare entities that this is not necessarily the case. For further corroboration, I reviewed two Ponemon Institute survey reports – Electronic Health Information at Risk: A Study of IT Practitioners and Are You Ready for HITECH? – A benchmark study of healthcare covered entities & business associates, both from Q4 2009. Following sample numbers from these reports further validate that the state of Information Security and Privacy among HIPAA Covered Entities (CEs) and Business Associates (BAs) is far from perfect:

Electronic Health Information at Risk: A Study of IT Practitioners

#

Question

% of respondents saying “Yes”

1

My organization’s senior management does not view privacy and data security as a top priority

70%

2

My organization does not have ample resources to ensure privacy and data security requirements are met – 61% of respondents.

61%

3

My organization does not have adequate policies and procedures to protect health information

54%

4

My organization does not take appropriate steps to comply with the requirements of HIPAA and other related healthcare regulations

53%

Are You Ready for HITECH? – A benchmark study of healthcare covered entities & business associates

#

HIPAA compliance requirements that are not formally implemented

% of respondents saying “Yes”

1

Risk-based assessment of PHI handling practices

49%

2

Access governance a and an access management policy

47%

3

Staff training

47%

4

Detailed risk analysis

45%

All this leads me to think of the possibility that some HIPAA CEs and BAs may not be detecting potential breaches. If you study the healthcare breaches that have been reported so far, almost all of them have been through physical losses of computers or media (which is easy to know and detect) or through reporting by third parties (victims, law enforcement, someone finding improperly disposed PHI paper records in trash bins  etc.).  I don’t know of any healthcare data breach this year that was detected through proactive monitoring of information systems.

As I covered in a related post on breach reports and what they tell us, I would recommend that CEs and BAs focus on certain key controls and related activities (see table below) in order to improve their breach prevention and detection capabilities:

#

Key Controls

Recommended Activities

1

Secure Configuration and Lockdown

Review configuration of information systems (network devices, servers, applications, databases etc.) periodically and ensure that they are locked down from a security configuration standpoint

2

Web Application Security

· Scan web applications periodically for OWASP Top 10 vulnerabilities and fix any discovered vulnerabilities

· For new applications under development, perform code reviews and/or vulnerability scans to fix any security vulnerabilities before the applications are put to production use (Studies show that it is far more cost effective to fix the vulnerabilities before applications are put to production use than after)

· Use Web Application Firewalls as appropriate

3

Strong Access Credentials

· Configure PHI systems and applications to have a strong password policy (complexity of the password, periodic change of password etc.)

· Implement multi-factor authentication on PHI systems and applications wherever possible


(Note: According to 2010 Verizon Data Breach investigation report, stolen access credentials lead to largest number of breaches from hacking incidents)

4

Access Assurance or Governance

· Conduct Access Certifications periodically, preferably at least every quarter for PHI systems and applications.

· Review access privileges within PHI systems and applications to ensure all access conforms to the “Least Privilege” principle. In other words, no user, application or service must have any more privileges than what is required for the job function or role

· If any excess privileges are found, they must be remediated promptly

· Revoke access to PHI systems and applications promptly in the event that a person leaves the organization or no longer requires access due to a change in the person’s job role within the organization

5

Logging, Monitoring and Reporting

· Identify “risky” events within PHI systems

· Configure the systems to generate logs for the identified events

· Tamper-proof the logs

· Implement appropriate technologies and/or processes for monitoring of the events (Refer to our related posts here and here for examples)

· High risk events must be identified and monitored through near-real-time alerts

· Responsibilities for daily review of log reports and alerts must be assigned to specific personnel

6

Encryption (Data at rest, media), Physical security of media

· Maintain an inventory of locations and systems wherever PHI exists

· Implement suitable encryption of PHI on laptops and removable media

· Implement appropriate physical security safeguards to prevent theft of devices or systems containing PHI

7

Security Incident Response

· Implement and operationalize an effective Security Incident Response program including clear assignment of responsibilities, response steps/workflows  etc.

· Test Incident Response process periodically as required

8

Security Awareness and Training

· Implement a formal security awareness and training program so the workforce is aware of their responsibilities,  security/privacy best practices and actions to take in the event of suspected incidents

· Require personnel to go through the security awareness and/or training periodically as appropriate

If you are familiar with the HIPAA Security Rule, you will notice that not all of the above controls are “Required” (as opposed to “Addressable”) under HIPAA Security Rule or in the proposed amendments to the rule under the HITECH Act. One may argue however, that the above controls must be identified as required based on “risk analysis” , which of course is a required implementation specification in the HIPAA Security Rule. In any event, CEs and BAs need to look beyond the HIPAA compliance risk and focus on the risk to their business or brand reputation if a breach were to occur.

Hope this is useful! As always, we welcome your thoughts and comments.

RisknCompliance Services Note

We at RisknCompliance maintain a up-to-date database of the current security threats and vulnerabilities at a detailed level. We are able to leverage this knowledge in  providing our clients with  high quality risk analysis.

Please contact us here if you would like to discuss your HIPAA security or privacy needs. We will be glad to talk to you about how we could be of assistance.

Be Sociable, Share!

2 Comments

  1. Kamal offers deep and excellent insight in this post which is grounded in data, facts and analysis rather than pure opinion and emotion which often accompanies the subject of PHI privacy and security. His recommendations on key controls are sound and proven. Indeed, more people and organizations striving to become HIPAA-HITECH compliant need to realize that the HIPAA Security Final Rule standards and implementation specifications set what most security professionals agree are a “floor” or baseline minimum. Excellent post!

  2. I would say that both the article pointing out the preponderance of physical loss and Kamal’s analysis are true. The difference is in reporting. A high percentage of business associate are totally unaware of HIPAA standards and wouldn’t recognize a breach if they fell in it. You do notice when your laptop is missing but like Anthem Blue Cross you may not notice that your on-line application system has a hole in it that allows anyone to go in and look at over 200,000 records.

Leave a Reply

Your email address will not be published.

*