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Cybersecurity in Health IT: Trends and Tips for Safeguarding PHI

 

 

 

 

 

 

 

 

 

On August 14, 2019, my colleague Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, Vice President of Privacy, Compliance and HIM Policy and I presented the third part of our four-part PHI Disclosure Management webinar series. In this webinar titled “Cybersecurity in Health IT: Trend and Tips for Safeguarding PHI,” we discussed updates from the 2019 HIPAA Summit, the concept of “defense in depth,” security frameworks, top security threats and best practices for protecting your organization.

2019 HIPAA Summit

The HIPAA Summit focused on advances in security technology and increased government cybersecurity initiatives. Considering recent data breaches, healthcare organizations must build cybersecurity awareness programs that ensure HIPAA compliance. Here are four top priorities:

  • Secure executive and board-level buy-in
  • Provide ongoing training and education
  • Perform an annual risk analysis
  • Create a comprehensive incident response plan

The Summit featured a panel discussion including a representative from Anthem, Inc. who spoke about the company’s cyberattack and resolution agreement, the single largest individual HIPAA settlement in history of $16 million. The breach report filed with the HHS Office for Civil Rights (OCR) indicated that cyberattackers had gained access to Anthem’s IT system via an undetected continuous and targeted cyberattack for the apparent purpose of extracting data, otherwise known as an advanced persistent threat attack. The investigation revealed the following risk factors:

  • Failure to conduct an enterprise-wide risk analysis
  • Insufficient policies and procedures to regularly review information system activity
  • Failure to identify and respond to suspected or known security incidents
  • Failure to implement adequate minimum access controls to prevent the cyberattackers from accessing sensitive electronic protected health information (ePHI)

Defense in Depth

In the traditional sense, defense in depth means applying a layered approach to protecting your assets, including a variety of techniques and technologies. The potential for leaving gaps in protection and the adoption of newer concepts such as zero trust should be reviewed. It is important to incorporate and execute on your security frameworks and risk management programs to ensure alignment while addressing cyber risks and threats.

Security Framework

Understanding your organization’s approach to security and risk management is critical. According to NIST, an effective security framework is based on five core tenets:

  • Identification—inventories for asset management, governance and risk management
  • Protection—access controls, awareness and training, protective technologies
  • Detection—tools to detect threats and events, continuous monitoring, manual/automated alerting
  • Response—planning, communications, analysis
  • Recovery—planning, improvements, communications

Relevant Controls for HIM

We highlighted focus areas for HIM in two categories. The first is Access/Account Management which includes workforce security, information access and auditing. HIM has great visibility into these sensitive workflows along with a deep understanding of where, why and how information is being shared. They must work closely with other departments—human resources, IT and compliance to establish policies and controls that prevent improper access to PHI.

The second category is Administrative, Physical and Technical with emphasis on:

  • Data classification—data flow mappings and sensitivity
  • Roles and responsibilities—privacy, security and legal
  • Information security awareness—education, training and policies
  • Information handling—use and disposal
  • Physical access—secure rooms

With the rise in requests for access to PHI by payers, attorneys and patients, ensuring secure rooms for access to electronic health records is essential.

Enterprise Engagement

As providers apply new technologies, workflows and practices to gain more efficiencies and secure operations, it’s important to engage privacy, security and legal teams early in the process. Help them understand the risks and identify any necessary corrective action plans (CAPs) up front.

Resolution Agreements

In addition to lessons learned from the Anthem breach, attendees gained insights from other examples in which failure to conduct enterprise-wide risk analysis was a major contributor to cybersecurity breach. Understanding how OCR judged and accounted for those activities promotes effective privacy and security programs.

Top Cybersecurity Threats in 2019

Based on a survey of 2,400 cybersecurity and IT professionals, a recent Ponemon Institute Cyber Risk Report revealed the top five cybersecurity threats organizations are most concerned about in 2019:

  • Third-party misuses or shares of confidential data
  • An attack involving IoT or OT assets
  • A significant disruption to business processes caused by malware
  • A data breach involving 10,000 or more customer or employee records
  • An attack against the company’s OT infrastructure resulting in downtime to plant and/or operational equipment

As healthcare organizations face increased risk of cybersecurity breach, third-party risk management is more important than ever. Rigorous due diligence is part of the risk analysis conducted by covered entities to ensure partners have HIPAA-compliant policies in place to safeguard PHI. Whether internal or outsourced, a standardized approach to understanding third-party security frameworks and policies is recommended.

The most important lesson learned for 2019 and years to come is clear: Perform an annual risk analysis and follow best practices for creating an appropriate incident response plan.

To learn more about strategies to protect your healthcare enterprise, fill out the form below to receive a copy of this webinar.

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Critical Practices to Improve Business Associate Management

In an HealthData Management ‘HIT Think’ article, MRO’s Anthony Murray and Rita Bowen discuss the critical role business associates play in a provider’s privacy and security program. They describe how more provider organizations incorporate HITRUST and SOC 2 frameworks into their third-party assurance processes. Together, HITRUST and SOC 2 provide the basis for an effective BA management program that promotes communication, confidence and common ground.

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HITRUST—What It Is and Why It Matters

What is HITRUST?

Founded in 2007, the Health Information Trust Alliance (HITRUST) evolved in response to the growing privacy and security challenges faced by the healthcare industry. Aligned with its mission to “champion programs that safeguard sensitive information and manage information risk for organizations,” HITRUST provides broad access to common risk and compliance management frameworks.

For example, the HITRUST CSF®, the cybersecurity framework, is a certifiable framework that provides a comprehensive, flexible and efficient approach to regulatory compliance and risk management. Established in 2015, it is a widely recognized security framework focused on the healthcare industry in the U.S. To ensure an inclusive set of baseline security controls, the HITRUST CSF leveraged nationally and internationally acceptable standards including ISO, NIST, PCI and HIPAA. As a result, the framework has been used successfully to demonstrate HIPAA compliance.

HITRUST regularly updates the CSF to incorporate new standards and regulations to make sure the framework remains relevant and current. As new regulations and security risks are introduced, provider organizations and third parties that adhere to the CSF can be well prepared with optimal security based on quarterly updates and annual audit changes.

Why HITRUST Is Important to BA Risk Management

As healthcare organizations face increased risk of privacy and security breach, recognizing the significant role played by their Business Associates (BAs) is critical. Conducting due diligence is essential before the partnership begins, and is part of the provider’s ongoing risk analysis to ensure partners have HIPAA-compliant policies in place to safeguard the privacy and security of protected health information (PHI). In recent years, many provider organizations have incorporated the HITRUST CSF as part of their third-party assurance process—requiring that BAs obtain CSF certification. This is largely due to the increased number of breaches involving third-party vendors.

Healthcare organizations that entrust PHI to a BA must ensure that sensitive information is properly safeguarded. Best practice is for providers to partner with compliant, secure BAs that offer compliance knowledge, guidance and value beyond the standard contracted services. Obtaining CFS certification demonstrates integrity and commitment to privacy and security practices aligned with stringent regulatory requirements and expectations of the healthcare industry.

With those priorities top of mind, MRO announced in May 2018 that its Release of Information platform ROI Online® had earned HITRUST CSF Certified status for information security. HITRUST incorporates a risk-based approach that includes federal and state regulations and standards to help organizations address challenges through a comprehensive framework of prescriptive and scalable security controls.

As healthcare’s most widely adopted security framework, HITRUST provides an industry standard for BA risk management and compliance. Covered entities can look to HITRUST certification for assurance that the foundation for implementing a framework with security controls required to safeguard PHI is already in place.

To learn more about the importance of HITRUST CSF and MRO’s journey to achieve certification, watch our video “MRO’s PHI Disclosure Management Platform ROI Online® Earns HITRUST CSF® Certification.”

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Webinar Recap: Cybersecurity- Protecting Your Healthcare Enterprise

On August 15, 2018, my colleague Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, Vice President of Privacy, Compliance and HIM Policy and I presented the third part of our four-part healthcare compliance webinar series. In this webinar titled “Cybersecurity: Protecting Your Healthcare Enterprise,” we covered points that healthcare organizations should consider to safeguard Protected Health Information (PHI) and increase their overall security posture.

Access Management

Policies and Procedures

HIPAA requires a number of administrative safeguards to protect PHI, specifically ePHI. Policies and procedures must be in place to ensure implementation and maintenance of appropriate protection.

• Workforce security is a critical piece to guide the proper use of PHI by anyone who is allowed access—including physicians, employees, volunteers and BAs.
• Information access authorization specifies who has access and why, based on minimum necessary guidelines.
• Ongoing security training supports accountability and access management.

Threat Prevention, Detection and Response

Prevention

Even with the most advanced technology, granting people access to systems remains one of the highest risks of introducing the possibility of serious incident. Attendees were reminded that policies and technologies must have additional controls in place:

• End user education and social engineering testing
• Strong passwords and account creation steps
• Malicious software protection
• System hardening practices

Detection

If something goes awry, it is important to have alert mechanisms in place—automated, manual or a combination of the two. For example, manual alerting includes 24-hour hotlines to report suspicious behavior. Technology applications such as FairWarning automatically trigger alerts to potential privacy violations. System log reviews are a good indicator of behavioral anomalies. Best practice is to leverage technology to automate data protection and ensure proper detection.

Response

In the event of an alert across the enterprise, a tested and documented incident response plan is necessary to ensure immediate response to a breach. The plan should include defined roles and responsibilities, testing scenarios and cyber insurance impacts. How will your organization ensure breach prevention considering the penalties being levied for high-exposure incidents?

At MRO, we have a dedicated incident response team. Part of their responsibility is to know state specifications, timeline controls and documentation requirements for proper reporting to the right people at the right time.

Information Governance

Information Governance is integral to an effective data security program. Incident response should be part of an enterprise information governance program—policies, procedures, tools and techniques that an organization applies to safeguard information and systems. Data classification and data mapping are essential tools to guide system impact assessments. Think about how and where your data goes and the importance of protection throughout its life cycle in your custody.

Risk Register

A risk register is a vital tool that lists all identified risks along with your organization’s risk score, responses, triggers, consequences and related information. Unlike a one-and-done document, this register is a fluid living document that must be constantly updated to reflect an accurate assessment of risk management and your security posture.

Cyber Extortion

With ransomware on the rise, user awareness training is more important than ever before. Additional protection measures include a formal ransomware policy and use of sophisticated technology to minimize attacks. Attendees received insights based on various types of cyber extortion including email and texting, along with examples of protection activities to promote cybersecurity.

To learn more about strategies to protect your healthcare enterprise, fill out the form below to receive a copy of this webinar.

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AHIMA Convention Reflections: Business Associate Management and Best Practices for Risk Analysis

At the 2017 AHIMA National Convention and Exhibit, Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, and I co-presented a session titled “Essentials for Business Associate Management: Due Diligence and Ongoing Risk Analysis.” In this presentation, we discussed ways to manage risk associated with Business Associates (BAs) for Covered Entities (CEs).

Rita and I reviewed industry trends around the renewed focus on vendor relationships and compliance, and the Office for Civil Rights’ (OCR) increased scrutiny of BAs. We covered many key components of thorough due diligence when evaluating BAs, and the necessary ongoing risk analysis once partnered.

The audience learned best practices that they can incorporate into their risk assessment process, which will make Business Associate management more bearable. Below is a video interview where I recap the presentation.

Video Recap: Managing Risk Associated with Business Associates for Covered Entities

 

Video Transcript

Anthony: I am Anthony Murray, Vice President of Information Technology for MRO.

Question: Tell us a little bit more about your presentation and the topic of BA Management.

Anthony: Today, Rita Bowen and myself presented on managing risks associated with Business Associates for Covered Entities. I think primarily what we were trying to drive home was a consistent approach to assessing risk when doing business with Business Associates within the Covered Entity space. It is a broad and deep topic. We covered a lot of different ways and concepts, so hopefully they came away with some ideas that they can incorporate into their risk assessment process to hopefully make their dealing with BAAs (Business Associate Agreements) a little bit more bearable.

Question: What best practices did you discuss during your presentation?

Anthony: We talked a lot about access controls, understanding the governance that’s in place, and trying to read the maturity scales of the Business Associates. What it really boiled down to was hopefully distilling down and understanding the services that the vendor is providing and associating the appropriate risk level to them. Based on the risk level, you hope to identify how deep into the privacy and security controls that they have in place are important to you as a company.

Question: What is MRO doing to address this topic?

Anthony: MRO is doing a number of things to help address this topic. One, is we have ongoing certifications to help augment what our CEs are going to do to assess us from a risk perspective. So, we’re trying to achieve things like HITRUST and perform our SSAE 16 and SOC type 2 audits. In addition, we also employ a number of very transparent controls that we talk about from the very onset of our relationship with our clients. How we manage access controls, how we report incidences and privacy threats all the way down to even giving access to our end user ongoing training seminars.

Question: What are some of the biggest trends and themes you’ve noticed at this year’s convention?

Anthony: I actually think this was one of the bigger topics between cyber and general privacy concerns with some of the changes in legislation. What you’re seeing is a continued focus on the business associates and risk they present. We saw a lot of good traction that we’re getting the paper work done when it comes to managing your business associates, but continuing to develop and look at the threat profile of the BAs continues to be a hot topic here.

Question: What is your favorite part about AHIMA?

Anthony: My favorite part of AHIMA is being around people who are all sharing the same struggles, challenges and opportunities that I’m facing. As a Business Associate, I’m confronted with CEs and other other agencies like ourselves that provide services to these hospitals all dealing with the same problems and being able to come together as a community and discuss it is just so reassuring that we’re not left out on an island.

To download slides from MRO’s Business Associate Management presentation, complete the form below.

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Five Ways CEs can Mitigate Breach Risk Associated with BAs

As advancements in health information technology allow increased access to Protected Health Information (PHI), the risk of breach is on the rise. In 2017 alone, there have been 233 reported data breaches, which have impacted 3,159,236 patients. This steady climb suggests that Covered Entities (CEs) and Business Associates (BAs) are still struggling to establish the measures needed to protect patient data and confidentiality.

CEs must be vigilant about the risks and threats directly related to their activities. And now more than ever, they need to focus on the additional threat vector presented by their BAs. As you would expect, the types of breaches encountered by BAs are similar to the threats facing CEs. The causes of breaches include malware/ransomware incidents, accidental disclosures, loss or theft of media containing sensitive data, physical loss of records, application and system vulnerabilities, social engineering exploits and payment fraud. While there are many different culprits of breach, improper and accidental disclosure of PHI is the most common cause of data security incidents. These improper disclosures of PHI include a wide range of errors such as comingled records and misdirected faxes and emails.

The impact of BA breaches on patients of a CE can run deep—from cases of identity theft to exposure of sensitive information regarding a condition, treatment or test that could lead to harm, embarrassment or discrimination. If fines are levied, sanctions and actions will be held against the CE as well.

In an upcoming AHIMA Convention educational session titled “Essentials for Business Associate Management: Due Diligence and Ongoing Risk Analysis,” my colleague Rita Bowen, MA, RHIA, CHPC, CHPS, SSGB, and I will review ways CEs can mitigate breach risk associated with BAs. The following is a sampling of what we will discuss.

    1. Perform initial due diligence. Identify what services are being performed, where the services are being performed, and what contracts should be in place including Master Service Agreements (MSAs), Business Associate Agreements (BAAs), Nondisclosure Agreements (NDAs), Data Use and Reciprocal Support Agreement (DURSA) and others.
    2. Get your security and compliance teams on board early in the process to avoid delayed services or rushed assessments. I cannot tell you how many meetings I’ve attended with our prospective client’s security and compliance teams, when we are just days away from finalizing a contract, and their opening statement is: “Well this is the first time we’re hearing of this. Let’s start from the beginning.” So, we just lost two weeks getting a project started, and the client needs us to go live in seven days. To avoid these types of delays, it’s recommended to have security and compliance teams involved in the onboarding of new partner services and technologies early in the process.
    3. Have a standard assessment. Have an equal way to measure the risk associated with the various services BAs can provide. No one shoe fits all, but attempting to keep the assessment process as standardized as possible allows for better assessments of risk. This assessment should cover all the applicable administrative, physical and technical controls associated with the services provided—all shoe sizes!
    4. Confirm cyber insurance. Make sure your BAs have adequate cyber insurance protections in the event of a breach—based on the services being delivered and the associated risk.
    5. Perform annual reviews and third-party assessments. Healthcare organizations should implement a formal program to review their BAs on an appropriate schedule. This would include your typical or an abridged assessment and any third-party certifications, accreditations or audits your BA has achieved.

    Complete the form to download the HCPro HIPAA Briefings article “Managing HIPAA Business Associate Relationships.”

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HIMSS17 Reflection: Security Driven to Forefront of Compliance

It’s wonderful to be surrounded by likeminded people seeking solutions to similar business challenges, and the annual HIMSS Conference and Exhibition always proves such an occasion for Health Information Technology (HIT) and Health Information Management (HIM) professionals. This year, over 42,000 HIT and HIM professionals, executives and vendors convened in Orlando for cutting-edge educational and networking opportunities.

My primary focus at the conference was to explore how today’s challenges can be turned into opportunities to strengthen MRO’s security posture and compliance stances, and also to provide more secure and efficient ways of exchanging Protected Health Information (PHI).

Privacy has come a long way in a handful of years, and now security is being driven to the forefront of compliance regulations. Here are some takeaways:

General Threat Detection

As the risk and threat landscape continues to evolve, organizations need to adapt. We must be ever-diligent in applying the proper safeguards, like implementing evolving and adaptive multi-tiered and multi-layered technologies to protect our sensitive assets, such as clinical, pharmacy or patient data. One specific threat facing healthcare organizations is ransomware.

Ransomware

Ransomware attacks – the hijacking and encrypting of an organization’s data by cybercriminals for purposes of extortion – are a major source of risk. These attacks are typically caused by employees clicking malicious links in emails or unknowingly opening files containing a malware virus, rendering data inaccessible.

Humans continue to be the weakest link in the healthcare security chain. Ongoing staff training can mitigate this risk. Regular training activities, like phishing exercises, can help instill security best practices in employees. Business Associates (BAs) should also provide regular ongoing training to their employees.

Third Party Vendor Management

Third party vendor management is another tough challenge facing the industry. Whether it comes from compliance requirements imposed by Covered Entities (CEs) on their BAs or requirements trickling down to vendors partnered with BAs, establishing trust and providing accurate assurances are necessary to operate in the medical space today. Risk assessments are a large part of this. Whether organizations are assessing themselves as part of their ongoing risk management programs, conducting formal third party assessments or engagement level assessments, all organizations need to conduct ongoing risk and third party due diligence.

The adoption of common privacy and security criteria healthcare organizations can attest to through groups like the Health Information Trust Alliance (HITRUST), and then trust many times over, has been slow but encouraging. Benefits of such attestation include minimized maintenance and management of third party assessments.

HIT and HIM professionals must be prepared to implement newer controls, provide more adaptive and holistic threat and breach management, and prepare to deal with and recover from the potential technical incidents impacting our organizations.

Learn more about third party vendor management in the MRO blog post “Four tips for Business Associate and subcontractor management.”

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