[BreachExchange] Defending Hospitals against Life-Threatening Cyber Attacks

[Audrey McNeil]

https://www.scientificamerican.com/article/defending-hospitals-
against-life-threatening-cyber-attacks/

Like any large company, a modern hospital has hundreds—even thousands—of
workers using countless computers, smartphones and other electronic devices
that are vulnerable to security breaches, data thefts and ransomware
attacks. But hospitals are unlike other companies in two important ways.
They keep medical records, which are among the most sensitive data about
people. And many hospital electronics help keep patients alive, monitoring
vital signs, administering medications, and even breathing and pumping
blood for those in the most dire conditions.

A 2013 data breach at the University of Washington Medicine medical group
compromised about 90,000 patients’ records and resulted in a US$750,000
fine from federal regulators. In 2015, the UCLA Health system, which
includes a number of hospitals, revealed that attackers accessed a part of
its network that handled information for 4.5 million patients. Cyberattacks
can interrupt medical devices, close emergency rooms and cancel surgeries.
The WannaCry attack, for instance, disrupted a third of the UK’s National
Health Service organizations, resulting in canceled appointments and
operations. These sorts of problems are a growing threat in the health care
industry.

Protecting hospitals’ computer networks is crucial to preserving patient
privacy—and even life itself. Yet recent research shows that the health
care industry lags behind other industries in securing its data.

I’m a systems scientist at MIT Sloan School of Management, interested in
understanding complex socio-technical systems such as cybersecurity in
health care. A former student, Jessica Kaiser, and I interviewed hospital
officials in charge of cybersecurity and industry experts, to identify how
hospitals manage cybersecurity issues. We found that despite widespread
concern about lack of funding for cybersecurity, two surprising factors
more directly determine whether a hospital is well protected against a
cyberattack: the number and varied range of electronic devices in use and
how employees’ roles line up with cybersecurity efforts.

A WIDE RANGE OF DEVICES

A major challenge in hospitals’ cybersecurity is the enormous number of
devices with access to a facility’s network. As with many businesses, these
include mobile phones, tablets, desktop computers and servers. But they
also have large numbers of patients and visitors who come with their own
devices, too—including networked medical devices to monitor their health
and communicate with medical staff. Each of these items is a potential
on-ramp for injecting malware into the hospital network.

Hospital officials could use software to ensure only authorized devices can
connect. But even then, their systems would remain vulnerable to software
updates and new devices. Another key weakness comes from medical equipment
offered as free samples by device manufacturers who operate in a
competitive market. They’re often not tested for proper security before
being connected to the hospital network. One of our interviewees mentioned:

“In hospitals … there’s a whole underground procurement process whereby
medical device vendors approach clinicians and give them lots of stuff for
free that eventually makes its way on to our floors, and then a year later
we get a bill for it.”

When new technologies bypass regular processes for purchase and risk
assessment, they aren’t checked for vulnerabilities, so they introduce even
more opportunities for attack. Of course, hospital administrators should
balance these concerns against the improvements in patient care that new
systems can bring. Our research suggests that hospitals need stronger
processes and procedures for managing all these devices.

STAFF BUY-IN

Getting hospital administrators to understand the importance of
cybersecurity is fairly straightforward: They told us they’re worried about
costs, institutional reputation and regulatory penalties. Getting medical
staff on board can be much more difficult: They said they’re focused on
patient care and don’t have time to worry about cybersecurity.

People typically treat cybersecurity protections as secondary to what
they’re trying to get done. One person we interviewed described why some
staff committed the cardinal cybersecurity sin of sharing a password:

“To use an ultrasound machine [you need a password, which] has to change
every 90 days. [Staff] just want to use the ultrasound machine. It’s not
holding a lot of patient data … so they create a shared login so that they
can provide patient care.”

The needs can vary widely across a hospital, in ways that can be
surprising—such as access to sites likely to carry malicious software. A
chief information officer at a research hospital told us,

“I personally believe that hardcore pornography has no purpose on hospital
supported devices. What did I do five years ago? I put up internet content
filters that prevented people from navigating to pornography. Within five
minutes, the director of psychiatry calls to tell me that we have a grant
to study pornography in a medical context [so we had to modify our
filters].”

These experiences are why we concluded that budget limitations are not as
crucial to hospital cybersecurity as employee involvement. A hospital can
buy as many pieces of hardware and software as it wants. If workers aren’t
following organizational procedures, the technology won’t keep hospitals
safe. Our research suggests that cybersecurity is as much about managing
people as it is about technology.

COMPLIANCE IS NOT SECURITY

The threat is nationwide, and keeps getting harder to defend against, as
one chief information security officer told us:

“The nature of attacks is increasingly sophisticated. It used to be my
biggest threat was … students. Today, it’s state-sponsored attacks,
terrorism and organized crime. It’s more threats than ever before of a more
serious nature.”

Unfortunately, many hospital administrators seem to believe that protecting
data is as simple as meeting state and federal regulations. But those are
minimum standards that don’t adequately address the threat. As one of our
interviewees said,

“Compliance is a low bar. I guarantee that little health care organizations
and hospitals would do nothing (without regulation). They would have a
piece of paper on a shelf called their security policy. It’s needed as a
backstop to get companies at least thinking about it. But being compliant
does not solve the greater risk management problem.”

Our research shows that hospitals need to think beyond compliance. Also,
with so few hospitals well defended against cyberattacks, all hospitals
appear more attractive as potential targets. In our view, it’s not enough
for hospitals to improve their own defenses—nor for regulators to raise
standards. They should manage, and evaluate the security of, the devices on
their networks and ensure medical staff understand how good cyber-hygiene
can support good patient care. Further, policymakers, health care leaders
and hospitals themselves should work together to make the industry as a
whole less susceptible to attacks that threaten people’s privacy and their
very lives.
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