Tales from the Trenches Show Security Issues Endemic to Healthcare

Mitchell Parker sees a great deal wrong with information security, especially in the healthcare industry, where he has worked for more than a decade.  

As the chief information security officer for Indiana University Health, he has seen a spectrum of issues: information overload from risk assessments, ancient — in Internet years — computers managing physical systems and devices, a chaotic mess of password systems that don't interoperate, and legacy data that cannot be decrypted, he said during a virtual Black Hat USA presentation on Aug. 5.

Many of these problems were self-inflicted by security teams finding their way. Other issues occurred because of a common problem: vendors overpromising, even straight-out selling snake oil. From data security companies threatening that government fines would befall those who didn't use their products, to proprietary encryption providers that stop supporting their decryption products, a variety of pitfalls await less-than-skeptical security teams, Parker said. 

"If someone says that you can try and solve all your problems for you instantly, that's how you know that you have snake oil," he said during his presentation. "Or someone claims they can fix everything without talking to you or analyzing or trying to meet your needs."

Well-implemented policies, some specific technologies, and a communicative security group can provide organizations with a strong cyber defense, he said during the briefing.

As an example, he describes a strategy for fighting business email compromise: adding a mandatory callback for a published number whenever an executive requests payment, especially if the destination account is overseas, has all but eliminated BEC fraud, he said. Antivirus software? Not very useful. Endpoint detection and response software, however, is much more useful in heading off an emerging compromise.  

The secret weapon against attacks using stolen and reused credentials was, unsurprisingly, two-factor authentication.

"If there is one technology that has stopped the majority of hack attempts, it is good two-factor authentication," he said. "A lot of the attacks find compromised accounts from one health system and they immediately try the credentials against every other health system." 

Security teams that communicate well are those that keep training to less than five minutes, tie any current lesson back to pressing security issues, distill advisories down to less than 200 words, and focus on the top 20% of security assessment results.

Two major issues, however, are not as easy to fix. Medical devices and physical systems often run on, or are managed by, computers running old versions of Windows. These systems tend to have long lifespans and are connected to the Internet, he said. 

"That means while we have done a great job with our desktops and EMRs [electronic medical record systems], we have a lot of unpatched machines with network access running older versions of Windows that are running our physical infrastructure," he said. "And realistically, that Amiga system running the HVAC for a school district in Michigan was more secure because it didn't have Internet access."

The other major issue is data integrity. Health data needs to be secure, but it also needs to be accessible in the future — sometimes 40 years or more into the future, Parker said. Unfortunately, many file systems used in healthcare settings do not have integrity checking. Worse, much of the data is protected by proprietary encryption software.

"We see significant churn in the encryption vendor market, which means that the data you have now will not be decryptable in 10 years," he said. "Open source solutions work, because you will have a better chance to read your data because the software project will be updated and maintained."

Parker also recommended healthcare organizations understand that external assessments don't always deliver a good picture of the organization's security. This is because internal managers and executives are often unwilling to discuss security concerns with external assessment firms.

"No one is going to tell an outsider where the security holes are. Why? Because when people think outsider, they think auditor," he said. "This is not a knock on the big firms I've worked with, but outsiders don't get answers. Insiders do." 

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