Information SecurityIn Healthcare Environments

Nicholas A. Davis, CISA, CISSPInformation Security ArchitectUniversity of Wisconsin-MadisonDivision of Information Technology (DoIT)

Introduction

• Background• Thank you for the invitation• Today’s Topic: Information Security

in Healthcare Environments• HIPAA and PHI Controls• Healtcare Environment

Vulnerability• Social Engineering• Precautions You Can Take• Q&A Session

HIPAA and PHI Controls

Information covered by HIPAA must be protected:1.Confidentiality: Only those with a need to know, can see the information.2.Integrity: Only those authorized to alter information, can do so.3.Availability: The information can be accessed by those who are authorized to view it.

HIPAA Obligations

Name, (full or partial)AddressSpecific dates (day and month), but not yearTelephoneFaxEmailWebpage addressComputer IP addressSocial Security NumberAccount identification numbersLicense identification numbersMedical record numbersHealth plan beneficiary numbersMedical device identifiers, such as serial numberAssociated vehicle VINs and other vehicle identification informationAny biometric identifier (fingerprint, eye scan, etc.)Photos and imagesAnything else which can be used to identify a person

Protected Identifiers

Technical controlsAdministrative controlsSome examples, consider your facilityBenefits and drawbacks of each

Types of Controls

Administrative Controls:•Easy to implement•Inexpensive•FlexibleWork best in environments in which people want to do the “right thing”Technical Controls:•Complex to implement•Costly•StringentWork best in environments in which adherence by everyone is critical

Types of Controls

Common points of HIPAA information leakage are:•Video monitors•Printers•Fax machines•Copiers•Unprotected trash binsThe best way to prevent information leakage is to practice the The Minimum Necessary Standard, which means that you should only access the minimum amount of HIPAA related information necessary to perform your job.

Information Leakage

• Create and use a data storage policy, including lifecycle management

• Never leave HIPAA information unprotected, electronically, or physically

• Don’t make un-necessary copies• Destroy electronic media and

paper copies containing HIPAA related information according to appropriate standards, before disposing

Preventing Information Leakage

Lockdown cables for computersLocked office area, lock desk drawersUse strong passwords, which adhere to best practicesLogout, when not in useConsider using a screen protector, to limit visibilityAntivirus, patching of Operating System, etc.Don’t install unauthorized software on your computerDon’t use file sharing services

HIPAA Sensitive Behaviors

• Any mobile device containing HIPAA information, should be encrypted and access protected

• This includes portable USB hard disks, flash drives, etc.

• Best idea is not to use mobile devices for HIPAA related work

Portable Devices

• Infected email attachments• Computer software from non-

secure sources• Websites• Files stored on external

electronic or magnetic storage media

How Computers Become Vulnberable to e-PHI leaks

• Avoid risks associated with malicious computer software

• Protect against unauthorized use of system user IDs and passwords

• Protect portable devices• Adhere to policies and

procedures• Consider using dedicated

computers• Report suspected incidents

HIPAA Security Summary

• Systems must be available when needed

• When things don’t work as planned, there must be an alternate method of access

• No single point of failure is appropriate when it comes to healthcare system access

• Plan your systems for the worst case scenario

Availability -Having a Plan B

Healthcare Environment Vulnerability

Diagnostic EquipmentWorkstationsAnything with an inputAnything connected via a network

Equipment

Nick’s visit to Immediate Care, last nightStaff member locks screen, leaves roomAlone in exam room with computerThe computer appears secured, but is it?

Theoretical Example

USB PortCD Drive

How Is the Computer Vulnerable?

Keyloggers

• Tracking (or logging) the keys struck on a keyboard, typically in a covert manner so that the person using the keyboard is unaware that their actions are being monitored

• Software or hardware based

Physically limit number of methods for machine inputUSB portsCD/DVD drive

•When possible machine itself should be physically secured / encased•When possible, do not leave machine unattended

Lesson Learned

Social Engineering

Technology Is NotThe Entire Answer

Strong computer security has two components:

The Technology: passwords, encryption, endpoint protection such as anti-virus.

The People: You, your customers, your business partners

Social Engineering

The art of manipulating people into performing actions or divulging confidential information

It is typically trickery or deception for the purpose of information gathering, fraud, or computer system access

Most Popular Type of Social Engineering

Pretexting: An individual lies to obtain privileged data. A pretext is a false motive.

Pretexting is a fancy term for impersonation

A big problem for computer Help Desks, in all organizations

Example:

Let’s Think of a CommonPretexting Example

Dear Windows User,It has come to our attention that your Microsoft windows Installation records are out of date. Every Windows installation has to be tied to an email account for daily update.

This requires you to verify the Email Account. Failure to verify your records will result in account suspension. Click on the Verify button below and enter your login information on the following page to Confirm your records.

Thank you,

Microsoft Windows Team.

• You are made to feel as if you are doing something wrong

• You are being pressured into performing an action

• There is a sense of urgency and immediacy

• There is no way to confirm veracity of that which is claimed

Warming Signs of Social Engineering

Phishing

• Deception, but not just in person

• Email• Websites• Facebook status updates• Tweets• Phishing, in the context of the

healthcare working environment is extremely dangerous

Don’t Touch That QR Code

• Just as bad as clicking on an unknown link

• Looks fancy and official, but is easy to create

What Phishing Looks Like

• As scam artists become more sophisticated, so do their phishing e-mail messages and pop-up windows.

• They often include official-looking logos from real organizations and other identifying information taken directly from legitimate Web sites.

Techniques For Phishing

• Employ visual elements from target site• DNS Tricks:• www.ebay.com.kr• www.ebay.com@192.168.0.5• www.gooogle.com• JavaScript Attacks• Spoofed SSL lock Certificates• Phishers can acquire certificates for domains they

own• Certificate authorities make mistakes

Let’s Talk About Facebook• So important, it gets its own slide!• Essentially unauthenticated – discussion• Three friends and you’re out! - discussion• Privacy settings mean nothing – discussion• Treasure Trove of identity information• Games as information harvesters

Socially Aware Phishing

Context Aware

“Your bid on eBay has won!”“The books on your Amazon wish list are on sale!”

Seems Suspicious

Too Good to be True, Even When It Is Signed

DetectingFraudulent Email

Information requested is inappropriate for the channel of communication:

"Verify your account."nobody should ask you to send passwords, login names, Social Security numbers, or other personal information through e-mail.

Urgency and potential penalty or loss are implied:

"If you don't respond within 48 hours, your account will be closed.”

Detecting FraudulentEmail

"Dear Valued Customer."Phishing e-mail messages are usually sent out in bulk and often do not contain your first or last name.

A Note on Spear Phishing

• Designed especially for you• Includes your name• May reference an environment or

issue you are aware of and familiar with

• Asks for special treatment, with justification for the request

Passwords

Your password is your electronic key to valuable resources.

Sharing – Toothbrush DiscussionTheft – DiscussionPassword Rotation - Discussion

Creating a StrongPassword

Following two rules are bare minimal that you should follow while creating a password.

Rule 1 – Password Length: Stick with passwords that are at least 8 characters in length. The more character in the passwords is better, as the time taken to crack the password by an attacker will be longer. 10 characters or longer are better.

Rule 2 – Password Complexity: At least 4 characters in your passwords should be each one of the following:

Creating a StrongPassword

1.Lower case alphabets2.Upper case alphabets3.Numbers4.Special Characters

Use the “8 4 Rule”8 = 8 characters minimum length4 = 1 lower case + 1 upper case + 1 number + 1 special character.

Do not use a password strength checking website! Any ideas why this is a bad idea?

Adware, Malware, Spyware

Adware – unwanted ad software which is noticedMalware – unwanted software which is noticed and potentially causes harmSpyware – unwanted software which goes un-noticed and harvests your personal information

Use endpoint protection!

Adware, Malware, Spyware

How these get on your computer:EmailWeb pagesDownloaded softwareCD, USB flash driveSometimes, out of the box

Trojan Malware

Baiting

Hey, look! A free USB drive!I wonder what is on this confidential CD which I found in the bathroom?

These are vectors for malware!Play on your curiousity or desire to get something for nothing

Don’t be a piggy!

Precautions You Can Take

A Note About Out of Office Assistant

Using the Out of Office responder in a responsible manner – minimum necessary information

Physical Security

• The UW is a fairly open and shared physical environment

• Seeing strangers is normal, we won’t know if they are here as friend or foe

• Lock your office• Lock your desk• Lock your computer• Criminals are opportunistic• Even if you are just gone for a moment• Report suspicious activity to your

administration and UW Police• If you have an IT related concern, contact

the Office of Campus Information Security

Sharing Information WithThe Public

• The University of Wisconsin is an open environment

• However, on occasion, this open nature can be exploited by people with nefarious intent

• Don’t volunteer sensitive information• Only disclose what is necessary• Follow records retention policies• When in doubt, ask for proof, honest

people will understand, dishonest people will become frustrated

Looking In the Mirror

• Which types of sensitive information do you have access to?

• What about others who share the computer network with you?

• The threat from within may exceed external threats

• File sharing software and services• Think about the implications associated

that data being stolen and exploited!

Traveling With Sensitive Information

• Minimum amount necessary• Don’t send as checked baggage• When going through security at the

airport, place computer as last item on conveyer belt and time your walk through concurrently

Questions andDiscussion

Nicholas Davisndavis1@wisc.edu 608-262-3837facebook.com/nicholas.a.davis