Mobi health2016 - Driving forces shaping healthcare

How To Make It Happen

Enrico FrumentomobiHealth Conference – Milan –

15th November 2016

“which are the driving forces shaping healthcare”

WHO AM I ?

• I am a “Security Guy” coming from a long healthcare experience

• HEALTHCARE• Telemedicine• Mobile health

• OFFENSIVE SECURITY• Malware • Social engineering• Intrusion• Innovative security system• Cyber-crime/cyber-terrorism

• @ ENRICOFF

copyright © 2016 Cefriel – All rights reserved

TWO BASE STATEMENTS

MCKINSEY• As the price of healthcare rises and safety lapses persist, developed countries are

seeking ways to lower costs and improve quality. Many are finding the solution in digital innovation.

MYSELF • [..] healthcare operators and patients’ worlds are highly digitalized, modifying how

healthcare operators and patients offer and use services.

• Today healthcare is again at the forefront: as one of the most attacked and promising areas of exploitation for cybercriminals and cyberterrorists due to the abundance of valuable information and for its role in critical infrastructure.


MCKINSEY REPORT

The study identifies three driving forces through which digital innovation is transforming HC• Improve care-delivery models through seamless data and information exchange• Harness the power of data through transparency and advanced analytics• Process digitalization and automation


LET ME INTRODUCE A WIDER POINT OF VIEW


WASPWirelessly Accessible Sensor Populations

No. 034963 No. 653618 No. 607642

MUSESMultiplatform Usable

Endpoint SecurityNo. 318508

TABLE OF CONTENTS


Society is getting older & more dynamic

Blended lifestyle

Smart Ecosystems

Future of the workforces

BLENDED LIFESTYLE



BLENDED LIFESTYLE

Smart Ecosystems


Tablet PC TabletConnected car

PC TV Tablet Tablet

Breakfast Transfer Office Lunch After DinnerMeeting Office Sleep

6:30 am 11:00 pm

MobileWearable

Connected car

Mobilewearable

Shopping

Mobile

12:00pm

SMART ECOSYSTEMS



Blended lifestyle

SMART ECOSYSTEMS


• Digital experience continuity nowadays are specialized for different contexts: for example the smartcars ecosystem or the home automation ecosystem.

• Contextual Intelligent Quotient (CQ), meant as the ability to constantly analyze the surrounding reality from different, uncorrelated points of view and adjust the decision making process in a matter of days/weeks.

• Spread across a wide range of citizens of a blended style of living

ECOSYSTEMS AFFECT HOW HEALTHCARE SERVICES ARE OFFERED

SMART ECOSYSTEMS



Blended lifestyle

SMART ECOSYSTEMS


FUTURE OF THE WORKFORCES

copyright © 2016 Cefriel – All rights reserved *CLOUT = Cloud of Things

CLOUT*


Blended lifestyle

Smart Ecosystems


• Moving to the humans is the new wave, a citation that represents the new trend in healthcare, of moving data and not people.

• For both patients and health operators.

MOVING TO THE HUMANS IS THE NEW WAVE



Blended lifestyle

Smart Ecosystems



Moving to the humans

PATIENT ECOSYSTEM



Patient ecosystem


• The “Patient Ecosystem” consists in the evolution of the Hospital as a place of care to a network of services for patients, provided in home environments, smart cities etc.

• For healthcare operators too..

• The healthcare infrastructures are rapidly becoming a network of services

ECOSYSTEMS IN HEALTHCARE


ECOSYSTEMS IN HC

DIGITAL ECOSYSTEM

PATIENT ECOSYSTEM

HEALTHCARE OPERATORS ECOSYSTEM


Patient ecosystem


• ICT Ecosystem: a network of integrated services that can interact with each other to offer the user a unique and seamless vision.

• Human Ecosystem: a community of people who interact, exchange information, combine, evolve in terms of knowledge, skills and contacts, in order to improve their lives and meet their own needs.

network of interconnected ICT services

ubiquitous assistance services.

ubiquitous care giver services.

ECOSYSTEMS IN HEALTHCARE


Patient ecosystem


ECOSYSTEMS IN HC

DIGITAL ECOSYSTEM

PATIENT ECOSYSTEM

HEALTHCARE OPERATORS ECOSYSTEM


Hosted by:• Hospitals, • National HC system, • as a service.

Enabled by culture, personal mindsets and habits (e.g., blending lives) and technologies, not only into the hospital (e.g., patients’ mobile apps)

Ecosystem Manager

PERSONAL BIG DATA-SPACE




Patient ecosystem

Personal big data-space

KEY ELEMENTS• Purpose of use (healthcare, wellness, profiling, …)• Level of privacy/security (sensitive, non sensitive, …)• Methods used to collect the data (HC/wellness professionals, medical devices, …)• Quality of data• Ownership of the data

• Source: “The Role of Machines in our Changing Concepts of Identity”, Talk-in-the-tower Task Force 1: Personal information space, http://mcaf.ee/5th0ug

• It is the sum of our personal data, generated by the different applications or different areas of interest, often overlapping.

http://mcaf.ee/5th0ug

BIG-DATA ANALYSIS



Patient ecosystem


Big-data analysis


• Advanced data analysis is often one of the key elements that differentiate one health service from another and healthcare is just starting to mine value from the amount of accumulated personal data.

HEALTHCARE SYSTEM CONGESTION



Patient ecosystem


Big-data analysis

Healthcare system congestion


• The congestion of the healthcare infrastructures is a consequence of the increasing number of people that need to be served

• “Population ageing is a triumph of humanity but also a challenge to society”, World Health Organization: Active Ageing: A Policy Framework. Geneva (2002)

• Source: WHO, European Health Information Gateway - http://mcaf.ee/leo7mh

http://mcaf.ee/leo7mh

EARLY DISCHARGE FROM HOSPITALS



Patient ecosystem


Big-data analysis


Early discharge from hospitals


• The foreseen increasing number of people using healthcare services pushes hospitals to increase the turnover of patients favouring the access to remote healthcare services

• Source: WHO, European Health Information Gateway - http://mcaf.ee/leo7mh

http://mcaf.ee/leo7mh

ASSISTED LIVING SYSTEMS & HOME-CARE HOUSES



Patient ecosystem


Big-data analysis



Assisted living systems Home-care houses


• The increasing adoption of remote assisted living systems is a consequence of the evolution of Hospitals from a place of care to a network of delocalised services

• The growth of the ecosystems also leads to a corresponding increase in the number of “hospitalised” environments

Smart environments (re)used also for HC

PERVASIVE HEALTHCARE SOLUTIONS



Patient ecosystem


Big-data analysis



Assisted living systems

Pervasive healthcare solutions

Home-care houses


• Pervasiveness of healthcare solutions is also a consequence of the ultra-mobile habits of people, who move more frequently, and the increasing wish of patients to continue their lives as much as possible when cured.

HOSPITAL 2.0 (THE BLENDED HOSPITAL)



Patient ecosystem


Big-data analysis





Home-care houses


• Source: PRECIOUS Project, http://www.thepreciousproject.eu/

http://www.thepreciousproject.eu/

HOSPITAL 2.0 (THE BLENDED HOSPITAL)



Patient ecosystem


Big-data analysis





Home-care houses


• Mobile patients• Mobile healthcare operators• HC service• Smart Environment (both sides)

SECURITY - HEALTHCARE UNDER ATTACK?



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

Source: Bitglass 2016 Healthcare Breach Report , US data

• average cost of generic identity breaches $154 (source: Ponemon)• average cost of PHI $363

EUROPE (absolute HC breaches)• 2014 : EU/WORLD = 32/448 → 29 UK, 1 DE, 1 NL, 1 IL • 2015 : EU/WORLD = 25/446 → 19 UK, 1 DE, 2 NL, 1 DK, 2 SRB• 2016 : EU/WORLD = 20/375 → 17 UK, 2 DE, 1 TR

Q3.2016 • #375 breaches, • #data stolen equals

80% of the breaches in all 2015

(Source: Gemalto, http://breachlevelindex.com/)

http://breachlevelindex.com/


Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

TODAY• Patient Health Attack

Model • Physician Health Attack

Model

(Source: Independent Security Evaluators, http://mcaf.ee/thwxza)

SECURITY - THREATS - HOW MANY WAYS TO ATTACK?


http://mcaf.ee/thwxza

SECURITY - THREATS



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

TODAY• Ransomware

• casual infections • Still haven’t seen specific ransomware e.g., targeting DICOM/HL7

• High Value of healthcare records on black-market• High vulnerability of the Hospitals to new threats• Easy to break software used in Healthcare (e.g., PACS)• Branches (small hospitals) not tightly connected with main Hospital, and less

prepared• .. including also their Business Associates (BAs)

• Regulations are not enough (e.g. regulation «one size does not fit all», HIPAA)• Low cyber-citizenship training for HC operators and patients• Still to come regulations among states

• e.g. GDPR and its consequences for EU healthcare services

SECURITY - THREATS



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

TOMORROW• Cyber murder• Combined Cybercrime and terrorism• "Disappearing" technologies, IoT (ultra-mobile, wearable, implantable, …)• The human side of security

• Moving to the humans is the new wave, also of the attackers• Healthcare is more vulnerable to SE than other sectors• Evolution of Social Engineering

SECURITY - THREATS - HUMAN SIDE OF SECURITY



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

SOCIAL ENGINEERING 2.0




Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

Social engineering is an attack vector that relies

heavily on human interaction (also mediated) and often involves tricking

people into breaking normal security

procedures, or performing requested actions (e.g.

clicking on links).




Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

• Situation in 2016 (Q2.2016) of attacks. • Source: "Phishing activity trends report unifying the global response to

Cybercrime," AntiPhishing Working Group (APWG), Oct. 3, 2016. [Online]. Available: http://docs.apwg.org/reports/apwg_trends_report_q2_2016.pdf

Human enabled threats: 95,22%

Automatic attacks: 4,87%

http://docs.apwg.org/reports/apwg_trends_report_q2_2016.pdf




Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

• What is cybersecurity today?• From geek-driven to business-

driven.

• www.dogana-project.eu

The DOGANA project focuses on the impact and the remediation of the human factor in security, which is one of the most demanding challenges of today’s security and for which no widely accepted and stable solutions currently exist.




Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

http://www.dogana-project.eu/

SECURITY - SOLUTIONS



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

• “After spending billions of dollars migrating to electronic health records, the health care industry is now looking to beef up its spending on data security” (source: Politico, 2015)

• Innovative penetration testing programs (see DOGANA)• Innovative awareness programs (together both patients and HC operators)• Mobile terminal management• Secure code development• “Immersion effect” also for security solutions (usability of security)• Adopt best practices of other application areas (e.g., banking)

HOW TO MAKE IT HAPPEN THEREFORE ?!?



Patient ecosystem


Big-data analysis





Home-care houses


SECURITY

HOW

MODERNIZE DATA INFRASTRUCTURES

CREATE INCENTIVES FOR NEW MINDSETS

ADJUST LEGAL FOR DATA EXCHANGE AND SOFTWARE

SECURITY


THANKS FOR YOUR ATTENTION

@ ENRICOFF@DOGANAproject

Mobi health2016 - Driving forces shaping healthcare

Healthcare

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