A new report from Verizon Security Research offers insights into how the healthcare industry compares with other industries with regard to data security, and in particular data breaches of various types. On April 27, the organization released its “2017 Data Breach Investigation Report,” the tenth annual such report, based on researchers’ examination of actual cyberattacks in several different industries.
Researchers have analyzed more than 42,000 cybersecurity incidents and nearly 2,000 data breaches from across 84 different countries, and from across several industries, defined as “accommodation and food services,” “educational services,” “financial and insurance,” “information,” manufacturing,” “public administration,” “retail,” and “healthcare.”
In the press release accompanying the release of the report, it was noted that “Healthcare has the unenviable task of balancing protection of large amounts of personal and medical data with the need for quick access to practitioners. Internal actors are well represented, with employees accessing patient data out of curiosity, or to commit identity fraud.” Meanwhile, the report’s authors noted, “privilege misuse, miscellaneous errors, and physical theft and loss represent 80 percent of breaches within healthcare,” with 68 percent of the threat actors being internal, 32 percent external, and 6 percent “partner.”
The report’s authors write of healthcare, “Being an information security professional for a healthcare organization is not easy. You have to deal with a multitude of medical records, stored electronically (in centralized databases and laptops alike), and possibly still on paper,” they note. “Those records also have personal information (name, address, social security number) often riding along. This information needs to be accessible quickly for patient care, so draconian access control mechanisms may do more harm than good. Another item to add to the ‘things-that---healthcare-CISOs’ list is the disclosure requirements for the industry. Insider misuse is a major issue for the Healthcare industry,” they point out. “In fact it is the only industry where employees are the predominant threat actors in breaches. Interestingly enough,” they write, “figure 20 shows the insiders’ motives are almost equally divided between financial and fun. This is a product of a lot of sensitive data that may be accessed by legions of staff members containing PII —that is perfect for identity theft—and medical history (sometimes of friends or relatives), that is very tempting for enquiring minds (that want to know!).”
What’s more, they state, “Doctors losing laptops, X-rays accidentally ending up in landfills, and employees giving J. Tinker’s discharge papers to J. Evers (and Evers’ to Chance) all help Miscellaneous Errors remain a top 3 pattern again this year. The breach counts in Figure 21 show that misdelivery, disposal errors and lost assets combine for almost 30 percent of all healthcare breaches—showing that it isn’t just malicious insiders that you need to worry about.”
One important qualification in terms of the methodology and conclusions in the report is around they’ve defined ransomware. “In our dataset, ransomware attacks are not counted as breaches, because typically we cannot confirm that data confidentiality was violated,” the report’s authors note. “However, the U.S. Department of Health and Human Services (HHS) has given guidance that ransomware incidents should be treated as a breach for reporting purposes. This year, ransomware accounts for 72 percent of malware incidents in the healthcare industry.”
Drilling down across all types of data breaches and across all seven industries covered by the report—accommodation, education, finance, healthcare, information, manufacturing, public, and retail—the report’s authors provide data points on page 10 of the report that offer further insight.
The table on that page spans three conceptual areas—“pattern,” “action,” and asset.”
In healthcare, under the “pattern” category, the data breaches recorded in the report break down as follows, by type; in descending order of numbers, they are as follows: “privilege misuse,” 125 incidents; “miscellaneous errors,” 114; “lost and stolen assets,” 92; “crimeware,” 54; “web app attacks,” 32; “point of sale,” 4; “denial of service,” 3; “cyber-espionage,” 2; and “everything else,” 40. It is interesting to compare the volume of incidents involving “privilege misuse,” “lost and stolen assets,” and “crimeware” in healthcare, with the volume of those types of other incidents in other industries, internationally. In that context, the volume of such incidents in healthcare parallels the volume of such incidents in the public sector, and differs from such volume across the accommodation, finance, education, manufacturing, and retail industries.
Meanwhile, in the “action” section, the categorization of data breaches in healthcare breaks down as follows: “error,” 154 incidents; “misuse,” 125; “hacking,” 84; “physical,” 73; “malware,” 66; and “social,” 37. In this “action” section as well, the volume of incidents in these specific categories, in healthcare, matches the public sector as well, and contrasts with the patterns of action in the other major industries.
And in terms of assets involved, the breakdown is as follows: “server,” 184; “media, 145; “user dev,” 76; “person,” 41; and “network,” 3.
The day after the release of the report, its lead author, Marc Spitler, a senior manager at the Washington, D.C.-based Verizon Security Research, a division of the Baskin Ridge, N.J.-based Verizon Enterprise Solutions, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the report, and his perspectives on data breach issues in healthcare, compared with those in the other industries that he and his team studied for the report. Below are excerpts from that interview.
Overall, how would you compare healthcare with the other industries you looked at for the report?
It’s a fascinating industry to look at; and it was one of the key reasons that we did an industry-by-industry view. It’s interesting that you picked up that the patterns were closest to the public, or government sector [which also includes law enforcement]. We get a lot of data from both sectors, because of the disclosure requirements for both sectors. Misappropriation of devices and other issues have to be disclosed. So for example, we can pick things up right from the HHS website. We have a really good view into both of those industries, which is why we always try to carefully frame things. And we say, don’t look at this and decide that one industry is ‘better’ than another. That being said, both healthcare and the public sector can have multiple motivations going against them, and they both have an insider threat.
The fact that healthcare actually has a majority of internal actors behind the data breaches, that’s certainly interesting. That’s why I enjoy talking about, what are the struggles of a security practitioner in healthcare? Their jobs are so difficult. A lot of people have access to data that is either rife for identity fraud, or for curiosity. And we see the same thing in the public sector—that ‘fun and curiosity’ motive, in criminal databases, where people in a police department will look at the criminal records of people without authorization.
The use of audit trails and behavioral monitoring to detect and prevent data breaches is becoming more and more important in healthcare. Is that also true in other industries?
Yes, absolutely. Regardless of what industry you’re in, one of the main tactics of a cybercriminal is that, once they get in, they’re not going to launch every area they can get into, because that will trigger awareness of their activities, so they’ll want to trigger some malware, etc. And so you need to monitor activities, because it’s not just about employees, anymore, it’s about everybody. So it’s paramount for healthcare to do this, but it’s not unique.
Is healthcare behind other industries in its capability to ramp up to meet cybercriminality and other causes of breaches?
It’s very hard to compare attempts to malware breaches. That said, there are trends in healthcare that I’d like to see changed. And in healthcare, not only do you have lots of people with access to data that everybody needs all the time, for patient care, and there’s that curiosity, that internal threat; also, the use of credit card incidents exists in healthcare as well in other industries. I’d also like to see a downtick in the number of lost and stolen devices in healthcare. It’s 2017: it’s time to encrypt your laptops and your thumb drives. And if a doctor leaves a laptop or smart phone or tablet on the subway. It’s not a data breach, it’s a security incident.
Is healthcare worse than other industries in terms of data being potentially exposed through loss or theft of devices?
I’m not willing to make that statement. There is an element of exposure. The thing is, it happens in other industries; they just don’t have to report it. So healthcare needs to encrypt.
Is there anything that stood out for you or that was surprising, in the healthcare industry results?
No, we definitely saw an increase in ransomware, but we saw that across industries. And in terms of how we categorize events as incidents or confirmed data breaches—we typically don’t categorize ransomware as a data breach unless there’s evidence of data exfiltration. That’s somewhat different from how ransomware is categorized. So I’m not sure that healthcare is more targeted than other industries; it appears opportunistic. I’m not going to make the statement that you’re more likely to get hit in healthcare; most ransomware turns out to be opportunistic. The challenge in healthcare is that the data access is constantly needed for the most noble of purposes, patient care. We do see it in what I call the ‘spray and pray’ spear-phishing attacks, as well as drive-by attacks, which are typically opportunistic in nature. So I’m not going to say you’re worse in healthcare than anyone else; but certainly, you’re a high-value target; and the data is very important.
What will happen in the next couple of years, in healthcare and in other industries?
I’m always looking for simple solutions. I’ve already talked about one, which is encryption. So I’d like to see encryption become more commonplace. I know there won’t be a reduction in loss or theft of assets, but I’d like to see those devices being encrypted beforehand. And I’d like to see greater awareness of the staff that in fact, we are auditing your access. It may not stop everything, but a good, solid warning banner, combined with security awareness training, could really help. Tell your staff, if you’re being nosey and curious, we’re going to find you out. And hopefully, that message will be received loud and clear.
Is there anything else you’d like to add?
It’s good to have a thorough conversation about the healthcare industry. I’m hoping that your readership will be able to take a look at that section and nod their heads. It will affirm how challenging it is to do their jobs. And what is the culture and the nature of the industry? And what are the business conditions, and why would that influence what the adversary is doing? And a lot of that is internal.