Being in a healthcare organization that is connected to several major University of California organizations, Sriram (Sri) Bharadwaj, chief information security officer (CISO) and director, information services, at UC Irvine Health (Irvine, Calif.), faces unique cybersecurity challenges compared with his CISO colleagues in other pockets of the U.S. But Bharadwaj says that this distinctiveness has led to a transformed cybersecurity culture at UC Irvine Health, one he hopes can be replicated by other patient care organizations.
In early February, Bharadwaj will be part of an expert panel at Healthcare Informatics’ San Diego Health IT Summit where he and his CISO peers will discuss ransomware risks in the wake of the NotPETYA and WannaCry cybersecurity incidents this year. Bharadwaj recently spoke with Healthcare Informatics Managing Editor Rajiv Leventhal about the current cybersecurity landscape, what threats are most concerning to him, and how being connected to other University of California healthcare organizations is making his job somewhat easier. Below are excerpts from that interview.
How do you see the cyber threat landscape right now in your region? Are things getting better?
The cyber threat landscape has definitely changed. When I look at just the UCs (University of California organizations), or any of the hospitals in our vicinity, they have changed purely for two reasons. First, we have started investing in technologies that help address some of the typical threats that we have seen in our environment. Now, have they been mitigated or remediated? I don’t think so; the threats have morphed into something else now that really needs to be addressed. But if you take a technology that you can use to trap issues at the perimeter rather than at the desktop or endpoint level, now your risk or threat mechanism has shifted to the perimeter rather than to your internal environment. That doesn’t mean the risk has gone away, though.
Second, the insider threats have not gone away; they are becoming more sophisticated in that people are allowing insiders to come through by making an error or mistake where they didn’t know that the threat existed. So you need more intelligent tools to actually understand the threat and then take measures to mitigate it.
Without giving up your “secret sauce,” what are some strategies you have deployed to better secure your data?
The biggest strategy we have implemented is a culture of security awareness. That’s the biggest thing we have done for quite some time now. The level of engagement we have from leadership has shifted from “It’s a security issue” to “I need to inform someone so that this doesn’t impact my organization.” That shift has helped us mitigate some of the risks we see at the insider threat level. The second thing we have done is make considerable investments in tools such as FireEye that allow us to take a look at things from a higher level perspective while also allowing us to share with others.
The FireEye deployment was actually done at the UC level, meaning at the UC Office of the President level, so it applies for all of the UC healthcare organizations. That level of engagement with the Office of the President allows us to look at threats and share threats across the UCs rather than with just one single UC at a time. That’s a big benefit for us.
How unique is this sharing process in your region compared with what goes on in other pockets of the country?
Not only is this unique, but we have also started sharing this information with health systems outside of the UCs. So for example, if there is a threat I see, we now have a relationship with all of the hospitals around us to help them make sure something we see won’t hit them. We have our [annual] CIO Forum with other CIOs in the region that allows all of the CIOs [in this area] to collaborate and figure out how to mitigate threats outside of just one single health system. And that allows us to fortify ourselves in a way so that we have a more robust threat protection rather than being in a reactive mode where you are addressing a threat after you have been hit.
The other thing we have done well is engage with the board at the local and regional levels. We have had conversations with CEOs and compliance officers who have had conversations with other hospital CEOs and compliance officers in this area. And that has created a big advantage for us. Facilitating those conversations gets everyone to understand the issues and understand why we are doing X, Y or Z.
Our conversation with the board started with explaining to them our threats and telling them how we’re doing. We do assessments every year through an external third party, and that assessment done at our level is shared among all of the UCs. And the assessment is used to identify areas of improvement across the organization. We also then look at the tools we deploy and how we could become better at improving our scores.
Three years ago our score was in the 40s or 50s, and now it’s in the top-5 percentile of hospitals across the U.S. Other UCs are applying to get there, but we have gotten there first. So there is definitely a different level of engagement at the senior C-suite level that is helping us [get better]. I also present at our compliance committee to help the [board] understand what these threats are. And almost all the time the question we get asked most is, “What else can we be doing to better protect ourselves?” If that is the level of engagement you are having with the C-suite then you should have no problem identifying either a resource or infrastructure need that you might have.
What are the biggest threats that keep you up at night, as it stands today?
The one area I am most worried about right now is around medical devices. Medical devices are vulnerable purely because of the way they are supported, the way they are put to use, and how the devices are managed. Those are things we need to evaluate.
The other threat is with the new and pervasive devices that our doctors want to use in the [healthcare] environment so they can provide the best care and do what’s best from a population health management standpoint. From a gut feel perspective, you know for sure that you will be addressing a different level of an environment that you now need to prepare for. The days of “everything is in the EMR” are gone, so that means the days of “just protecting the EMR” are gone, too. You have to now look at the broader application portfolio, including medical devices. For example, let’s say you have a network infrastructure that’s segmented in a way so you can identify threats coming from these devices and how they traverse the network. Many hospital organizations don’t have that today and that’s a big issue that we need to hit once we identify the challenges with some of these medical devices.
What advice can you offer for your CISO colleagues who are struggling?
Keep your employees engaged. And that does not just mean asking them to take a course, but I am talking about making security part of the fabric and part of the culture. See something, say something. That’s what we expect our people to do and that’s what is protecting us.
Phishing is very common. Our CEOs and CFOs send me emails every time they believe something could be a phishing message. They are now cautious about opening all emails that might look suspicious; that’s the level we have gotten to. They have realized that they are part of my perimeter and the framework.
The other thing we did is a social engineering mock test where we had the help desk call someone [in the organization] and ask for his or her user ID and password. That test spread like wildfire; we started with one department and in an hour all departments knew about it and started warning others about this caller. That level of engagement we have with our employees really helps keep us on guard. I would tell every CISO to do this.
Finally, I would advise to have that conversation with your C-suite and allow them to understand the threats. Be transparent and open, and help them understand the numbers. CISOs tend to be the technical guys in their own departments, but you should help the board understand that the reason you are there is to protect them. A car going at 65 MPH is going great because you always know that you have the breaks. Your board is going 65 MPH because they rely on you as a CISO to put the right controls in place to make sure they are protected. Show them how you do it.
Can you offer one cybersecurity prediction for 2018?
I have a strange feeling that medical devices will be the next wave to hit us. There will be a worm or something that is released through one of these devices. Some of them are made by companies that are not normally focused on security as a main priority, and there is nothing wrong with that—they are medical device manufacturers. We don’t know as an industry how many of these devices are out there, what OS (operating system) they are running, or if they have already been compromised and are gathering data sitting inside the network. These medical devices are lurking monsters in the back end.
