An investigation into security protocols at several U.S. Navy and Air Force hospitals and clinics found a number of serious security vulnerabilities that left electronic health record (EHR) systems and patient data unprotected from unauthorized access and disclosure, according to a recent U.S. Department of Defense Office of Inspector General report.
The report, “Protection of Patient Health Information at Navy and Air Force Military Treatment Facilities,” states that officials from the Departments of the Navy and Air Force “did not consistently implement security protocols to protect systems that stored, processed and transmitted EHRs and PHI (protected health information) at the locations tested.” Specifically, the DoD OIG identified issues at the Naval Hospital Camp Pendleton, San Diego Naval Medical Center, the U.S. Naval Ship (USNS) Mercy, 436th Medical Group and Wright-Patterson Medical Center.
The report aimed to determine whether the Departments of the Navy and Air Force designed and implemented effective security protocols to protect EHRs and PHI from unauthorized access and disclosure, and the report follows an earlier report found similar security flaws at Defense Health Agency (DHA) and Army facilities.
The OIG investigators visited three Navy facilities—Naval Hospital Camp Pendleton, Camp Pendleton, California; San Diego Naval Medical Center, San Diego; and the U.S. Naval Ship Mercy, San Diego—and two Air Force facilities—the 436th Medical Group, Dover, Delaware and Wright-Patterson Medical Center, Dayton, Ohio. The investigators reviewed 17 information systems at the five locations; 3 DoD EHR systems; three modified EHR systems used aboard the USNS Mercy, two DHA-owned systems and nine service-specific systems.
The security gaps were so significant that both services could be liable for millions of dollars in penalties for violations of the Health Insurance Portability and Accountability Act (HIPAA), according to the report. For example, officials for the DHA, Navy and Air Force considered single-factor authentication, such as a user name and password, more efficient to access PHI while providing bedside care; however, single-factor authentication is less stringent and present a greater risk of compromise, the report states.
Currently, the Defense Department's Military Health System provides medical and dental services to about 9.4 million beneficiaries worldwide at 673 medical treatment facilities, including 55 military hospitals and 373 military medical clinics.
Some of the issues identified at Navy and Air Force hospitals and clinics were related to accessing networks using multifactor authentication, configuring passwords to meet DoD length and complexity requirements, mitigating known network vulnerabilities, granting users access based on the user’s assigned duties, configuring systems to lock automatically after 15 minutes of inactivity, reviewing system activity reports to identify unusual or suspicious activities and access and developing standard operating procedures to manage system access.
When known network vulnerabilities were found, network administrators at all five facilities often failed to address them or mitigate them, the OIG's report said. In addition, the CIOs of the medical treatment facilities did not develop plans of action and milestone to mitigate vulnerabilities affecting their networks.
The report states that at the Dover Clinic, a June 21, 2017 scan revealed that 342 of the 1,430 vulnerabilities identified on a May 10, 2017 network scan remained unmitigated. Those 342 vulnerabilities consisted of 34 critical and 308 high vulnerabilities. Also, the report found that system administrators did not consistently require written justification as a condition to obtain and elevate system access privileges.
The report also found that the lax security protocols stemmed from a lack of resources and guidance, system incompatibility and vendor limitations.
“Without well-defined, effectively implemented system security protocols, the DHA, Navy and Air Force compromised the integrity, confidentiality, and availability of PHI. In addition, ineffective administrative, technical, and physical security protocols that result in a violation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 could cost the medical treatment facilities up to $1.5 million per year in penalties for each category of violation,” the report states.
The OIG report concluded that DoD EHR systems that process, store and transmit PHI for about four million service members, retirees and family members are exposed to greater risks unless actions are taken to improve security and reduce the threat of PHI compromise.
The OIG report recommended that the DHA configure the EHR systems to lock automatically after 15 minutes of inactivity. And, the report recommends medical treatment facility CIOs develop a plan of action and milestones and take appropriate steps to mitigate known network vulnerabilities in a timely manner and implement procedures to grant access to systems based on roles that align with user responsibilities.
Another recommendation was that the surgeons general for the Air Force and the Navy “assess whether the systemic issues identified in this report exist” at other medical treatment facilities.
