Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.
Balancing Needs In The Fight Against Cybercrime
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Radiologists may not consider imaging systems to be at high risk of cyber attack. But it is for exactly this reason that radiologists must be especially careful.
The extension of equipment beyond its expected lifetime, and its reliance on operating systems with out-of-date security can make aging imaging systems an attractive target for hackers. The connection of radiology systems, such as X-ray systems, PET and CT scanners to PACS — and the connection of PACS to electronic medical records systems as part of enterprise imaging initiatives — have upped the ante.
"All it takes is one component — one crimp in the armor — to take down the environment,” said Michael McNeil, head of global product and security services at Philips Healthcare, a leading provider of medical devices and services. A single infected device can spread malware throughout a hospital network, McNeil said.
Increasing the vulnerability of radiology to attack is hesitancy on the part of radiologists to remedy vulnerabilities. “Radiologists may feel they’re not likely to be targeted,” he explained. "Consequently they may look at security measures as an unnecessary burden on their daily routine."
System designers of radiology devices and the IT systems to which they connect must be aware of radiologists' concerns, McNeil said. But they also must do what they can to protect patient data.
Healthcare providers are especially at risk to one of the fastest proliferating and potentially damaging kinds of cyber attack — ransomware. This digital form of extortion uses malware to encrypt the victim's stored data. The cybercriminals hold this data hostage, refusing to decrypt it until the victim pays a ransom.
In February 2016, Hollywood Presbyterian Medical Center in Los Angeles was the victim of a ransomware attack. Hackers encrypted some of the hospital’s systems and demanded a $17,000 ransom to decrypt it. After paying the ransom in Bitcoin, the healthcare facility regained control of the infected systems. But that was three days later.
The need to access digital patient data creates a strong incentive for hospitals to knuckle under to ransom demands. Healthcare providers are being further compelled to give in to demands by their fiduciary liability. Senior executives may be held liable if their institutions lose sensitive patient data.
Bearing such dark-sounding names as CryptoLocker, CryptoWall, CryptXXX, and TeslaCrypt, ransomware has encrypted the computer systems of thousands of organizations in recent years, yielding ransoms running into the hundreds of millions of dollars. Often these are paid in Bitcoins, the attackers’ preferred currency.
According to the U.S. Department of Justice, the number of cyber attacks has quadrupled since 2015, averaging more than 4,000 per day. The United States has been the hardest hit, accounting for 28 percent of malware infections globally.
A prime institutional target of attackers is healthcare whose providers are 4.5 times more likely to be hit by CryptoWall malware than those in other industries.
Assessing Cyber Risk
The industry’s vulnerability to ransomware attacks has put cyber security professionals on notice, according to McNeil. And the manufacturers are responding. “The healthcare industry is going through some growing pains when it comes to (protecting against) ransomware and other threats," he said. "But it is maturing quickly.”
To be effective, cyber security must protect against ransomware as well as other threats. And it must address all medical devices and IT systems within the hospital network, because each connects with others as part of a digital ecosystem. It is, therefore, prudent, according to McNeil, for hospitals and other care providers to partner with medical device manufacturers to create a unified front against cyber attacks.
“At Philips, we provide continuous product security status documents (to customers) indicating the hospital’s potential security vulnerabilities and how to identify, track, and assess these threats,” he said. “We’re focused on ‘security by design,’ meaning we do appropriate risk assessments looking at the different type of threat vectors as they emerge and their potential consequences.”
Among the Philips products receiving special attention is IntelliSpace PACS. This information system is designed not only to facilitate the accuracy and data availability but also the integrity of patient data, according to McNeil. IntelliSpace incorporates high security technical standards so as to maintain confidentiality, integrity, and availability of patient data.
Philips informatics business group, Healthcare Informatics Solution and Service (HISS), has implemented measures that comply with U.S. Department of Defense regulations. These measures, as built into Philips' ISPACS 4.4.550, provide state-of-the-art privacy and security. "We are deploying our solution broadly to everyone, whether you are a military or government organization or not," he said.
Collaboration is essential to reduce the risk of ransomware, McNeil added. Philip’s Security Center of Excellence shares information with leading cyber security researchers and test facilities around the world, assisting them to rapidly eliminate, reduce, and mitigate cyber threats.
This is good news for radiologists and other providers in the chain of patient care. Assured that equipment designers have taken steps to protect patient data as it travels across the hospital’s digital ecosystem, providers can focus on what they do best — providing healthcare.
CEOs and CIOs may decide on purchases, but radiologists are the users of imaging equipment. That makes their experience critically important. When designing radiology equipment, it all comes down to striking an effective balance, according to McNeil.
"We have to make (data flow) as seamless as possible but still secure," he said. "We have to maintain the ability to access information with no degradation in the timing by which those reports and files are accessed."