Physician cybersecurity

Viruses, malware and hackers pose a threat to patients and physician practices. The AMA has curated resources and tips for physicians and health care staff to protect patient health records and other data from cyberattacks. 

Change Healthcare cyber issue

On Wednesday, Feb. 21, Change Healthcare began experiencing a cyber security issue and isolated its systems to prevent further impact. Optum, UnitedHealthcare, and UnitedHealth Group (UHG) systems were not affected by the issue, according to information provided by UHG. UHG has indicated they have taken appropriate action to contain the incident so that customers and partners do not need to sever network connections and disrupt vital services. Learn more.

Picture Archiving Communication Systems (PACS) vulnerability

Picture Archiving Communication Systems (PACS) are widely used by hospitals, research institutions, clinics and small health care practices for sharing patient data and medical images. In 2019, researchers disclosed a vulnerability in these systems that if exploited could potentially expose patient data. PACS servers are easily discoverable by attackers using simple open source scanning tools. If left unpatched, these systems can expose patient records to unauthorized access. Infected PACS servers can also compromise connected clinical devices and spread malicious code to other parts of your office network. There continues to be a number of unpatched PACS servers still in use today.

The AMA recommends that physicians reach out to their PACS vendors about patching their systems. More information about this vulnerability can be found on this Health Sector Cybersecurity Coordination Center alert (PDF).

Potential Russian cyberattack fact sheet

In a recent brief, the Biden-Harris administration urged the nation’s critical infrastructure, including health care organizations, to harden cyber defenses to prepare for potential Russian cyberattacks. “Based on evolving intelligence” the brief states “the Russian Government is exploring options for potential cyberattacks.” Organizations are advised to mandate multi-factor authentication, protect against known vulnerabilities, back up and encrypt data, and drill emergency plans to prepare for cyberattacks.

Organizations are also encouraged to engage proactively with their local FBI field office or CISA Regional Office to establish relationships in advance of any cyber incidents. For instance, your organization's information technology and security professionals should visit the websites of CISA and the FBI where they will find technical information and other useful resources to help strengthen your medical practice’s cybersecurity.

Privacy and security risks from online tracking technologies

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) and the Federal Trade Commission (FTC) are cautioning hospitals and telehealth providers about the privacy and security risks related to the use of online tracking technologies that may be integrated into their websites or mobile apps and may be disclosing patients’ sensitive personal health data to third parties. Tracking technologies are used to collect and analyze information about how users interact with websites or mobile apps and may continue to track users and gather information about them even after they navigate away from the original website to other websites. 

Ransomware and email phishing attacks are on the rise

Ransomware is a form of malicious software designed to encrypt files on a computer or other device, rendering any files and the systems that rely on them unusable. Malicious actors then demand ransom in exchange for decryption. Ransomware actors often target and threaten to sell or leak data (e.g. business and patient records) or authentication information (e.g. usernames and passwords) if the ransom is not paid. This is particularly concerning if a health system’s EHR or other medical technology is infected. In recent years, ransomware incidents have become increasingly prevalent among health care organizations.

A main conduit for ransomware is your office’s email systems. Email is the preferred attack vector for malicious phishing campaigns. By mentioning current events, threat actors carrying out attacks can craft emails that are likely to capture recipients’ attention and lure them to click a link or download a file containing malicious code—this is referred to as phishing. Given the recent shift to more telework and remote options, organizations and workers face increased risk of falling victim to phishing emails and cyberattacks.

The HHS and the U.S. Cybersecurity & Infrastructure Security Agency (CISA) have created resources and guides to help medical practices and other small business protect against ransomware and phishing:

• Counter Phishing Guide (PDF)
• Ransomware (PDF)

Strengthening Cyber Defenses: CISA’s Free Vulnerability Scanning Service

The Cybersecurity and Infrastructure Security Agency (CISA) offers a wide range of free tools and services to help organizations address their cybersecurity needs. One of the services provided by CISA is its vulnerability scanning tool which regularly monitors and assesses internet-connected technology to evaluate their security health. This tool checks for thousands of vulnerabilities, weak configurations, configuration errors, and poor security practices. By enrolling in CISA’s vulnerability scanning tool, health care organization owners and IT staff can make prioritized decisions to protect their medical practices from cyber threats and disruptions, while also identifying vulnerabilities, improving response strategies, and significantly reducing risk—all of which strengthen defenses against evolving cyber threats. To learn more about CISA’s vulnerability scanning tool, please visit the CISA webpage on the vulnerability scanning services.

New risk assessment tool available

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) and the Assistant Secretary for Technology Policy (ASTP) released a new version of the Security Risk Assessment (SRA) Tool. The SRA Tool is designed to aid small and medium-sized health care organizations in their efforts to identify and assess potential risks and vulnerabilities to electronic protected health information (ePHI) when conducting a risk analysis as required by the HIPAA Security Rule. Conducting an accurate and thorough risk analysis is a foundational activity to protect ePHI from cyber-attacks and to comply with the HIPAA Security Rule.

The downloadable SRA Tool is a desktop application that walks users through multiple choice questions to help identify and assess potential risks and vulnerabilities to ePHI. References and best practices to strengthen an organization’s cybersecurity posture are provided while using the tool.

AMA cybersecurity resources

The AMA has developed tips and advice on protecting your computers and network to keep your patient health records and other data safe from cyberattacks. Download and share with your staff and IT:

• How to improve your cybersecurity practices (PDF)
• Cybersecurity checklist for office computers (PDF)
• Protect your practice and your patients from cybersecurity threats (PDF)
• Infographic: Cybersecurity in health care (PDF)

Creating an informative e-mail campaign

In an effort to spread awareness of cybersecurity across your organization, a packet of infographics, images and posters have been developed along with simple instructions to help you create an informative and engaging email campaign. The email campaign instructions and images can be found in the NCSAM Package.

Additionally, health care and security experts have developed a set useful materials to help guard your entire medical practice against cyberattacks. These materials have been designed with small to medium-sized medical practices in mind.

The main document (Health Industry Cybersecurity Practices) explores the five most relevant and current threats to physician offices and recommends 10 cybersecurity practices to help mitigate these threats. Technical volumes 1 and 2 provides the “how” so physicians and office administrators can implement these practices in their small, medium or large health care organizations.

Government resources for practices

In response to HOD policy, the AMA has developed several cybersecurity resources for physicians. In addition to what is found on this page, please see additional information (PDF) about government resources for practices, cyber hygiene services and Stark Law and Anti-Kickback Statute protections for donations of cybersecurity technology. 

HHS Health Sector Cybersecurity Coordination Center launches cybersecurity website

The HHS Health Sector Cybersecurity Coordination Center (HC3) has recently launched a new website to help physicians and their medical practices be better informed about potential cyber threats. HHS is working with practitioners, health care organizations and cybersecurity experts to understand the threats facing the health care sector, learn the patterns and trends used by malicious actors, and provide information and approaches on how the medical practices and hospitals can better defend themselves.

New guide to assist your cyber hygiene

The HHS has released a cybersecurity implementation guide to help the public and private health care sectors prevent cybersecurity incidents. The "Cybersecurity Framework Implementation Guide," provides specific steps that health care organizations can immediately take to manage cyber risks to their information technology systems. Today's climate of increasingly sophisticated cyberattacks can negatively impact patient care, cripple business operations, expose sensitive health data and harm a practice’s reputation. Additionally, lack of attention to regulatory compliance increases the risk for fines and other penalties. The guide also contains information to assist small health care organizations. 

New HSCC cybersecurity video series for physicians

Cybersecurity is a patient safety issue. The Healthcare Sector Coordinating Council (HSCC) has just released a new one-hour (total) cybersecurity video series to help clinicians better understand the ins and outs of cyber hygiene. The HSCC is a national public-private partnership dedicated to strengthening the nation’s health care critical infrastructure. This “Cybersecurity for the Clinician” video training series includes eight videos explaining in easy, non-technical language what clinicians and medical students need to understand about how cyber attacks can affect clinical operations and patient safety, and what you can do to help keep health care data, systems and patients safe from cyber threats.

EHR cyber vulnerabilities

The HHS cyber agency published an updated threat brief (PDF) outlining common threats to electronic health records (EHR), including phishing attacks, malware, and cloud threats. While EHRs are important components in managing your patients’ electronic medical records, EHRs are valuable targets to cyber attackers because of the protected health information they contain.

Cyber threats can originate from criminals seeking to sell medical records on the dark web or black market. Cybercriminals may also lock down EHRs using ransomware and demand a ransom payment before access is restored to your EHR. Attacks may also originate from threat actors looking to disrupt the U.S. health care system. This brief helps EHR users understand vulnerabilities in their health information technology environment and provides guidance in identifying and preventing attacks—which is key to protecting EHRs and vital patient data.

HIPAA Security Rule for physicians and medical practices

The OCR and the National Institute of Standards and Technology (NIST) have published a resource for physicians and their medical practices to help bridge HIPAA security requirements and good cybersecurity practices. This resource can not only improve compliance with the law but also bolster your cybersecurity. 

The publication provides an overview of the HIPAA Security Rule, strategies for assessing and managing risks to electronic protected health information (ePHI), suggestions for cybersecurity measures and solutions that physicians and medical practices might consider as part of an information security program, and resources for implementing and complying with regulations.

Protecting electronic health information

Most EHR systems have security features built in or provided as part of a service, yet they are not always configured or enabled properly. This can lead to unauthorized access to your patients’ electronic health information. It is important to learn about the basic features of your EHR and ensure they are functioning and are updated when necessary. Health care organizations—along with their EHR vendors—should make protecting their EHRs from cyber threats a top priority in order to keep their patients safe and secure. This document developed by the HHS (PDF) lists several resources that can strengthen the cybersecurity in your medical practice.

Strong authentication can protect patient records

Strong authentication is analogous to a locked door in the cyber world. Weak or non-existent authentication processes leave your computer network open to intrusion by malicious actors and increase the likelihood sensitive information will be compromised—including patients’ electronic health information and your EHR. Robust authentication serves as the first line of defense against malicious intrusions and attacks. The HHS has published guidance to help physicians implement stronger authentication processes to prevent many cyber-attacks.

Cyber insurance and resources for small practices

The HHS cybersecurity advisory group recently posted a newsletter (PDF) highlighting several health care cyber articles. These include information on cyber insurance and incident response protocols for small medical practices.

Incident response is the ability to discover cyberattacks and prevent them from causing harm. Incident response is often referred to as the standard “blocking and tackling” of information security. Small organizations are often challenged by incident response management. HHS provides recommendations to establish and implement an incident response plan.

New tool to help small- and medium-sized medical practices assess security risks

The OCR and the Office of the National Coordinator for Health Information Technology (ONC) at the HHS have released version 3.4 of the Security Risk Assessment (SRA) Tool. This tool is designed to aid small- and medium-sized health care organizations in their efforts to assess security risks. Conducting a yearly security risk assessment is required to be compliant with HIPAA. The latest version of the SRA Tool contains a variety of feature enhancements based on user feedback and public input.

HHS HIPAA video series

The HHS has created several tools and resources to help medical practices defend against cyber-attacks. HHS’ first video includes examples of real-world cyber-attack trends and explores how implementation of appropriate HIPAA Security Rule safeguards can help detect and mitigate common cyber-attacks. The next video covers the HIPAA Security Rule’s Risk Analysis requirement. The webinar discusses how a thorough assessment of potential risks and vulnerabilities is key to good cyber-hygiene.

The AMA continues its advocacy work to improve health care cybersecurity. 

• AMA letter to OIG on “Solicitation of new Safe Harbors and Special Fraud Alerts" (PDF)
• AMA letter to Congress on cybersecurity and the use of legacy technologies in health care (PDF)
• AMA letter to FDA on "Developing a Software Precertification Program: A Working Model" (PDF)
• AMA statement to FDA on intersection of big data, privacy and competition (PDF)