Physician cybersecurity

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

The AMA is advocating for you

The AMA has achieved recent wins in 5 critical areas for physicians.

Read Progress Report

The U.S. Department of Health and Human Services (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 discussed the HIPAA Security Rule’s Risk Analysis requirement. The webinar discussed how a thorough assessment of potential risks and vulnerabilities is key to good cyberhygiene. Topics include:

• What does it mean to be accurate and thorough
• How to prepare for a risk analysis
• What purpose does a risk analysis serve once completed
• Examples from OCR investigations
• Risk analysis and risk management resources

Lastly, HHS has developed a downloadable tool designed for small and medium-sized practices to help staff conduct a security risk assessment as required by the HIPAA Security Rule. The tool walks users through the security risk assessment process using a simple, wizard-based approach. Users are guided through multiple-choice questions, threat and vulnerability assessments, and asset and vendor management.

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.

In recognition of National Cybersecurity Awareness Month, The Office for Civil Rights (OCR) has produced a new video for medical practices on how the HIPAA Security Rule can help physicians defend against cyber-attacks. 

This presentation is intended to educate medical practice staff on real world cyber-attack trends and explore how implementation of appropriate HIPAA Security Rule safeguards can help detect and mitigate common cyber-attacks. Topics include:

• OCR breach and investigation trend analysis
• Common attack vectors
• OCR investigations of weaknesses that led to or contributed to breaches
• How Security Rule compliance can help regulated entities defend against cyber-attacks

The video presentation may be found on OCR’s YouTube channel.

The Office for Civil Rights (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. Specific topic areas include:

• Explanations of the HIPAA Security Rule’s risk analysis and risk management requirements.
• Key activities to consider when implementing Security Rule requirements. 
• Actionable steps for implementing security measures.
• Sample questions to determine adequacy of cybersecurity measures to protect ePHI.

The Office for Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC) at the U.S. Department of Health and Human Services (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 is also hosting two webinars to help answer questions and assist medical practice staff with using this tool. Register for the webinars:

• Sept. 13, 12-1:00 p.m. Eastern
• Sept. 14, 3-4:00 p.m. Eastern

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. 

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 U.S. Department of Health and Human Services has published guidance to help physicians implement stronger authentication processes to prevent many cyber-attacks.

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.

The U.S. Department of Health and Human Services 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. 

Using this guide, health care organizations can assess their current cybersecurity practices and risks– identifying gaps for remediation. The guide serves as a roadmap for health care and private health sector organizations to implement four concepts: 

• Guiding risk management principles and best practices.
• Providing common language to address and manage cybersecurity risk.
• Outlining a structure for organizations to understand and apply cybersecurity risk management.
• Identifying effective standards, guidelines and practices to manage cybersecurity risk cost-effectively based on business needs.

The U.S. Department of Health and Human Services’ (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.

Cyber is one of the most significant risks facing the health care sector and it is on the rise. Cyber insurance policies appear to hold more value than in the past but one size does not fit all. HHS has gathered some thoughts to consider when looking at cyber insurance coverage for your practice.

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.

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.

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. 

The U.S. Department of Health and Human Services' (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. 

The U.S. Department of Health and Human Services (HHS) recently launched a new cybersecurity website tailored to help physicians and other health care providers protect their computer systems from cyber threats. Physicians, hospital administrators and IT professionals across all organizations, regardless of size, will find a one-stop site for useful, impactful, and industry-tested resources, products, videos, and tools. These resources can help raise awareness, provide vetted cybersecurity practices, drive behavioral change and mitigate the most current and relevant cybersecurity threats in health care.

Electronic health records are enhanced versions of traditional medical records—making information available instantly and securely to authorized users. Most electronic health record (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 U.S. Department of Health and Human Services (HHS) (PDF) lists several resources that can strengthen the cybersecurity in your medical practice.

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)

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).

A resource from the AMA and the American Hospital Association provides steps physicians should take (PDF) to prepare for the coming months as many physician practices are or have reopened, including cybersecurity and privacy considerations.

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.

This new site lists several resources, including:

• Threat briefs with best practices and information on COVID-19 related cyber threats
• Sector alerts with high-level information to assist non-technical audiences

Responding to a spike in cyber threats that exploit telework technologies during the COVID-19 pandemic, the AMA and the American Hospital Association (AHA) teamed up to provide physicians and hospitals with guidance on protecting a remote work environment from cyber criminals. "Working from home during the COVID-19 pandemic" (PDF) offers actions to strengthen home or hospital-based computers, networks and medical devices from the rise in COVID-19-themed security threats and attacks. The resource includes checklists, sources, tips and advice on strengthening protections to keep pace with deceptive cyberattacks that could disrupt patient care or threaten medical records and other data.

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.

According to a first-of-its kind survey, physicians are greatly concerned about the theft of private patient information and loss of access to critical medication lists, diagnoses and lab results.

The research also showed the physician perspective is often missing from many major cybersecurity efforts. 

The AMA is well-positioned to better include the physician input in cybersecurity efforts going forward.

The main findings identified three key themes:

1. Cybersecurity Is a patient safety issue.
2. Physician practices rely on health IT vendors for network and system security.
3. HIPAA compliance Is not enough to protect patient records.

The AMA has also 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:

• Technology considerations for the rest of 2020 (PDF)
• 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)
• Working from home during COVID-19 pandemic (PDF)

The AMA continues its 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)