Live data from Hacker News

Hospitals are a weak spot in U.S. cybersecurity

axios.com

121–130 of 166 posts

Re: Hospitals are a weak spot in U.S. cybersecurity

#121
I work in health tech (full stack insurance), and sit next to security and IT, so this is a frequent topic of conversation for us. :)

For some context, this is one of our favorite websites/datasets: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf.

It is a structured archive of all reported health data breaches, major or minor, over the last 15 years or so, as reported by the breached entities. They’re required to report breaches as part of HIPPA compliance, or something related to it.

It’s a fascinating quilt of stories, with patches for phishing, accidental email attachments forwarded, and rogue admins. Fun reading. You can also load it into sqlite and find some interesting results (leakiest companies, states with most breaches reported, etc).

Hospitals might be a weak spot, but at least their weaknesses are ruthlessly well documented! As opposed to, say, financial infrastructure which IME is a similar horror show of monkey patched sftp servers.

Solving this collective technical debt is a massive coordination problem. It’ll be interesting to see if we ever get there. My suspicion is that the changes will be driven by monopolistic insurers, if ever, since that’s where all the money comes from (if you go to doctor at hospital X, your coinsurance will be Y instead of Z, because doing business with X is more/less risky due to their documented data practices). But it’s just a suspicion, this kind of thing might not be solved in our lifetimes.

Re: Hospitals are a weak spot in U.S. cybersecurity

#122
post #39

Earlier quoted context omitted.

The famous critique on HITRUST by a healthcare security guy that went viral, calling it "Cumbersome, Expensive, and Arbitrary": https://www.linkedin.com/pulse/open-letter-hitrust-alliance-...

Yep, and yet I’ve been able to successfully implement it in a 1 year project in a prior org (as part of a team obviously). HITRUST isn’t that bad, and it’s better than the alternative, which is HIPAA directly. I would best describe HIPAA as Vague, Fruitless, Bureaucratic, and Arbitrary. HITRUST is a huge improvement even if it’s not perfect.

Wasnt HIPAA not intended for security or privacy when it was originally developed? Merely as a standardized approach so various vendors could integrate easier. I could be mis-remembering this though.

Re: Hospitals are a weak spot in U.S. cybersecurity

#123
post #71

Earlier quoted context omitted.

Fax is odd, it was a fantastic thing when it first came about, and it has some desirable properties. - It's direct point to point communication (over a network) - The transport network is dedicated and not open to anyone and covered by quite strong laws in many countries - It's easy to see the history of communications - It's easy to see if the other end successfully received something - It's relatively standardized…

Some points seem contradictory. How do faxes have history that's easy to see, and if the other end successfully received, but it doesn't have delivery receipt like email?

not sure I'm understanding? But fax sends data via a protocol, it knows it has sent by virtue of the protocol completing. The fax can keep trying sending and it will keep track of those faxs that have gone through vs those that haven't. Email doesn't have delivery receipts....it's either done by bolting it on in clients or various hacks used by spamme....errr..email marketing systems.

Re: Hospitals are a weak spot in U.S. cybersecurity

#124
post #103

Earlier quoted context omitted.

Backend is all MUMPS. Frontend was for a long time coded in Visual Basic 6. VB6/MUMPS stack is... not ergonomic to code in. Epic is easy to hate (it's everywhere), and for good reason. However, the alternatives are not obviously better unless there's been some radical innovation. There are definitely systems designed for a particular piece of a hospital (ex, ER, or labs, etc) that are probably better than Epic is, bu…

> The main problem is that the customer is not the nurses, it's the legal/financial/administrative side. This. The reason my medical staff like me is that I fight for usability for them, and push back against legal when they make requests that aren't backed up by the regulations. Legal hates me for the same reason, I know the regs and I'm willing to fight them on it.

Happen to have an email I could send you? It's sigint security stuff you might want to look into.

My email is jwconway at protonmail dot com.

Re: Hospitals are a weak spot in U.S. cybersecurity

#125
post #47

Healthcare CIO here. This is true. Healthcare is still using paper fax. It has a 30 year old data interchange format that no one really supports because it's more profitable to lock in customers to your EMR. Healthcare is HORRIBLE about upgrading anything, at changing processes, and technological progress in general. Healthcare is VERY backwards from a tech standpoint. Another problem is that EVERYTHING is custom, we…

People need to stop hating on fax. Hospitals still use fax because it is a much more punishable crime to tap phone lines which requires physical access, as opposed to a server that could be infected from a hacker halfway across the world.

> Hospitals still use fax because it is a much more punishable crime to tap phone lines which requires physical access

Punishable, sure, but that's CYA thinking. It's less secure, because there's no way to encrypt fax like you can encrypt email. Punishment doesn't help anyone except the CEOs, unless, of course, it was the CEO's information that got leaked.

Also, yes, phone calls are sent over the Internet just like emails. The big difference is, yes, that phone audio isn't encrypted.

Re: Hospitals are a weak spot in U.S. cybersecurity

#126
post #47

Healthcare CIO here. This is true. Healthcare is still using paper fax. It has a 30 year old data interchange format that no one really supports because it's more profitable to lock in customers to your EMR. Healthcare is HORRIBLE about upgrading anything, at changing processes, and technological progress in general. Healthcare is VERY backwards from a tech standpoint. Another problem is that EVERYTHING is custom, we…

What if there was an open source EMR? *nix backend with browser interface. The huge amount of money saved could pay for support, customisation and implementation. Perhaps I’m being naive, but a system where the institution has more ownership would go down well I think. We are about to get an Epic EMR and all the clinical staff are basically expecting a catastrophe.

Re: Hospitals are a weak spot in U.S. cybersecurity

#127
post #81

Earlier quoted context omitted.

In my world they sure are. Want health records on your iPhone? Well that comes via FHIR. You can even see the FHIR resource JSON in the Health app. But there are many systems in a hospital. And as EuphoricEmu pointed out within the hospital, admits, discharges and movements throughout the hospital are still done via HL7v2 (a delimited and structured format). Additionally, I would absolutely NOT build a new system on…

Unfortunately consumer-facing use cases are the ones big EMR vendors like Epic are focusing on with FHIR, push is often neglected or left out meaning we still have to rely on good old HL7v2 to get real time feeds out of the system.

FHIR Subscriptions do exist.

Re: Hospitals are a weak spot in U.S. cybersecurity

#128
post #126
post #47

Healthcare CIO here. This is true. Healthcare is still using paper fax. It has a 30 year old data interchange format that no one really supports because it's more profitable to lock in customers to your EMR. Healthcare is HORRIBLE about upgrading anything, at changing processes, and technological progress in general. Healthcare is VERY backwards from a tech standpoint. Another problem is that EVERYTHING is custom, we…

What if there was an open source EMR? *nix backend with browser interface. The huge amount of money saved could pay for support, customisation and implementation. Perhaps I’m being naive, but a system where the institution has more ownership would go down well I think. We are about to get an Epic EMR and all the clinical staff are basically expecting a catastrophe.

The VA's old system (VistA) is that open source solution - but other hospitals didn't want to use or buy it.

I think the EMR industry is driven more by safety, liability, and revenue for hospitals (in that order) than by patient/physician desired features or security.

It's also difficult to build tooling that interconnects across all of the medical specialties - and with the amount of customization that some providers want.

Re: Hospitals are a weak spot in U.S. cybersecurity

#129
post #128
post #126

Earlier quoted context omitted.

What if there was an open source EMR? *nix backend with browser interface. The huge amount of money saved could pay for support, customisation and implementation. Perhaps I’m being naive, but a system where the institution has more ownership would go down well I think. We are about to get an Epic EMR and all the clinical staff are basically expecting a catastrophe.

The VA's old system (VistA) is that open source solution - but other hospitals didn't want to use or buy it. I think the EMR industry is driven more by safety, liability, and revenue for hospitals (in that order) than by patient/physician desired features or security. It's also difficult to build tooling that interconnects across all of the medical specialties - and with the amount of customization that some provider…

Hey thanks, I hadn't heard about it [1]. Apparently VistA has the highest user satisfaction of any EHR! Sounds like what is missing is the equivalent of Red Hat, which can support and implement the product, although implementation would be much more involved.

[1] https://en.wikipedia.org/wiki/VistA

Re: Hospitals are a weak spot in U.S. cybersecurity

#130
post #27

Earlier quoted context omitted.

Specialist I went to attempted to collect a photograph in the waiting room, as well - "please hold still a second while I take your picture for the doctor", with a webcam sitting atop the counter between us.

these are times when i say no thankyou thats not medically necessary, and obsruct the cam or turn around if its unobstructable.

> attempted

:)

Post reply on HN