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This source is relevant since it goes over various vulnerabilities and how to fix them. I learned that some healthcare providers still do not encrypt data at rest.

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This article goes over the various sorts of cybersecurity hazards there are in healthcare through a vulnerabilities-impact-practice model. Vulnerabilities are mainly common-sense things that simply needed training to avoid. This article goes over vulnerabilities such as lack of encryption of data at rest, which can easily be comprised with a usb attack, but this vulnerability can be patched by implementing encryption at rest.

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This source is a scholarly source since it is written for other researchers, and they have created their own data.

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IOS Press Ebooks - Cybersecurity Challenges in Healthcare
Source #9

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IOS Press Ebooks - Cybersecurity Challenges in Healthcare

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Cyber security attacks evidence has shown that many sectors and industries are still at an insufficient level of readiness to counter these threats, including healthcare organizations and the entire healthcare industry. The COVID-19 pandemic has additionally launched the issue of cyber protection of healthcare systems and connected medical and other devices as well as modern IT components, which are often the entry point for attackers against healthcare organizations.

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This source is useful to me because it talks about cybersecurity difficulties with the context of healthcare. I learned that many healthcare systems are outdated.

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This article talks about the main challenges of Cybersecurity in the healthcare space, and the biggest problems in the context of the healthcare industry. The main reasons that the article talks about is that patient information is very valuable on the darkweb, there is outdated technology in use in many healthcare offices, and there is insufficient cyber risk training among workers.

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This source is a trade source because it is written for those in the cybersecurity industry with a focus on healthcare. Since they did not create any of the evidence it is not a scholarly source.

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Cybersecurity in The Healthcare Industry

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Cybersecurity in The Healthcare Industry

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Cybersecurity in the healthcare industry (cybersecurityguide.org)
Source #8

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Over the past decade, the cyberthreat to the healthcare industry has increased dramatically, along with the sophistication of cyberattacks. Industry and government both recognize this new era. For each improvement delivered by automation, interoperability, and data analytics, the vulnerability to malicious cyberattacks increases as well.

Cyberattacks are of particular concern for the health sector because attacks can directly threaten not just the security of systems and information but also the health and safety of patients.

Healthcare organizations are attractive targets for cybercriminals for three main reasons:

Criminals can quickly sell patient medical and billing information on the darknet for insurance fraud purposes.

Ransomware's ability to lock down patient care and back-office systems make lucrative ransom payments likely.

Internet-connected medical devices are susceptible to tampering.

Cybersecurity issues in the healthcare industry

Health organizations, large and small, are prime targets for cybercrime. The growing number of healthcare-related cyberattacks is an indication that smaller health providers are falling victim to cybercriminals at an increasing rate.

Large healthcare providers often have the resources necessary to mount a formidable cyberdefense strategy. These large hospitals and health provider chains can often afford to hire a chief information security officer, staff a security operations center, and subscribe to the best threat intel services.

Some of the most notable cyberattacks of the last decade were against healthcare institutions.

Community hospitals, independent doctors, and dentists don't often have the luxury of spendy cybersecurity defenses. Yet, they shoulder the same cyber risks and present an equal opportunity for criminals. The American Medical Association states that nearly 57 percent of medical practices in the U.S. have ten or fewer physicians, and about 10 percent are solo practitioners.

Unable or unwilling to pay exorbitant ransoms, many small healthcare providers cannot survive these attacks and feel forced to close their businesses. These practitioners are fully aware that paying a ransom demand, by no means, guarantees that the hacker will release data or equipment. Nor does it ensure that they will not sell your patient's data on the darknet.

The American Dental Association reported that in August 2019, hundreds of dental practices were affected by ransomware. The attack focused on a dental-focused technology provider and locked dentists out of their data.

A ransomware incident in August 2019 forced Wood Ranch Medical in Simi Valley, California, to close its doors on December 17, 2019. A note on their website said, "Unfortunately, the damage to our computer system was such that we are unable to recover the data stored there. With our backup system encrypted as well, we cannot rebuild our medical records," the note continues. "As much as I have enjoyed providing medical care to you, I will not be able to attend to you professionally after that date."

Arguably the most respected and informative security industry annual report is the Verizon DBIR (Data Breach Investigations Report). The 2020 DBIR indicates the substantial increase in the number of breaches and incidents overall is reflected in the healthcare sector. Healthcare suffered a 71 percent increase in breaches or incidents in 2020 over 2019.

Financially motivated criminal groups continue to target the healthcare industry primarily with ransomware attacks. Lost and stolen assets are also a problem, and human error is alive and well in this vertical. Lest one think that most healthcare cyberattacks are launched from some clandestine bunker, it is essential to note that nearly half of the breaches in this sector come from internal bad actors.

Last year the DBIR reported that the healthcare sector had internal actor breaches (59 percent) exceeding those by external actors (42 percent). This year, external actor breaches are more common at 51 percent, while breaches executed by internal actors fell to 48 percent. However, this is a small percentage, and healthcare remains the industry with the highest amount of internal bad actors.

As a glimmer of hope, the 2020 DBIR shows that privilege misuse incidents have declined across the board. In 2019 privilege misuse stood at 23 percent. This year it dropped to 8.7 percent. Privilege misuse is the direct result of poor access control. Users have more access rights than they need to do their jobs, and the organization fails to monitor the activity of privileged accounts properly and establish appropriate controls. The decrease in this type of event can be seen as reflecting improved security policies and training. These indicators denote an increase of security awareness within the organization.

Privilege misuse incidents are responsible for user errors that result in data loss or unauthorized access by an adversary. Privilege misuse is not to be confused with internal bad actors.

Another change that goes along with decreased insider misuse breaches is a corresponding drop in multiple actor breaches. The healthcare sector has typically been the leader in this type of breach. This type of breach usually occurs when external and internal actors combine forces to steal data used for financial fraud. The multiple actor breaches last year were at 4 percent, and this year dropped to 1 percent.

The top cybersecurity error experienced by the healthcare industry is misdelivery. This error tends to fall into two categories. One is when an email is sent to the wrong email address, or distribution list, and sensitive data is received by unauthorized personnel. The second is the snail mail equivalent; when address labels for a mass mailing get out of sync and confidential information is mailed to the wrong recipient.

Case study of cybersecurity breach in healthcare

In 2019 a small community health system in Wyoming fell victim to a cyberattack. Campbell County Health operates a 90-bed acute care hospital in Gillette and nearly 20 clinics across the county. Attackers locked up sensitive patient information and medical devices then demanded a ransom.

As a result of the attack, Campbell County Health employees found it necessary to cancel services, including radiology, endocrinology, and respiratory therapy. Reports indicate that the organization transferred patients to hospitals as far away as South Dakota and Denver. Cash registers, email, and fax were all unavailable. Doctors had to resort to pen and paper to document medical conditions, and with prescription records inaccessible, patients were required to bring medication bottles to visits.

Many security professionals see the eventuality of a cyberattack against any given healthcare organization a matter of when - not if.

In a video address to the community, Andy Fitzgerald, Chief Executive Officer of Campbell County Health, said, "CCH is not the first organization, hospital or otherwise, to be hit with a ransomware attack. Every organization is subject to this type of cybercrime. We were not the first, and, unfortunately, we won't be the last to experience this. Individuals, as well as organizations, must remain constantly vigilant, at home and at work, in order not to become a victim of this kind of crime. CCH had strong systems in place before the attack, and we have invested in additional measures, but the threat remains for all of us."

What makes cybersecurity challenging within the healthcare field?

The healthcare sector has all the cybersecurity challenges facing any business, plus unique challenges all their own. They must protect their networks, databases, and endpoints from attack. They are responsible for protecting private financial and medical information about their patients and employees. They often protect valuable intellectual property. Additionally, they have challenges few other businesses encounter. The number of connected medical devices has exploded over the last ten years. Nearly every conceivable piece of medical equipment is now web-enabled or connected to the organization's operational network.

Healthcare providers are deploying more connected medical devices every day, and they can make up as much as 74% of the devices connected to a hospital's network. The prevalence of medical device hijacking has spawned the use of the term "medjacking" to describe these attacks aimed specifically at connected medical devices.

These connected devices are often necessary to sustain the life of the patient. Disabling them, or modifying their functionality, can mean the difference between life or death. Like any digital device, updates are needed to keep them running and safe.

Connected devices include patient tracking wristbands, equipment tracking for crash carts, ventilators, portable X-ray machines, and vital-sign monitors. All of these devices communicate across the hospital network providing doctors with valuable patient information entered into electronic health records. The transmitted data allows doctors to provide more affordable care. Clinicians can work faster and in safer conditions. And each of those devices acts as an entry point for cybercriminals to exploit.

Late last year, Black Book Market Research LLC surveyed over 2,800 security professionals from 733 organizations to identify gaps, vulnerabilities, and deficiencies that persist in keeping hospitals and physicians proverbial sitting ducks for data breaches and cyberattacks.

The report showed healthcare's cybersecurity struggles are caused by budget constraints. It is costly to replace legacy software. Past reports from security researchers show that the majority of healthcare medical devices operate on legacy platforms. Fifty-six percent of healthcare providers still rely on legacy Windows 7 operating systems. Many of these providers struggle with understanding or performing necessary patches.

Nothing could be of higher priority than the health and well being of patients, and communication between healthcare providers and patients or between the various healthcare functions has been refined to an art. So, why does the healthcare profession struggle with cybersecurity?

The top cybersecurity challenges facing the healthcare industry are:

Patient information is valuable on the darknet.

Medical devices often lack adequate security controls.

Medical professionals need the ability to access medical data remotely.

Insufficient cyber risk training among healthcare workers.

Outdated technology used in many healthcare facilities.

Very few healthcare providers are oblivious to the extraordinary cybersecurity risks shouldered by the industry. Their position as the most attacked business sector has not escaped notice. The issue of cybersecurity has risen to the forefront of concerns for this sector. There are seminars, conferences, white papers, and myriad cybersecurity training opportunities for healthcare professionals.

Like any other business sector, efficiencies are introduced to enhance competitive advantage. One of the significant efficiencies leveraged by healthcare providers is how much time they spend with each patient. Too much time with one patient means someone else's medical needs may not receive attention.

Dr. Christian Dameff is the Medical Director of Cybersecurity at the University of California, San Diego. In a November 2019 Ars Technica article, he states, "I have a lot of patients that I need to take care of, and I have only a finite amount of time to take care of them. Even with my cybersecurity expertise and my understanding of these problems, I still really wrestle with the thought of, 'If I'm only going to see this patient for 15 minutes and might not ever see them again, do I talk to them about patching their pacemaker, or do I talk to them about their horribly uncontrolled diabetes and high blood pressure? Ideally, those things would not be mutually exclusive, but that's just not the reality of modern medicine and modern healthcare."

Dr. Dameff is required to prioritize healthcare over cybersecurity. No one would want it any other way, but the necessity to make such a choice highlights the need for this sector to find new solutions to their unique needs.

Cybersecurity solutions for the healthcare industry

Currently, the healthcare industry is losing ground in its battle against cybercrime. Antiquated computing systems and too few trained cybersecurity professionals combined with an increase in connected medical devices have left this sector vulnerable. Technological advances in patient care equipment, systems, and processes have outstripped improvements in backend support systems where valuable patient information is stored.

The current global pandemic only exacerbates these problems. In May 2020, Bitdefender Labs, a leading cybersecurity vendor, reported, "With healthcare systems under constant strain amid the SARS-CoV-2 global pandemic, hospitals and healthcare facilities around the world have also been hit by a wave of cyberattacks, including ransomware attacks. While officials have already issued warnings that hospitals, governments, and universities may be more conscious about losing data and access to critical systems, Bitdefender telemetry reveals that the number of cyberattacks and ransomware incidents directly targeting healthcare significantly increased over the past couple of months.

The number of cyberattacks detected at hospitals in March increased by almost 60 percent from February, according to Bitdefender telemetry. This is the highest spike in our global evolution of cyberattacks detected at hospitals reported over the past 12 months, showing that cybercriminals have clearly leveraged the pandemic to launch these campaigns."

Cybersecurity solutions for healthcare organizations should provide safeguards that exceed those of most businesses. Arguably, these systems and devices should be equal to or surpass those used in financial organizations in terms of the level of protection provided.

To achieve this goal, healthcare institutions must look at each new platform proposed in terms of the medical benefits provided to their patients and the risk of cyberattacks.

According to the Forrester New Wave: Connected Medical Device Security, Q2 2020 Report, any security platform under consideration for introduction into the medical environment should be thoroughly evaluated against the following criteria.

Architecture

Where do sensors and appliances need to be placed in the network for typical operation? How many sensors or appliances does the typical hospital require? What information does the vendor's product require to be transmitted off-premises? How is this data secured (both in transit and at rest)?

Analytics and Reporting

Does the vendor produce dynamic reports that effectively communicate risks associated with a medical device environment?

Attack Response

What are all the remediation and response actions available to customers when a security attack is identified (e.g., configuration changes, device quarantine, behavioral block, device removal from network, etc.)?

Threat Research

How does the vendor discover new medical device threats and vulnerabilities?

Device Visibility

How granular is the classification taxonomy of the devices in the environment (i.e., device function, type, OS/firmware, vendor, and model)? How does the vendor ensure that classification taxonomy remains up to date in light of new devices, vendors, models, etc.?

Vulnerability Management

Does the product track medical device vulnerabilities (i.e., CVEs and medical device security advisories)? How are these reported on, and what actions can be taken from the admin console?

Integrations

What are all of the native, out-of-the-box integrations with third-party security and IT operations tools? Which are bidirectional, and what are the specific benefits to customers?

Vision

How well does the vendor's product vision align to address the major customer requirements for medical device security?

Roadmap

What are the vendor's short-term and long-term product roadmaps? How differentiated is the roadmap from the competition? Are the planned features expected to contribute meaningfully to customer and product success?

Conclusion

Cybersecurity influences every aspect of the Healthcare industry, from the confidentiality of sensitive health information to insurance rates to patient care. Industry and government leaders acknowledge that healthcare trails where it should be in cybersecurity technologies, standards, and processes.

While some call for additional governmental regulation to ensure patients and their data are protected, many healthcare leaders understand that voluntary compliance with the strictest standards is the only way to stave off further, and sometimes, onerous compliance regulations.

As concerning as today's known healthcare cybersecurity threats are, the scariest of all cyber threats may still lie ahead. Researchers in Israel announced last year that they have created a computer virus capable of adding tumors into CT and MRI scans. In the wild, this malware could fool doctors into misdiagnosing patients, according to a story by Kim Zetter in The Washington Post.

The healthcare industry faces significant cybersecurity challenges unique to that sector. When lives, not just fortunes, are at stake, the best and brightest in computer science, medical science, and business must work in concert to find innovative solutions to address the threats bearing down on medical care as we know it.

Further reading
Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients 50 things to know about healthcare data security & privacy Medical & IoT Device Security for Healthcare HIPAA Journal - Healthcare/cybersecurity

# data[].attributes.attachment_link.title
Cybersecurity in the healthcare industry

# data[].attributes.attachment_link.description
Over the past decade, the cyberthreat to the healthcare industry has increased dramatically, along with the sophistication of cyberattacks. Industry and government both recognize this new era. For each improvement delivered by automation, interoperability, and data analytics, the vulnerability to malicious cyberattacks increases as well.

# data[].attributes.body
This source is relevant since it talks about security techniques for healthcare IoT, which is relevant for my topic of cybersecurity and healthcare. I learned that Artificial Intelligence can be used to identify threats on healthcare networks.

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This article discusses the current infrastructure of tech and how it can be improved. Currently, healthcare uses an IoT (Internet of Things) to connect all of its devices. This is very common in many industries. This article discusses the use of neural networks to secure these cloud healthcare systems and shows how effective they are. The authors' goal is to get this AI technology into all healthcare companies soon.

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This article is a scholarly source because it does a study itself, and the authors of this article created all of the tables and data shown in the article. In addition there are 62 references, also a sign of a scholarly article.

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Cybersecurity of multi-cloud healthcare systems: A hierarchical deeplearning approach

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Cybersecurity of multi-cloud healthcare systems: A hierarchical deeplearning approach

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Cybersecurity of multi-cloud healthcare systems: A hierarchical deep learning approach - ScienceDirect
Source #7

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Author links open overlay panel Lav Gupta a

Show more

Abstract

With the increase in sophistication and connectedness of the healthcare networks, their attack surfaces and vulnerabilities increase significantly. threaten patients' health and life by stealing or altering data as it flows among the multiple domains of healthcare networks. The problem is likely to exacerbate with the increasing use of for timely and accurate detection of Malicious agents IoT devices, edge, and core clouds in the next generation healthcare networks. Presented in this paper is MUSE, a system of deep hierarchical stacked malicious activity that leads to alteration of meta-information or payload of the dataflow between the IoT gateway, edge and core clouds. Smaller models at the edge clouds take substantially less time to train as compared to the large models in the core cloud. To improve the speed of training and accuracy of detection of large core cloud models, the MUSE system uses a novel method of merging and aggregating layers of trained edge cloud models to construct a partly pre-trained core cloud model. As a result, the model in the core cloud takes substantially smaller number of epochs (6 to 8) and, consequently, less time, compared to those in the edge clouds, training of which take 35 to 40 epochs to converge. With the help of extensive evaluations, it is shown that with the MUSE system, large, merged models can be trained in significantly less time than the unmerged models that are created independently in the core cloud. Through several runs it is seen that the merged models give on an average 26.2% reduction in training times. From the experimental evaluation we demonstrate that along with fast training speeds the merged MUSE model gives high training and test accuracies, ranging from 95% to 100%, in detection of unknown attacks on dataflows. The merged model thus generalizes very well on the test data. This is a marked improvement when compared with the accuracy given by un-merged model as well as accuracy reported by other researchers with newer datasets. neural networks

Introduction

The cost of providing healthcare is steep and spiraling globally. The US alone spent about $4.1 trillion in 2020, a staggering 19.7% of the GDP [1]. Despite substantial healthcare budgets, most countries are saddled with inefficient healthcare systems. Administrations are frequently blamed for inadequate response to medical emergencies, delays in diagnosis of acute cases, insufficient monitoring of chronic patients, re-admissions, and above all, too many preventable errors. Some readers will be surprised to know that preventable errors are a leading cause of deaths in the US [2].

To improve treatment outcomes with timely and accurate diagnosis and, at the same time, reduce the rising cost burden of healthcare on governments, modern healthcare is increasingly relying on technology. Trends show the prevalence of the Internet of Things (IoT) devices for the collection of patient data and the use of multi-cloud computing for storage and analytics. Cloud adoption, including multi-cloud and hybrid cloud, is projected by International Data Corporation, a market intelligence company, to be a staggering 90% of mid-size and large size organizations by 2022 [3]. In healthcare the growth multi-cloud is expected to be 37% in 2021 as against 19% in 2019 [4]. These developments have the potential of saving crucial minutes in the diagnosis and treatment of critical, hospitalized, or ambulance bound patients. In other words, they could drastically improve the chances of patients' survival and return to good health.

Medical IoT is helping implement automatic remote monitoring and recording of patients' vital signs, allowing closer monitoring, which is not possible manually. The global Covid-19 pandemic has accelerated the adoption of medical IoT in hospitals [5]. Because of rapid upsurge in the use of IoT devices, analytics and storage are being increasingly pushed from premises to the edge and further to large public clouds (also called core clouds in this paper). These technology trends promise to reduce reliance on brick-and-mortar healthcare infrastructure and make the next generation healthcare less expensive and more efficient. Despite the expected gains from the infusion of new technologies, the undesirable fallout is the increasing susceptibility of patients and hospitals to crippling malicious attacks [6]. Over the last two years, 90% of healthcare organizations have suffered at least one cyberattack [7]. This adds up to a 71 percent increase in breaches or incidents in 2020 over 2019 [8]. Among all major sectors of the economy, the largest number of ransomware related insurance claims during 2015-2019 came from the healthcare sector [9]. Any attack on critical patient data, flowing through an intricately designed healthcare system, poses severe threats to patients being diagnosed, treated, or carried to a medical facility on an ambulance. Research of Choi and Johnson shows that data breaches affect a hospital's 30-day mortality rate adversely [10]. These attacks not only threaten serious repercussions on routine medical procedures, but also present the risk of critical medical devices, such as pacemakers, being hacked and endangering patients' lives. A recent example is recall of insulin infusion pumps by the US Foods and Drugs Administration because of the possibility of attackers changing settings and takeover control of insulin delivery [11].

The next generation healthcare is expected to make extensive use of sensing devices, clouds, and virtualization of communication. This makes the system complex, opens the boundaries of the constituent domains and increases the attack surface. Security and privacy concerns have so far limited the adoption of cloud infrastructure in healthcare to about 14% [12]. Conventional intrusion detection systems (IDSs) become largely ineffective in such an environment [13]. Additionally, there is lack of research in finding more effective means to tackle increased risk of attack in the next generation healthcare. This provides the motivation for this work. Consequently, the objective of this work is to create a credible defense, against known and unknown or "zero-day" attacks.

In this paper, we propose MUSE ( Merged Hierarchical Deep Learning System with Layer Re use for Se curity), a system consisting of a hierarchy of distributed deep learning models in the edge and the core clouds. MUSE secures healthcare providers' operational systems from attacks arising within or outside their organizations. MUSE predicts attacks on dataflows by examining the data being transferred to and from the clouds and detecting even very subtle changes in the metadata associated with these flows. The models working in the edge and core clouds are trained to identify malicious activity by detecting abnormal variations in the metadata features like source- or destination-byte-count, retransmissions because of payload error, mean packet size, content size of the data and packet transfer rate.

The novelty of this work lies in tackling the increased attack surface of the next-generation health care systems by using a hierarchy of cooperating neural network models in the edge and the core clouds. The challenge in doing this is obvious. The distributed deep learners grow in size and complexity as we move from the edge of the IoT domain through the smaller edge clouds to the larger core clouds. Any effort to increase the training speed often results in reduction in detection accuracy. We tackle the dual challenges of fast training of large and complex core cloud models and high accuracy of detecting known and unknown attacks by using an innovative merged deep neural network (DNN) models in the core clouds. The novelty of the method lies in its hierarchical implementation and use of merged trained edge models to reduce training time in larger core cloud while still maintain high accuracy of detection.

Specific contributions of this paper are:

(a)

Establishing a reference architecture for critical healthcare applications, e.g., ambulance bound critical patients.

(b)

Based on the attack surface presented to the flow of data in the multi-domain next-generation healthcare architecture, evolving a threat model to clearly defne the information technology and operational technology related threats and their mitigations.

(c)

Proposing a novel method based on hierarchical DNNs to protect the patient data flowing between the IoT domain and the edge cloud and between the edge clouds and the core clouds.

(d)

Evolving a merged core cloud DNN for improvement in training time and accuracy of prediction of abnormal activity in the data flows.

(e)

Evaluating the proposed method and discussing the results.

The rest of the paper is organized as follows. In Section 2, we discuss the related work to show how our work fills an existing gap. Section 3 presents the conceptual layout and architecture of the next generation healthcare network, laying down a foundation for discussing the threat model in Section 4. The merged hierarchical model is discussed in Section 5. In Section 6, we discuss the evaluation results. Finally, Section 7 gives a summary of the conclusions.

Section snippets

Threat model for the healthcare network

The threat model essentially provides an understanding of the attackers, attacks, and mitigation and is crucial in deciding the security strategy. In IoT-Multicloud systems the designers must rely on the convergence of information technology (IT) and operational technology (OT) to run and maintain infrastructures. The architecture and the threat model that we propose draw from the Microsoft STRIDE architecture for clouds, covering threat categories Spoofing, Tampering, Repudiation, Information

CRediT authorship contribution statement

Lav Gupta: Conceptualization, Methodology, Investigation, Software, Formal analysis, Original draft, Revisions. Tara Salman: Resources, Review and editing. Ali Ghubaish: Review and editing, Validation, Resources. Devrim Unal: Visualization, Writing, Review, Funding acquisition. Abdulla Khalid Al-Ali: Visualization, Writing, Review, Project administration, Funding acquisition. Raj Jain: Visualization, Conceptualization, Supervision, Review, Project administration, Funding acquisition.

Funding

This publication was made possible by NPRP grant 10−0125−170250 from the Qatar National Research Fund (a member of Qatar Foundation) and NSF grant CNS-1718929 from the National Science Foundation. The findings achieved herein are solely the responsibility of the author[s].

Lav Gupta is a senior member of IEEE. He received a BS degree from the Indian Institute of Technology, Roorkee, India in 1978, and an MS degree from the Indian Institute of Technology, Kanpur, India in 1980 and a Ph.D. degree in Computer Science & Engineering from Washington University in St Louis, Missouri, USA in 2019. He is currently an Assistant Professor at the University of Missouri in St. Louis.

He has worked for about fifteen years in telecommunications planning, deployment, and

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View full text

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Cybersecurity of multi-cloud healthcare systems: A hierarchical deep learning approach

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Author links open overlay panel Lav Gupta Person a Envelope Show more With the increase in sophistication and connectedness of the healthcare networks, their attack surfaces and vulnerabilities increase significantly. threaten patients' health and life by stealing or altering data as it flows among the multiple domains of healthcare networks.

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How can we better detect cybersecurity threats in current healthcare architecture?

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How can we better detect cybersecurity threats in current healthcare architecture?

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This article is useful to me since it puts the phishing problem in the context of healthcare and HIPAA, which is my topic. I learned from this article that a lot of attacks on healthcare systems come from emails and email phishing.

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In healthcare, email-related breaches used to be rare. Almost non-existent. In 2012, only 4% of breaches in healthcare were email related. In 2020, that number skyrocketed to 42%. The World Health Organization (WHO) has reported five times more than the usual number of attacks than they normally see in a month. Some healthcare organizations don't have to comply with HIPAA, but this article recommends that companies should still comply with HIPAA and make sure that their systems are secure to prevent email phishing and other kinds of threats from compromising their systems.

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This source is a trade source as it provides data and recommendations to healthcare organizations for cybersecurity, and it also doesn't have ads.

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The Phishing Problem in Healthcare (healthitsecurity.com)
Source #6

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This article is relevant because it discusses phishing statistics, where medical records are often compromised, so knowing these statistics will be important to craft a good paper. From this article I learned a lot about what the most common forms of phishing are and what their subject lines commonly are.

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This article gives statistics on how much phishing occurs and other details about phishing. For example, it went over the most popular email titles, and up there was "Stimulus Cancellation Request Approved" and popular services such as Amazon, even career services such as Workday. PDFs were the most common malicious attachment (Don't open pdfs from random emails!) The main data that was taken in these phishing attacks was log in information, personal data, and number 3 were medical records, which is a very scary thing to be revealed. As for the amount of phishing that happens per year: each employee receives on average 14 malicious emails per year.

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This article is a trade source because it is written for others in the cyber-security space and gives statistics on how many phishing attacks there were with tables and data. Since the data is just compiled in the article and not actually collected and the article is not intended for researchers, it is not a scholarly source, but rather a trade source.

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Must-Know Phishing Statistics: Updated 2022

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Must-Know Phishing Statistics: Updated 2022

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Phishing Statistics (Updated 2022) - 50+ Important Phishing Stats - Tessian
Source #4

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Looking for something more visual? Check out this infographic of the key statistics.

The frequency of phishing attacks

And 2021 research from confirmed this trend, citing a 2 percentage-point rise in phishing attacks between 2019 and 2020, partly driven by COVID-19 and supply chain uncertainty. 2021 Cybersecurity threat trends report suggests that at least one person clicked a phishing link in around 86% of organizations. The company's data suggests that phishing accounts for around 90% of data breaches.

How phishing attacks are delivered

. The increase in phishing attacks means email communications networks are now riddled with cybercrime. 96% of phishing attacks arrive by email. Another 3% are carried out through malicious websites and just 1% via phone. When it's done over the telephone, we call it and when it's done via text message, we call it Symantec research suggests that throughout 2020, 1 in every 4,200 emails was a phishing email.

When it comes to targeted attacks, 65% of active groups relied on spear phishing as the primary infection vector. This is followed by watering hole websites (23%), trojanized software updates (5%), web server exploits (2%), and data storage devices (1%).

The most common subject lines

According to Symantec's 2019 Internet Security Threat Report (ISTR) , the top five subject lines for business email compromise (BEC) attacks:

of real-world phishing emails revealed these to be the most common subject lines in Q4, 2020:

1. IT: Annual Asset Inventory

2. Changes to your health benefits

3. Twitter: Security alert: new or unusual Twitter login

4. Amazon: Action Required | Your Amazon Prime Membership has been declined

5. Zoom: Scheduled Meeting Error

6. Google Pay: Payment sent

7. Stimulus Cancellation Request Approved

8. Microsoft 365: Action needed: update the address for your Xbox Game Pass for Console subscription

9. RingCentral is coming!

10. Workday: Reminder: Important Security Upgrade Required

The most common malicious attachments

2021 Tessian research suggests that PDFs are the most common type of malicious file attached with phishing emails. This trusted and versatile file format can be used to hide phishing links, run JavaScript, and deliver fraudulent invoices.

SonicWall's 2021 Cyber Threat report suggests that there was a huge jump in the number of malicious PDFs and Microsoft Office files (sent via email) between 2018 and 2020. Workers are particularly likely to click these trusted formats. The volume of malicious Office and PDF files did start to dip in 2021, however, as some workers returned to working in the office.

However, it's important to note-as users become more wary of opening suspicious-looking files-that many malicious emails don't contain an attachment. In fact, 2021 Tessian research found that 76% of malicious emails did not contain an attachment.

The data that's compromised in phishing attacks

The top three "types" of data that are compromised in a phishing attack are:

1. Credentials (passwords, usernames, pin numbers)

2. Personal data (name, address, email address)

3. Medical (treatment information, insurance claims)

When asked about the impact of successful phishing attacks, security leaders cited the following consequences:

60% of organizations lost data

52% of organizations had credentials or accounts compromised

47% of organizations were infected with ransomware

29% of organizations were infected with malware

18% of organizations experienced financial losses

"These costs can be mitigated by cybersecurity policies, procedures, technology, and training. Artificial Intelligence platforms can save organizations $8.97 per record. "

The cost of a breach

In 2021, estimated that businesses worldwide lose $1,797,945 per minute due to cybercrime-and that the average breach costs a company $7.2 per minute. IBM's 2021 research into the cost of a data breach ranks the causes of data breaches according to the level of costs they impose on businesses.

Phishing ranks as the second most expensive cause of data breaches-a breach caused by phishing costs businesses an average of $4.65 million, according to IBM. And Business Email Compromise (BEC)-a type of phishing whereby the attackers hijack or spoof a legitimate corporate email account-ranks at number one, costing businesses an average of $5.01 million per breach.

That's not the only way phishing can lead to a costly breach-attacks using compromised credentials were ranked as the fifth most costly cause of a data breach (averaging $4.37 million). And how do credentials get compromised? More often than not, due to phishing.

On the plus side, IBM found that businesses with AI-based security solutions experienced a significant reduction in the costs associated with a data breach. In fact, AI security solutions were found to be the biggest factor in cutting breach costs, from $6.71 million to $2.90 million.

Losses from business email compromise (BEC) have skyrocketed over the last year. The According to Verizon , organizations also see a 5% drop in stock price in the 6 months following a breach. FBI's Internet Crime Report shows that in 2020, BEC scammers made over $1.8 billion - far more than via any other type of cybercrime.

And, this number is only increasing. According to the Anti-Phishing Working Group's Phishing Activity Trends Report, the average wire-transfer loss from BEC attacks in the second quarter of 2020 was $80,183. This is up from $54,000 in the first quarter.

Costs associated remediation generally account for the largest chunk of the total. Importantly, these costs can be mitigated by cybersecurity policies, procedures, technology, and training. Artificial Intelligence platforms can save organizations $8.97 per record.

The most targeted industries

CISCO's 2021 data suggests that financial services firms are the most likely to be targeted by phishing attacks, having been targeted by 60% more phishing attacks than the next-highest sector (which CISCO identifies as higher education). Tessian's 2021 research suggests workers in the following industries received a particularly large quantity of malicious emails:

1. Retail (an average of 49 malicious emails per worker, per year)

2. Manufacturing (31)

3. Food and beverage (22)

4. Research and development (16)

Phishing by country

Not all countries and regions are impacted by phishing to the same extent, or in the same way. Here are some statistics from another source showing the percentage of companies that experienced a successful phishing attack in 2020, by country:

Phishing awareness also varies geographically. Here's the percentage of people who correctly answered the question: "What is phishing?", by country:

The most impersonated brands

2021 Tessian research found these to be the most commonly impersonated brands in phishing attacks:

The common factor between all of these consumer brands? They're trusted and frequently communicate with their customers via email. Whether we're asked to confirm credit card details, our home address, or our password, we often think nothing of it and willingly hand over this sensitive information. But it's not just consumer brands that scammers impersonate. Public bodies are also commonly mimicked in phishing scams.

Between August 2020 and July 2021, the UK's tax authority (HMRC) reported:

Over than 450 COVID-19-related financial support scams

More than one million reports of "suspicious contact" (namely, phishing attempts)

More than 13,000 malicious web pages (used as part of phishing attacks)

The rates of phishing and other scams reported by HMRC more than doubled in this period.

Facts and figures related to COVID-19 scams

Exploitation of individuals looking for details on disease tracking, testing and treatment

Impersonation of medical bodies, including the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC)

Financial assistance and government stimulus packages

Tailored attacks against employees working from home

Scams offering personal protective equipment (PPE)

Passing mention of COVID-19 within previously used phishing lure content (e.g., deliveries, invoices and purchase orders)

And the COVID phishing surge is far from over. In December 2021, the US Federal Trade Commission (FTC) launched a new rule-making initiative aiming to combat the tidal wave of COVID scams, having received 12,491 complaints of government impersonation and 8,794 complaints of business impersonation related to the pandemic.

Phishing and the future of work

The move to remote work has presented many challenges to business-and the increased range, frequency, and probability of security incidents are among the most serious. New working habits have contributed to the recent surge in phishing because IT teams have less oversight over how colleagues are using their devices and can struggle to provide support when things go wrong.

80% of security professionals surveyed said they had encountered increased security threats since the shift to remote work began.

Of these, 62% said phishing campaigns had increased more than any other type of threat.

Employees said they believed IT departments would be able to mitigate these phishing attacks if they had been working in the office

35% of companies reported that their employees either circumvented or disabled remote security measures

Workers at organizations that lacked effective remote collaboration tools were more than eight times as likely to report high levels of security evasion

83% of companies with relaxed bring-your-own-device (BYOD) usage led to increased security issue

"Humans shouldn't be the last line of defense. That's why organizations need to invest in technology and other solutions to prevent successful phishing attacks."

What can individuals and organizations do to prevent being targeted by phishing attacks?

While you can't stop hackers from sending phishing or spear phishing emails, you can make sure you (and your employees) are prepared if and when one is received.

You should start with training. Educate employees about the key characteristics of a phishing email and remind them to be scrupulous and inspect emails, attachments, and links before taking any further action.

Review the email address of senders and look out for impersonations of trusted brands or people (Check out our blog CEO Fraud Email Attacks: How to Recognize & Block Emails that Impersonate Executives for more information.)

Always inspect URLs in emails for legitimacy by hovering over them before clicking

Beware of URL redirects and pay attention to subtle differences in website content

Genuine brands and professionals generally won't ask you to reply divulging sensitive personal information. If you've been prompted to, investigate and contact the brand or person directly, rather than hitting reply

But, humans shouldn't be the last line of defense. That's why organizations need to invest in technology and other solutions to prevent successful phishing attacks. But, given the frequency of attacks year-on-year, it's clear that spam filters, antivirus software, and other legacy security solutions aren't enough.

That's where Tessian comes in. By learning from historical email data, Tessian's machine learning algorithms can understand specific user relationships and the context behind each email. This allows Tessian Defender to not only detect, but also prevent a wide range of impersonations, spanning more obvious, payload-based attacks to subtle, social-engineered ones.

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Phishing Statistics (Updated 2022) - 50+ Important Phishing Stats - Tessian

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And 2021 research from confirmed this trend, citing a 2 percentage-point rise in phishing attacks between 2019 and 2020, partly driven by COVID-19 and supply chain uncertainty. 2021 Cybersecurity threat trends report suggests that at least one person clicked a phishing link in around 86% of organizations.

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This source is relevant as it discusses how to actually prevent phishing, which will be important to write in a paper about cybersecurity and healthcare. A lot of these procedures are being used at healthcare workplaces to make them more secure. I learned from this source how to not be victim to phishing scams.

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Most phishing scams can be easily detected by following one simple philosophy: if it's too good to be true it probably is. In addition, the FTC goes into detail about different things that emails may claim but are not true, such as an email reporting "suspicious" activity in your account. The 4 steps that the FTC recommends to prevent this are: Get an antivirus, set your cell phone to update software automatically, use multi-factor authentication, and back up your data into the cloud.

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This source is a popular source as it was written by the FTC for consumers to understand how not to fall for phishing scams. Since its intended audience is the public, it must be a popular source.

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How to Recognize and Avoid Phishing Scams

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How to Recognize and Avoid Phishing Scams

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How to Recognize and Avoid Phishing Scams | Consumer Advice (ftc.gov)
Source #5

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How To Recognize Phishing

How To Protect Yourself From Phishing Attacks

What To Do if You Suspect a Phishing Attack

contact the company using a phone number or website you know is real - not the information in the email.Attachments and links might install harmful malware.

What To Do if You Responded to a Phishing Email

If you think a scammer has your information, like your Social Security, credit card, or bank account number, go to . There you'll see the specific steps to take based on the information that you lost.

If you think you clicked on a link or opened an attachment that downloaded harmful software, update your computer's security software . Then run a scan and remove anything it identifies as a problem.

How To Report Phishing

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How to Recognize and Avoid Phishing Scams

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Scammers use email or text messages to trick you into giving them your personal and financial information.

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This source is relevant as it discusses email phishing, a big topic in cybersecurity. A lot of hacks start with an employee of the company clicking on an email link, so it is important to look into phishing. This source helps me understand what an effective way is to prevent phishing attacks, which will be important in writing my paper.

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This article did a study of different types of training to see how effective they are at preventing phishing attacks. The trainings they did were Context-based micro training and training using games. In addition, eye-tracking was used to actually see if people are looking at the common signs of phishing emails. Interestingly enough, context-based micro training was much more effective than the control and the game-based training was pretty much the same as the control.

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This source is a scholarly source. It is written for researchers, and it uses data that it created and discusses it. In addition, there are 54 references which is quite a bit, and this is all indicative of a scholarly source.

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Evaluation of Contextual and Game-Based Training for Phishing Detection

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Evaluation of Contextual and Game-Based Training for Phishing Detection

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Evaluation of Contextual and Game-Based Training for Phishing Detection.: Discovery Service for Michigan State University Libraries (ebscohost.com)
Source #3

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Sign in with your credentials to access the EBSCOhost premium information resources provided by your subscribing institution.

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What are the components of Cybersecurity in Healthcare Specifically? 

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What are the components of Cybersecurity in Healthcare Specifically? 

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This source is helpful to me because it discusses cybersecurity in healthcare, which is also another rephrasing of my topic sentence. This article provides the overview necessary for understanding what cybersecurity in healthcare is.

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This source discusses different ways that viruses and threats are transmitted to healthcare providers. It then goes over how to fix these things. E.g. emails and phishing, how to avoid phishing and what it actually is, physical security and how it may be breached, etc.

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This source is a trade source as it is located on a trade organization's website and describes the main issues of cybersecurity in the healthcare industry.

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Cybersecurity in Healthcare | HIMSS
Source #2

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Cybersecurity in Healthcare Laws and Regulations

The Health Insurance Portability and Accountability Act ( HIPAA) is a federal requirement in the U.S. which applies to covered entities and business associates. HIPAA consists of the HIPAA Privacy Rule, Security Rule and Breach Notification Rule. Covered entities include health plans, healthcare clearinghouses, and healthcare providers who electronically transmit any health information in connection with transactions for which the U.S. Department of Health and Human Services has adopted standards.

Examples of covered entities include physician practices, ambulatory surgical centers, hospitals, long-term care facilities, health plans, healthcare clearinghouses, among others. Business associates perform functions or services on behalf of covered entities. Business associates may create, receive, transmit, or maintain protected health information on behalf of the covered entity. Examples of business associates include accountants, attorneys, cloud service providers, document storage companies, third party billing services and others.

The HIPAA Privacy Rule, 45 CFR Part 160 and Subparts A and E of Part 164 , sets forth permitted and required uses and disclosures of protected health information. The protected health information may exist in any form, including on paper, film and in electronic form. Protected health information is a form of individually identifiable health information.

The HIPAA Security Rule, 45 CFR Part 160 and Part 164, Subparts A and C, sets forth requirements for electronic protected health information. In other words, the confidentiality, integrity and availability of electronic protected health information must be maintained by covered entities and their business associates.

The HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414, requires HIPAA covered entities and their business associates to provide notification following a breach of unsecured protected health information.

A breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information. An impermissible use or disclosure of protected health information is presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised based on a risk assessment of at least the following factors:

The extent to which the risk to the protected health information has been mitigated

The nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification

The unauthorized person who used the protected health information or to whom the disclosure was made

Whether the protected health information was actually acquired or viewed

Covered entities and business associates, where applicable, have discretion to provide the required breach notifications following an impermissible use or disclosure without performing a risk assessment to determine the probability that the protected health information has been compromised.

There are three exceptions to the definition of breach:

1. The covered entity or business associate has a good faith belief that the unauthorized person to whom the impermissible disclosure was made, would not have been able to retain the information.

2. The inadvertent disclosure of protected health information by a person authorized to access protected health information at a covered entity or business associate to another person authorized to access protected health information at the covered entity or business associate, or organized healthcare arrangement in which the covered entity participates. In both cases, the information cannot be further used or disclosed in a manner not permitted by the Privacy Rule.

3. The unintentional acquisition, access, or use of protected health information by a workforce member or person acting under the authority of a covered entity or business associate, if such acquisition, access, or use was made in good faith and within the scope of authority.

Similar to a covered entity, a business associate also is directly liable and subject to civil penalties for failing to safeguard electronic protected health information in accordance with the HIPAA Security Rule. Additionally, covered entities must establish business associate agreements with their business associates.

A business associate agreement is a written contract between a covered entity and a business associate which must address the following:

1. Authorize termination of the contract by the covered entity if the business associate violates a material term of the contract

2. Establish the permitted and required uses and disclosures of protected health information by the business associate

3. Provide that the business associate will not use or further disclose the information other than as permitted or required by the contract or as required by law

4. Require the business associate to implement appropriate safeguards to prevent unauthorized use or disclosure of the information, including implementing requirements of the HIPAA Security Rule with regard to electronic protected health information

5. Require the business associate to report to the covered entity any use or disclosure of the information not provided for by its contract, including incidents that constitute breaches of unsecured protected health information

6. Require the business associate to disclose protected health information as specified in its contract to satisfy a covered entity's obligation with respect to individuals' requests for copies of their protected health information, as well as make available protected health information for amendments (and incorporate any amendments, if required) and accountings

7. To the extent the business associate is to carry out a covered entity's obligation under the Privacy Rule, rRequire the business associate to comply with the requirements applicable to the obligation to the extent the business associate is to carry out a covered entity's obligation under the Privacy Rule

8. Require the business associate to make available to HHS its internal practices, books and records relating to the use and disclosure of protected health information received from, or created or received by the business associate on behalf of, the covered entity for purposes of HHS determining the covered entity's compliance with the HIPAA Privacy Rule

9. Require, at termination of contract if feasible, the business associate to return or destroy all protected health information received from, or created or received by the business associate on behalf of, the covered entity

10. Require the business associate to ensure that any subcontractors it may engage on its behalf that will have access to protected health information agree to the same restrictions and conditions that apply to the business associate with respect to such information

11. Authorize termination of the contract by the covered entity if the business associate violates a material term of the contract.

HIPAA is enforced by the U.S. Department of Health and Human Services Office for Civil Rights (OCR). OCR has the authority to interpret and enforce HIPAA. Accordingly, it is best for to keep up with guidance from OCR as it relates to the interpretation and enforcement of HIPAA.

42 CFR Part 2

42 CFR Part 2 protects patient records created by federally funded programs for the treatment of substance use disorder. At the state level, healthcare provider organizations must also be aware of other applicable privacy and security laws. Certain special types of health information are deemed to be super protected health information under state law. Examples include records related to drug and alcohol abuse, HIV-related information, and the like.

Section 5 of Federal Trade Commission Act

Section 5 of the Federal Trade Commission (FTC) Act applies to entities other than not-for-profit entities. Specifically, Section 5 of the FTC Act provides that "unfair or deceptive acts or practices in or affecting commerce... are... declared unlawful." The failure of an organization to adequately safeguard computer systems and infrastructure may be deemed to be "unfair" according to the FTC. Additionally, a deceptive practice is one in which consumers are falsely misled into believing that their privacy and/or security of their information is safeguarded.

European Union General Data Protection Regulation

Any organization that processes the personal data of data subjects (people) in the European Union must comply with the General Data Protection Regulation (GDPR). "Processing" includes data collection, storage, transmission, analysis and the like. "Personal data" is any information that relates to a person, such as without limitation names, email addresses, IP addresses, eye color and the like-essentially, any personally identifiable information or information that may be identifying of an individual.

GDPR is broader than HIPAA and regulates any information that may be used, directly or indirectly, or identify a person that is in the European Union. In other words, GDPR applies to many types of personal information, whereas HIPAA regulates protected healthcare information. Even if an organization is located outside of the European Union, GDPR may still apply if:(1) the organization offers goods or services to individuals within the European Union (whether or not a payment is required from them) or (2) the behavior of individuals in the European Union is monitored by the organization. Additionally, GDPR applies to both controllers and processors. A "controller" means a natural or legal person, public authority, agency or other body which, alone or jointly with others, determines the purposes and means of the processing of personal data. A "processor" means a natural or legal person, public authority, agency or other body which processes personal data on behalf of the controller.

In order to lawfully process the information of a data subject, there must be a lawful basis for doing so. Lawful bases include the following:

1. Consent from the data subject

2. Performance of a contract, where the processing of the data is necessary

3. Where the processing is necessary for the purposes of the legitimate interests pursued by a controller or processor

Personal Information Protection and Electronic Documents Act

The Personal Information Protection and Electronic Documents Act (PIPEDA) applies to private-sector organizations across Canada that collect, use or disclose personal information in the course of a commercial activity. Hospitals are generally governed by provincial laws in Canada, but PIPEDA may apply in certain instances.

Certain types of information are excluded from PIPEDA. Business contact information such as an employee's name, title, business address, telephone number or email addresses that is collected, used or disclosed solely for the purpose of communicating with that person in relation to their employment or profession.

Cybersecurity in healthcare threats continue to evolve and, in turn, so must cybersecurity solutions to combat these threats. In order to stay ahead of these threats, we must increase our situational awareness about what is happening and share more information about what is going on with our peers and colleagues. Healthcare organizations must continue to support cybersecurity professionals as they help to safeguard patient data. There is no better time than the present to increase cybersecurity defenses, while enhancing the capabilities and knowledge of staff.

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Cybersecurity in Healthcare Laws and Regulations The Health Insurance Portability and Accountability Act ( HIPAA) is a federal requirement in the U.S. which applies to covered entities and business associates. HIPAA consists of the HIPAA Privacy Rule, Security Rule and Breach Notification Rule.

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This source is helpful because it exactly relates to my topic; HIPAA and cybersecurity, and how companies store data in such a regulatory environment.

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This source discusses how HIPAA has evolved and what current cybersecurity practices are being used to guard data. In addition, it makes recommendations for which specific kinds of data protection are the best.

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This source is a scholarly source as it is located in a research journal and does not have any ads on the page.

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Healthcare cyber security and HIPAA assurance with business associates

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Healthcare cyber security and HIPAA assurance with business associates

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by Janice Ahlstrom et al.
Found in the MSU database.
Source #1