SCCM Resource Library-They Are Watching You: Cybersecurity in Medicine

Video Transcription

Well, welcome to this session. This is They Are Watching You, Cybersecurity in Medicine. I'm Nelson Sanchez-Pinto. I'm an assistant professor at Northwestern University.  I do both critical care and informatics in pediatrics. And I'll be the session moderator for this session. As a brief introduction, we're going  to talk a little bit about hacking in health care. I have no relevant disclosures. So the history of hacking in health care is as old as the history of computer hacking.  This is an article from the early 1980s, 1982, about this group of hackers, the so-called computer capers at the time. That moniker did not stick. And we know them as hackers today.  And this was a group of kids from Milwaukee. They called themselves the 414s. And they were the classic image of the hacker that you'd imagine, kids, teenagers,  smart with access to technology, hacking into systems. And what was interesting is that at the time, these kids had access to the early versions  of personal computers and analog modems, those old slow modems to connect to the internet. And just with that, those simple tools, they were able to hack into Los Alamos National  Laboratory, so a federal institution, a bank in LA, and to Memorial Sloan Kettering Cancer Center. So right there, from the beginning of the early hacking  into computer system, there's a hacking to Memorial Sloan Kettering. And in fact, of all those three hacks, the only one that had an economic impact  was the hack into Memorial Sloan Kettering Cancer Center, where these hackers erased billing records worth about $1,500. So not a tremendous amount of damage,  but damage nevertheless. And so here, sort of illustrating the fact that healthcare has been involved in this kind of problems with hacking from the beginning.  And nowadays, hacking in healthcare is a major problem. There's estimated millions of records being breached every year in the US alone, and more around the world.  Tons of phishing, fraud, and wire fraud through phishing scams by email to healthcare providers,  also across the world. And it's become a major issue, major economic issue, and a major, simply, functional issue of being able to practice care using electronic systems  when these are compromised. There's different types of hacking, and many of these we're all familiar with, but just to give us sort of an overview of those,  the first type is the so-called phishing attacks, or phishing emails, and these are, we receive some of these almost all of us, at least once a week.  These are legit appearing emails that make you either click on a link, or open a document that then contains some form of malware that infects your computer,  or through social engineering, the hacker may be able to trick you to give some form of your credential, logins, passwords, credit card information, things of that nature.  In this case, this is a phishing email from a hacker that's making it appear as if it's from PayPal, and you can receive this from people claiming to be your bank,  claiming to be your healthcare insurance company, et cetera.  The big types of software that cause hacking, the so-called malware, are the next big group, and these are software that infects your computer and cause different issues.  Classically, we call these viruses, and computer viruses are the ones that infect your computer and cause some sort of damage to files, or slow down your computer,  and those are sort of the generic name. And then more specifically, there's other types of viruses or malware, including ransomware, which is malware  that's designed to cause some damage to your computer or encrypt a part of your computer and will not solve those things until you pay something to the,  or give something to the hacker, and so it puts your computer under quote-unquote ransom. There's also spyware, which is a silent malware  that just monitors your activity in the computer, and that information is used by the hacker for some other motives, and we're actually currently having, in the US,  sort of discovering that we've had major spyware infecting federal computers from hackers in Russia.  So this is very relevant, not only in healthcare, but sort of at the national level. And then there's so-called Trojan malware, which are these viruses  that once they infect your computer, they don't cause necessarily any damage to your computer, but they open a back door,  a so-called back door for the hacker to go in and out your computer whenever they want, potentially for this virus to send packages of data  from your computer with a certain frequency to give this hacker or this group of hackers  privileged access to your information. And then there's the umbrella database breaches, which is another type of hacker attack in which through some mechanism,  either a malware or Trojan that allows the hacker to access a back door to a database or some other, maybe a phishing scam where they are able to get password access to a system.  The hacker gets access to a database and they steal the records from that database because of their valuable information, either for selling this information  or to using it to steal identity, things like that.  Ransomware and other malware in healthcare is a common issue nowadays,  as I was saying earlier.  The map on the right is a map of the so-called WannaCry ransomware. This is an attack back in 2017 in which this malware infected about more than 300,000 computers,  individual computers across the world. You can see the map there, highlighting the places where those computers were infected. And what it did, it encrypted the hard drive  for those computers and it popped a message that said if you pay 300, sort of the equivalent of $300 in Bitcoins, they would decrypt the hardware so that you could continue working  on whatever you were working. So it's classic ransomware. They made your files inaccessible and until you paid, they would not make them accessible to you again.  And again, this happened across 300,000 computers across the world. The problem is that because healthcare has become a connected industry, many thousands of those computers  were actually computers in healthcare systems, particularly mostly affected within the healthcare system, whereas the national health services in the UK.  Here on the left is a news briefing, a news from the New York Times talking about that problem where the computers affected within the NHS in the UK  were so affected that it actually caused the lay of care and some other issues with the provision of healthcare through this electronic system. So even though this was a ransomware  that was so generic for any computer, it actually made a huge impact in healthcare systems.  There's also been ransomware that's targeted specifically hospitals. This is a news from Hollywood Presbyterian Hospital in LA that was attacked by a ransomware attack  and requested the equivalent of $17,000 in Bitcoins to the institution for the computer systems to go back online. And then this is another cyber attack that was not a ransomware,  it was just a virus attack that was also generic, but also in the same way that the WannaCry ransomware affected healthcare systems, this one also affected healthcare systems  also in the UK primarily, but caused significant slowdowns and shutdowns of systems that were critical for providing care. So again, healthcare being tremendously affected by it.  Perhaps what's come more in vogue in the last couple of years is the medical data breaches, not so much the ransomware and the malware affecting healthcare systems,  but medical data breaches have become a major problem. Hackers essentially are stealing millions of medical records and selling them mostly in the dark web.  And some of these can go for up to $1,000 for the medical record for an individual patient. And what are these hackers looking for in the medical records?  Why are they hacking and stealing this information? And the motivation is simple. This is information that extremely valuable for monetizing it. So the medical records,  just by the nature of what they are used for, contain a lot of personal financial data. They contain the name, date of birth,  social security number, credit card numbers for patients, and they can be used by hackers or those who buy it, this information in dark web due to impersonations, fraud,  identity fraud and things like that.  The personal health information in the electronic medical records, so the medications that you're receiving, diseases that you've been diagnosed with,  all that information, that detailed medical history can also be extracted from this medical records. And this can be used by hackers to do things like blackmailing, extortion,  and things of that nature.  Provider data can also be hacked and extracted from this medical records. And this can be done by physician identity and also identifiers, national identifiers  for these decisions can be used to make fraudulent claims to insurance companies and Medicare. There's a lot of cases of Medicare and other private insurance claim fraud,  which initially may fall on the provider itself,  when the authorities believe that that provider is making fraudulent claims. And then in several cases, it's been uncovered that it's actually a third person  that was using that physician's identity to make fraudulent claims. This has become a major issue too. And finally, there's within the drug mills and prescription drug mills arena,  there's also hackers who sell pharmacy data, so prescription labels and barcodes and things of that nature, so that some other either hackers or some other perpetrators  will create forge labels and force prescriptions to obtain prescription drugs that then they will sell illicitly or smuggle illicitly and make money out of it.  So what can providers do?  Be alert of phishing emails. We get notifications from our ITs, cybersecurity folks oftentimes to be on the lookout for these.  And that's specifically when there's some that are known, we get sort of warnings, be careful with this type of email, be careful with this subject heading.  So when you see these, be careful. If you see one that is clearly a phishing email or you suspect it's a phishing email, there's usually ways to report it  to your IT cybersecurity systems. You know, with an icon, Outlook has an icon where you can click and it says phishing and this will report it.  Avoid using weak passwords and unencrypted devices.  Be careful with devices that contain patient data.  Control the physical access to your electronic devices so that there's no sort of physical hacking into your computers or other systems.  Foster a cybersecurity culture within your teams. For those of us who do a lot of data science research and have a lot of data,  access to a lot of data through databases and whatnot,  it's important that we create a culture of very focused cybersecurity, strong passwords, not changing this data from computer to computer,  definitely not use devices that are unsafe.  And just be nice to your cybersecurity folks. They can be annoying sometimes because it seems like they're slowing our workflow, but they're just doing their job  and it's an important job. And we owe it to our patients, we owe it to ourselves to be safe with the data that we're handling because it's extremely valuable.  So for today's presentation, hopefully this introduction helped you frame sort of hacking and healthcare. But for today's two presentations, we'll have two phenomenal speakers.  Alan Guo from, he's a professor of surgery at State University of New York at Buffalo. I believe they were victims of hacking and he's gonna talk about that experience  so in his talk entitled, What to Do When Your EMR is Hacked. And the second presentation will be by Paius Mather who's an anesthesiologist and critical care physician  at Cleveland Clinic. He's also the founder of Banex, which is an AI healthcare company and a community of AI in healthcare experts. And he's gonna be talking about issues  with cybersecurity and telemedicine. His talk is entitled, Telemedicine and Cybersecurity, A Match Made in Hell. So hopefully you enjoy both of these presentations.  We will have a live Q&A afterwards. We'll be happy to discuss more details then. So as you think of questions, make sure you write those down  and we can have some interactive time after the two talks.  So hopefully you enjoy them. Thank you. Hi, everybody. Thank you to be here. It is my privilege to be here to discuss about cybersecurity in medicine  during the Critical Care Congress. And I was asked to talk about the topic regarding what we should do if our EMR is hacked.  I'm not an IT specialist and I'm not holding any hospital administration position. I'm only a acute care surgeon. I'm a trauma surgeon and surgical intensivist.  The reason I feel comfortable to talk about this topic is because I have had personal experience with this terrible EMR attack of our hospital that I was working with.  So I have nothing to disclose. So we're gonna share with you with our hospital experience and what we should do. So several years ago, our hospital just experienced a cyber attack  the attacker didn't gain access to the system through malicious emails or compromised flash drive.  Instead, they use an automatic combination,  millions, millions of password combination and got access to the master password. And then in the encrypted vast amount of hospital data rendering it unreadable.  This effect included EMR, the e-prescription, PAX, and of course the internet. The hacker then demanded 1.7 bitcoins  for each infected computer. 1.7 bitcoin is like at that time,  1 bitcoin is probably $2,000. So it's quite amount of money. And this attack affected more than 6,000 computers  in our healthcare system. So we have the cybersecurity expert,  including FBI and Cisco, Symantec and Medifactor work with us and decided not to pay for ransom. So we immediately shut down everything  and turn everything to the paper-based medical documentation  and face-to-face communication.  So here I listed 10 topics that we should do  when we experienced a cyber attack.  And number one, you can see from here,  when the computer's down, now you do not have the patient information. You don't know the patient's past history. You don't know what surgery he had.  Fortunately, we have a system called HealthyLink.  HealthyLink is an electronic clinical information exchange platform amongst hospitals in Western New York.  It covers eight counties. They will have everything together. We share information. So the purpose of doing this is to improve  the quality of care and to enhance the patient's safety and mitigate the healthcare cost. Fortunately, prior to the ransomware attack, we had already uploaded patient information  to get to that point to the system. So now we're using a personal computer laptop. We're able to get access to HealthyLink and at least get some information out from there.  Number two, for the medical documentation,  we immediately turn it to downtime procedures. That means we just use old-fashioned handwriting documentation, including for HNP,  for daily progress notes, free up notes, post-up notes, consultation, procedure notes, everything.  But we have to educate the young trainees,  the residents, because they are good at computer, but they are not paper-based documentation. And we have a binder with a whole bunch of  copies of all forms so they can use it to do the medical documentation. So was the provider order entry. Now you don't have a bundle of like, for example, the insulin drip protocol,  the sliding scale, all kinds of stuff. So we need to make copies of the old forms and make it to folders and get the resident and the new young physician to use them to put  in the daily orders. After that, we did a study and we show, as you can see from here, that the resident, we had a survey and we found that the resident had stress when they  are doing the paper-based medical documentation. We do not have time to go over this. Communication is another big problem. As you know, before the system was down,  we have internet, we have different kind of way of communication. Now everything is down. So we need to turn to more like face-to-face communication. And we also have a HIPAA  compliant texting system called Cortex and we use it very extensively for the physician  communications. And I also published a paper about our experience and you can see here there's  a significant change. Now we have more face-to-face communication after the system was down as  compared to the normal time, etc. So another publication we submitted, another paper we submitted is about the interpersonal professional communications. When the system, the health  care, the EMR system is down, we are up. So we have more, we engaged in more implicit and deliberate  communications. Imaging is another big problem, right? We know we use PAC system. Now the PAC is  down. So we need to use a vintage of the x-ray view boxes. And then like here when you have an  IC rounds, we got to have the portable chest x-ray machine, the x-ray machine, and when they take an  x-ray we can look at the x-ray immediately at the bedside. And the radiology, they have a dedicated  in-house radiologist, 24 hours by the care standard, have a wait rate for us. And now we have need to  call the radiologist directly about the finding and they can fax the report directly to the unit.  So set your vintage viewing light, the viewing boxes, just in case.  For the lab result, we got the same problem. Now the lab result will not be in the computer. So  they will call in, the lab will call in for the lab result or they were going to fax it to the  unit. For sending the specimen, now the pneumatic delivery system is also affected. So we have to so we have to hand deliver the specimen to the lab.  E-prescription. In the state of New York, starting 2016, the practitioners  have been mandated to use an electronic prescription, no paper-based prescription.  Now, due to the attack, suddenly we do not, we couldn't file, submit an electronic prescription  and we do not have enough prescription pads. And the State Department of Health delivered a whole bunch of generic prescription pads to us the following day after the attack.  And we need to educate the residents as to how to  fill out the prescription pad. They don't do it so often nowadays.  Scheduling is also affected. So now there's nothing in the computer. As you can see from here,  everything is handwriting. So in terms of scheduling, we have some, the orthopedic cases was down significantly due to the fact that they didn't have the imaging. They didn't have  the hot copy film while they were operating the patient. So they canceled many, many cases.  But you can see from here, I did the comparison, the total cases was not significantly decreased. It was not.  Resident education, that is good. The residents learn a lot during the cyber security attack.  During this time, they have more time to focus on the face-to-face communication. They have more  time to sit in a group for discussion and attending physician has more time to talk to them  and discuss with the residents about the cases. And we need a lot more education for the residents.  So the  digital naive millennials, they lack adaptability to the paper-based system. So with the increasing  level of the cyber security threat, preparedness should be included, in my opinion, to the GME  curriculum. And we need to treat ransomware attack similarly to the way other disasters are handled and that preparedness for unexpected downtime should be included in the hospital  service and in the GME curriculum. The more else we learn from the stories, keep calm and carry on and everything will be fine. So this is my talk. Thank you very much.  Well, thank you and welcome to this presentation on telemedicine and cyber security. Two major issues, one that we have learned and adopted very well this year during the pandemic  and the other a threat that we have faced and we are learning to adopt better. And how do they  intersect? That's what I'm going to talk about and help explain through this talk. A few disclaimers,  I'm not a cyber security expert. I do chair the compliance committee for anesthesiology I'm not a cyber security expert. I do chair the compliance committee for anesthesiology  institute at ClinClinic and I'm a member of the corporate compliance committee at ClinClinic.  So I'm very much involved in dealing with these cyber security threats from compliance point of  view. I'm also the co-chair for the data science knowledge education group for SCCM. As I mentioned,  these are two clear and present dangers. One that pretty much everybody is very familiar with,  which is the coronavirus or COVID-19. The other one that a lot of us are getting more familiar  with, we have seen a lot of news in the media and in print about these virus alerts or attacks,  but I think we need to have a better understanding which will help us prepare in a better manner as we expand our telemedicine reach to our patients.  Now many of you might be familiar with the great hack attack. There was the SolarWinds breach  and that has impacted not just private companies but also some of the U.S. government institutions  which have some of the finest cyber security measures already in place. Some organizations  and people have compared it to as significant as the Pearl Harbor attack. So it was a pretty  significant cyber attack that happened in the same year as the COVID-19 pandemic, but I'm not sure  if many of us realize how significant this has been for us. So it tells you while in the middle  of the pandemic, as we have been adopting telemedicine for providing better care to our  patients, we have been more vulnerable. And as we know, telemedicine for us as a tele-critical  care solution has been expanding even prior to this year. We have been able to serve many more  patients in a global manner using some of the technology and leveraging some of the audiovisual  opportunity across the world. But when we think about tele-critical care, we also have to think  about the vulnerability. And it takes me back to the days of mathematics where you have to think  about the probability. In this particular diagram, which is for the National Emergency Tele-Critical  Care Network, which is a consortium of many organizations set up by the U.S. Army, you can  see there are many interconnections. There are many nodes. There are many people who are looking  to serve tele-critical care resources across the network. And the probability over here is the  number of people who are involved in this, the number of intersections that are there between  the technology points. You can think about the EHR that is being used, the IV pumps that are being  integrated, and think about all the audiovisual intersections that are there. And then these,  across the entire nation, are all possible vulnerable points for us. During this pandemic,  another thing that was allowed to serve our patients better were a lot of different audiovisual tools. Some which have pretty significant security measures, but then there are many  which have made it more easy for some of these cybersecurity threats to occur.  It has been a challenge. As you see, the telemedicine across the world is being served by many different groups and organizations. So, when you are using a telemedicine product  or a telecritical care product, that might have been built at a completely different place from  where it is being used, or it might be getting serviced, or many of its components might be  getting serviced at different locations throughout the world. And this is continuously expanding. There is a significant amount of critical care dollars that are attached to this,  not just in the U.S., but also in Europe and in Asia.  And we have known about the vulnerabilities and the cyberattacks that have occurred this year.  So, we think about where we are providing these tele-IC services, how these are being serviced, as I showed in that picture on the left. But then on the right are the countries  where these cybersecurity threats are originating from, or those countries which are being attacked  through these cybersecurity threats. And you might wonder, why? Why is that so? Why are so  many of these cybersecurity threats originating, especially in the field of telemedicine or  telecritical care? Well, it's to gain access to data. Here is a news item that talks about that patient medical records can fetch you as much as $1,000 per patient on dark web.  So, there are clear financial benefits to these cybersecurity threats, or these organizations,  which lead to them developing these tools to obtain data. There are also organizations which have malicious intent. And then there are people who just, for the sake of adventure,  want to generate some of these threats. So, there are different motivations for people to proceed with this. And there is a significant cost associated with it.  So, these are the numbers that have been thrown out there, which are the cost estimations  for these cybersecurity breaches in a given year, $600 billion. And you realize a lot of these  occur because of certain internal breaches. So, people making the systems and processes that are already there at your local place more vulnerable because of some access.  And it's not just the cost of these mitigation measures, but it's also the cost of prevention  of these cybersecurity threats that has been growing continuously year over year across the world. So, here in US, a joint cybersecurity advisory group or a task force was set up  between the Department of Homeland Security and HHS, the health services,  which provided this alert earlier in the year showing how some ransomware and some of the cyberattacks are being used, and they are making us more vulnerable.  It laid out the foundation for how we can try to prevent or risk manage some of these attacks.  So, the best practices were laid out through this organization and through their advisory.  So, I would recommend that if you're interested, please look at this reference and look at some  of the best practices and measures that were laid out. And I would also recommend that you  that is to improve your network. If you have a ransomware attack, what do you do?  And then user awareness that is for every single caregiver which is in your organization.  And it's not just for the preventive measures, but also for what do you do if you are faced with a ransomware or a cyberattack? They provide some checklists that you can use  and you can counter some of these attacks using that.  Importantly, this year what we have learned is that we need to prepare for disasters. And the fundamentals of disaster management, which has been provided by SCCM, does provide  for certain operational aspects which you can use during these attacks. So, while the FDM is  very much focused on provision of critical care during disasters, a lot of tools in there can  be used for some of these cyberattacks or during these times where you might be facing these viral  attacks. So, I would think people would use these resources in case they are facing these problems.  It is also important that we report these. Many times people don't know what to do when they face  a cyberattack or a ransomware. Well, the first thing as an individual is to report it to your  organization. Sometimes these attacks are related to some of the equipment that you might be using.  A lot of them are related to EHR, but with all the medical devices which are connected,  they also provide points of vulnerability and want us to think about how to use the  appropriate measures and how to report those. And those are listed over here, including reporting to  FDA and FBI. So, while this year we have been able to finally get a vaccine or a few different vaccines which have been able to counter the impact of COVID-19 and hopefully in the  new year 2021, we'll get rid of the coronavirus pandemic. Similarly, for the cyber viral attacks,  there is hope that some of these risk measures will be able to provide us with essentially a  vaccination and these attacks will not occur or will at least not be as severe as we have faced  in the past. But in the meantime, it is important to know that we are vulnerable and some of the  resources that I shared with you might help in preventing those and in mitigating those  if you face some of these problems. At the end, you know, critical care is going to be there to  help our patients, whether there's a pandemic or whether there's a cyber attack or not.  And for us, taking care of the patients is important and failure is not an option. I'm happy to take any questions during the discussion time period. Thank you very much.  Hello, everyone. Can you hear me okay?  Yep. Excellent. Well, thank you for those phenomenal presentations and for sharing your experience with cybersecurity. So I guess the big disclaimer for the three of us  is that none of us are experts in cybersecurity. I don't think there's a physician attending critical care Congress right now that is necessarily an expert in cybersecurity.  This is something that we don't do necessarily until we're sort of thrust in a cybersecurity situation or as part of our work, we're involved in issues with cybersecurity.  So it's a little bit of an orphan topic and I think a critical one as we've learned. And I think that I wanna acknowledge that the SCCM's interest in educating us,  educating the community in cybersecurity is a critical step to prevention, which I think is something that Dr. Mathur has alluded to in his talk. So let's get onto it.  Start with the questions, please. For the attendees that have questions, please put them in the Q&A box. I will try to get to the ones with the highest points.  So if you don't have a question, but somebody else has posted the question that you're interested in, make sure you upvote that question so that we'll get to them.  And I'll start with the highest voted question so far, which is an excellent question. We're talking about preparedness, we're talking about prevention and being ready.  The first question is, should we have routine drills for cybersecurity and downtimes so that we get used to the idea of the downtime procedures, paper orders, and other processes?  Should this be something that we do on a regular basis in the same way we do other types of simulation and preparedness in the hospital?  Yeah, I only have a comment on the residents and educational standpoint. We are the big trauma centers with, you know, 18-bed ICU. And the residents are part of our team  providing patient care. So we wrote several papers on this topic in terms of resident education and the experience. And we advocate that this needs to be included  in the curriculum of the resident rotation.  The new centennial generation, they are not so familiar to the paper-based  medical documentation, everything.  They are all difficult. So they need to learn something that in case something happened because the cyber attack rates is getting higher and higher in this world.  Yeah, and I imagine, I mean,  I guess I graduated from medical school in 2005. And so I'm kind of a little more recent. I just had maybe one year in residency where I was doing paper charts  and, you know, calling the lab to get lab results. And I think in medical school, we had the viewing boxes for the X-rays. I think in residency by then we had a PAC system.  So even myself, you know, 15 years ago, and I've essentially done my whole medical career with technology, EHRs, you know, PAC systems,  and sort of the technology nowadays. So I can't imagine anybody graduating even in the last 10 years that they've never, you know, seen an actual paper chart or place a paper order,  or maybe their handwriting is even worse than in the past and, you know, just make a little script that nobody can understand. So I can think that that's a huge problem,  particularly for the generation that's now completely unaccustomed to doing work without the electronic, you know, electronic systems that are so convenient.  And Nelson, I would actually add from my experience, being the compliance officer over here with Anesthesiology Institute at the Young Clinic,  and also part of the corporate compliance, we take this very seriously. So we work with our cybersecurity gurus over here in preparing for this constantly.  And one of the important aspects of our compliance program is an assessment of threats. And those threats could be those phishing emails,  those threats could be your USB access sites, or threats could be medical devices. And I don't know if our audience saw, but just yesterday FDA announced a medical device  cybersecurity team that will be formed to look at the vulnerability of medical devices. So this is coming right from the top level,  recognizing that these are all vulnerable areas for us. And a lot of data transfer is happening across different places. I think about in a global world, like we are in today,  it's not just hospitals, we are health systems. And these health systems are supported by a lot of vendors outside, not just outside your health system, but outside the country too.  So the access points are multiple. And the preparation for that is extremely important. The preparation, the prevention is extremely important.  So we do do a lot of these preventive checks to make sure our access points are secure. We do do certain drills, which are like the downtime procedures  to make sure that our downtime procedures are strong enough. Could there be larger efforts in that area to have like proper disaster management drills?  Because you can imagine the entire health systems, EHR going down and the data access going down, that creates significant patient care problems.  Sometimes hospitals have had to shut down and transfer patients. So you need to prepare for something as big as that in certain situations. So that's a great question.  And I think that's where we need to understand our vulnerability. And that's where we need to understand that despite telemedicine providing access  to a lot of different patient care areas, it has those vulnerabilities and we need to know about it and be prepared for that.  And so in the same vein of sort of the drills and simulation is in part of preparedness is part of a educational process. And Dr. Guo was talking about educating the residents.  But I think that another big component of these types of threats is the multiple entry points within the healthcare system, right? And I think, if you think of viruses in general,  ransomware type viruses, malware as a virus, and you compare it to COVID-19 as a biological virus, we can start finding some similarities  in the sense of how we would attack the virus. So one way is sort of the public health systems recommending, trying to control the borders and things of that nature,  that would be the same as cybersecurity team in a hospital trying to control firewalls and whatnot. But then a lot of the transmissions happen  because of the individuals, not wearing a mask, getting together in parties and whatnot. The same thing can be thought about in the malware world  where people are opening phishing emails, not understanding that that's putting a threat into their own network within the hospital  and falling victims to this type of attacks, bringing their own devices that might be infected and using them in the hospital environment, even when they're asked not to do so.  So I think the educational part to the individual practitioners of healthcare, clinicians and other administrative staff that works within the healthcare network  to understand that the risk that they're pushing to their hospitals is an important one. I don't know, what is the approach in Cleveland Clinic to educate the healthcare providers  to be safer in that regard?  Yeah, so we do have many educational programs regarding that. We use our web for a lot of those education. And I can tell you a lot of organizations  are using essentially like white hat techniques where they will send some kind of a phishing email, which is truly not a phishing email to test the system,  whether you hook onto that or not, or whether you report that or not. So a lot of organizations are using such systems to test the systems on a continual basis  and provide certain education. But at the end, technology issues need to be dealt with technical solutions. So the best solutions are those technical solutions  which provide end-to-end encryption and also provide the best level of security. Just trying to memorize certain things is much, much harder.  Dr. Gu, there's another question that maybe you can address, which was, should we, to be more protected, should we have sort of an air gaps systems  where like the very secure FBI and CIA and NSA databases are essentially disconnected from the internet and just have sort of this private networks within healthcare organizations  to prevent this type of attacks. And the reason why I'm asking you, Dr. Gu, it's because in part, part of the, if I understood correctly,  part of the ransomware attack that you guys were victim of was actually a system that's trying to connect different outside medical centers  and facilitate the sort of the exchange of records to improve care. So I guess that sort of, that's in conflict with that idea of really closing everything off, right?  I think we got frozen here for a second.  I'm sorry, my connection is so bad.  I think you're a victim of a malware that's slowing you down.  I think we're running out of time for this session, but you guys, the attendees, you're very fortunate that you keep, will keep seeing us if you want for longer.  We have another session that's coming up in about nine minutes. I'm sorry. Oh, no worries. I'm introducing the next session that you'll also be there.  So it's called Continue the Conversation in Data Science. So we'll shift gears a little bit from the cybersecurity, although we can talk about that a little bit more  and transition to talking more about data science and critical care. We'll have two well-known experts in data science joining the three of us. So Jill Claremont from Pittsburgh  and Robert Stevens from Johns Hopkins will be joining.  Robert will be moderating the session and we'll have a longer discussion about data science and possibly we'll also discuss a little bit about cybersecurity.  So that's the next session starts in about nine minutes. So 1 p.m. Central Time. Make sure you click on the schedule for today to that next session so that you can join.  And it will be a live session, will be a moderated live session, which are rare in this Congress where we have all these videos. So you get the opportunity to see five people,  normal people talking live. So answer, put questions there and hopefully you enjoy the discussion. So we'll see you in a little bit. Thank you, Dr. Mathurin. Thank you.

Video Summary

In this session on cybersecurity in medicine, the speakers discussed the history of hacking in healthcare, the different types of hacking attacks, and the impact of these attacks on patient care and data security. They emphasized the need for healthcare providers to be aware of and prepared for cybersecurity threats, and provided suggestions for prevention and response. They also highlighted the importance of educating healthcare professionals about cybersecurity and incorporating it into medical training. The speakers stressed the need for a strong cybersecurity culture within healthcare organizations, and the role of individuals in protecting patient data by being vigilant about phishing emails and using strong passwords. They also discussed the growing problem of medical data breaches, where hackers steal and sell patient records for financial gain. The session concluded with a reminder of the importance of reporting cyber attacks and sharing information in order to collectively address this issue and protect patients' information and safety.

Asset Subtitle

Administration, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Discuss methods used by cybersecurity criminals to hack into electronic medical systems
Identify steps to mitigate the privacy threat posed by electronic record-keeping and telemedicine
Determine what measures should and should not be taken when the electronic medical record or telemedicine encounter is hacked

EMR Hacking
L. Nelson Sanchez-Pinto

What to Do When Your EMR Is Hacked!
W. Alan Guo

Telemedicine and Cybersecurity: A Match Made in HE$$
Piyush Mathur

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Informatics

Tag Medical Legal Issues

Tag Economics

Year 2021

Keywords

cybersecurity

medicine

hacking

healthcare

attacks

patient care

data security

prevention

response

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