Senator Demands Answers Over Exposure of Medical Images in Unsecured PACS

Sen. Mark Warner (D-Virginia) has written to TridentUSA Health Services demanding answers about a breach of sensitive medical images at one of its affiliates, MobileXUSA.

Sen. Warner is the co-founder of the Senate Cybersecurity Caucus, which was set up as bipartisan educational resource to help the Senate engage more effectively on cybersecurity policy issues. As part of the SCC’s efforts to improve cybersecurity in healthcare, in June Sen. Warner asked NIST to develop a secure file sharing framework and wrote to healthcare stakeholder groups in February requesting they share best practices and the methods they used to reduce cybersecurity risk and improve healthcare data security.

The latest letter was sent a few days after ProPublica published a report of an investigation into unsecured Picture Archiving and Communications Systems (PACS). PACS are used by hospitals and other healthcare organizations for viewing, storing, processing, and transmitting medical images such as MRIs, CT scans, and X-Rays. The report revealed more than 303 medical images of approximately 5 million Americans had been left exposed on the Internet due to PACS security failures. Those medical images were stored on 187 U.S. servers, including those used by MobileXUSA.

In the letter, Sen. Warner said “It appears that the information held by MobileXUSA was made accessible due to sloppy cybersecurity practices – no software vulnerabilities were involved, and no explicit hacking was required [to access the images].”

Sen. Warner said HIPAA requires security controls to be applied to keep sensitive data protected, including medial images stored in PACS, and that both TridentUSA and MobileXUSA have a duty under HIPAA to ensure their PACS are not publicly accessible and that proper controls are applied to prevent unauthorized access and data theft.

By October 9, 2019, Sen. Warner requires answers to questions about the cybersecurity practices at both companies to determine how medical images in the PACS were exposed and why the lack of security protections was not detected internally.

Specifically, Sen Warner wants to know about the audit and monitoring tools employed to analyze its HIPAA-mandated audit trails, whether systems that access the PACS and DICOM images comply with current standards and use access management controls, what identify and access management controls are applied for IP-addresses and port filters, if a VPN or SSL is required to communicate with the PACS, the frequency of vulnerability scans and internal HIPAA compliance audits, what server encryption processes are in use, and whether the companies have an internal security team or if security is outsourced.

PACS and the DICOM image format have been designed to facilitate the sharing of medical images within an organization and with authorized third parties, but it is the responsibility of each organization to ensure that those systems are secured to protect patient privacy.

Healthcare organizations can face many challenges securing their PACS without negatively impacting workflows. To help healthcare organizations secure their systems, NCCoE has recently released new NIST guidance for healthcare providers to help them secure the PACS ecosystem.

Author: Steve Alder has many years of experience as a journalist, and comes from a background in market research. He is a specialist on legal and regulatory affairs, and has several years of experience writing about HIPAA. Steve holds a B.Sc. from the University of Liverpool.