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Verizon has released its annual Protected Health Information Breach Report which delves deep into the main causes of breaches, why they occur, the motivations of internal and external threat actors, and the main threats to the confidentiality, integrity, and availability of PHI.
For the report, Verizon analyzed 1,368 healthcare data breaches and incidents where protected health information (PHI) was exposed but not necessarily compromised. The data came from 27 countries, although three quarters of the breached entities were based in the United States where there are stricter requirements for reporting PHI incidents.
In contrast to all other industry sectors, the healthcare industry is unique as the biggest security threat comes from within. Insiders were responsible for almost 58% of all breaches with external actors confirmed as responsible for just 42% of incidents.
The main reason for insider breaches is financial gain. PHI is stolen to commit identity theft, credit card fraud, insurance fraud, and tax fraud. Verizon determined that 48% of all internal incidents were conducted for financial gain. 31% involved accessing medical data out of curiosity or for fun, 10% of incidents were attributed to easy access to data, with 3% of incidents occurring due to a grudge and a further 3% for espionage. External attacks are primarily conducted for financial gain – extortion and the theft and sale of data.
Verizon also looked at the actions that lead to PHI incidents and data branches, with the most common problem being errors. Errors were behind 33.5% of incidents within this category, which included the misdelivery of emails and mailings, errors made disposing of PHI, publishing errors, loss of PHI, misconfigurations, programming mistakes and data entry errors. The main incident cause was misdelivery of documents, which accounted for 20% of all incidents in the error category.
The second biggest breach category is misuse, accounting for 29.5% of all incidents. 66% of incidents in this category were attributed to privilege abuse – accessing records without authorization. Data mishandling was behind 21.6% of incidents and possession abuse – the misuse of access to physical records – was behind 16.9% of incidents in the misuse category.
The physical category includes theft of records and devices, snooping, tampering, disabled controls, and surveillance. 16.3% of all healthcare PHI incidents were placed in this category, with theft accounting for 95.2% of all incidents. The theft of laptops was the main incident type. Almost half (47%) of laptop theft incidents involved the devices being taken from employees’ vehicles. The use of encryption would prevent the majority of these incidents from exposing PHI.
Hacking may make the headlines, but it accounted for relatively few breaches – just 14.8% of all healthcare PHI incidents were placed in this category. The main cause of breaches in the hacking category was the use of stolen credentials (49.3% of incidents), with credentials often stolen via phishing attacks. Brute force attacks taking advantage of weak passwords were behind 20.9% of incidents. 17.9% of hacking breaches involved the use of backdoors.
Malware was involved in 10.8% of all PHI incidents. While there were a wide range of malware types and variants used in attacks, by far the biggest category was ransomware, which accounted for 70.5% of attacks.
Social attacks accounted for 8% of all incidents. This category involves attacks on employees. Phishing was involved in 69.9% of incidents in this category, followed by pretexting (11.7%), and bribery (7.8%). Pretexting is the next stage on from phishing, when access to email accounts is used to send further emails – BEC attacks for example.
Verizon offers three suggestions which in the short term will help to reduce the number of PHI related incidents and data breaches.
Full disk encryption should be deployed on all portable electronic devices used to store PHI. This simple measure would prevent PHI from being accessed in the event of loss or theft of an electronic device.
The routine monitoring of medical record access – a requirement of HIPAA – will not prevent breaches, but it will reduce the severity of insider incidents and allow healthcare organizations to take corrective action quickly. When employees are aware that records are routinely monitored it can also act as a deterrent and reduce theft and unauthorized access incidents.
The final course of action is to implement solutions to combat ransomware and malware. While defenses can and should involve the use of spam filters and web filters, simple measures can also be taken such as not allowing laptops to access the Internet if they are used to store large quantities of PHI.