Clinical laboratories are particularly tasty targets for cybercriminals seeking the abundance of protect health information contained in patient electronic health records
Recent data from cybersecurity company Netwrix of Frisco, Texas, shows that 84% of healthcare organizations—including clinical laboratories and pathology groups—caught at least one cyberattack in the past year and “69% of them faced financial damage as a result.” That’s according to the company’s latest Hybrid Security Trends Report which notes that 24% of healthcare organizations are “fully cloud-based,” as opposed to just 11% of non-healthcare industries.
“Phishing was the most common type of incident experienced on premises, similar to other industries. Account compromise topped the list for cloud attacks: 74% of healthcare organizations that spotted a cyberattack reported user or admin account compromise,” the Netwrix report notes.
Phishing, where cybercriminals send fake emails and texts to unsuspecting employees that trick them into providing private information, continues to be one of the most prevalent cyberthreats experienced by healthcare organizations and often serves as the catalyst for much larger and more dangerous cyberattacks.
This is particularly dangerous in clinical laboratories where as much as 80% of protected health information (PHI) in patients’ electronic health records (EHRs) is laboratory test results and other personal medical data.
“Protected health information (PHI) is one of the most expensive types of data sold on darknet forums, which makes healthcare organizations a top target for cybercriminals, said Ilia Sotnikov (above), security strategist and VP of user experience at Netwrix, in the report. Clinical laboratory patient electronic health records are particularly weighted toward PHI. (Photo copyright: Netwrix.)
Don’t Open That Email!
Typical phishing scams begin with innocent-looking emails from companies that appear to be legitimate and often contain language that implies urgent action is needed on the part of the user. These emails can be very convincing, appear to originate from reputable companies, and usually instruct users to open an attachment contained in the email or click on a link that goes to a known company website. However, the site is a fake.
Once the harmful file attachment is opened, users will be directed to download fake software or ransomware that attempts to capture the user’s personal information. When visiting a malicious website, consumers will often receive pop-ups with instructions for updating information, but the true purpose is to harvest personal data.
Never provide any personal information to an unsolicited request.
If you believe the contact is legitimate, initiate a contact with the organization using verified data, usually via telephone.
Never provide any passwords over the phone or in response to an unsolicited Internet request.
Review any accounts, such as bank statements, often to search for any suspicious activity.
“Healthcare workers regularly communicate with many people they do not know—patients, laboratory assistants, external auditors and more—so properly vetting every message is a huge burden,” said IT security expert Dirk Schrader, VP of security research at Netwrix, in the report. “Plus, they do not realize how critical it is to be cautious, since security awareness training often takes a back seat to the urgent work of taking care of patients. Combined, these factors can lead to a higher rate of security incidents.”
Top 10 Brands Faked in Phishing Scams
Phishing emails often appear to be from legitimate companies to lull the recipient into a false sense of security. In a January 22 report, Check Point Research (CPR) announced its latest Brand Phishing Ranking for the fourth quarter of 2024. The report reveals the brands that were most frequently impersonated in phishing attacks by cybercriminals for the purpose of stealing personal information from consumers.
According to the CPR report, 80% of disclosed brand phishing incidents occurred within just 10 brands (listed below with each brand’s percentage of phishing attacks). They are:
According to the report, fraudulent domains “replicated official websites to mislead shoppers with fake discounts, ultimately stealing login credentials and personal information. These fraudulent sites replicate the brand’s logo and offer unrealistically low prices to lure victims. Their goal is to trick users into sharing sensitive information, such as login credentials and personal details, enabling hackers to steal their data effectively.”
Steps Clinical Labs Can Take to Protect Patients’ PHI
Clinical laboratories and pathology groups can take precautions that minimize the risk of allowing cybercriminals access to their patients’ PHI.
“A core defense strategy is to minimize standing privileges by using a privileged access management (PAM) solution. Another is to implement identity threat detection and response (IDTR) tools to quickly block malicious actors using compromised credentials,” said Ilia Sotnikov, security strategist and VP of user experience at Netwrix, in the report.
The threat of phishing scams is a lingering issue that everyone in healthcare should be aware of and take necessary precautions to recognize and prevent having one’s PHI stolen. Clinical laboratory management should constantly remind lab personnel and contractors to be vigilant regarding fake emails and texts from well-known brands that ask for private information.
Recent intrusions into the hospitals’ IT systems resulted in blocked medical records including medical laboratory data
Healthcare cyberattacks continue to be a threat that bring potentially costly business consequences for clinical laboratories. Just in the past month, two hospital systems had their health information technology (HIT) systems disrupted due to security incidents. In response, the hospitals’ medical laboratories were forced to switch from digital to paper documentation and, in at least one case, the organization reportedly had difficulty accessing electronic laboratory test results.
At Tallahassee Memorial, an “IT security issue” on Feb. 2 resulted in the organization shutting down its IT systems for 13 days, including at its clinical laboratory. The hospital’s computer network went back online on Feb. 15, according to a news release.
At Atlantic General Hospital, according to an AGH news release, IT personnel discovered a ransomware attack on Jan. 29 that affected the hospital’s central computer system. As a result, the walk-in outpatient laboratory was closed until Feb. 14.
These recent cyberattacks underscore the importance for clinical laboratory leaders to have plans and procedures already in place prior to a disruption in access to critical patient data.
Healthcare cyberattacks can be a “complete blindside for a lot of organizations that think they have protections in place because they bought a product or they developed a policy,” said Ben Denkers (above), Chief Innovation Officer at CynergisTek, an Austin, Texas-based cybersecurity company, in an exclusive interview with The Dark Report. Since clinical laboratory test results make up about 80% of a patient’s medical records, disruption of a hospital’s IT network can be life threatening. (Photo copyright: The Dark Report.)
Laboratory Staff Unable to View Digital Diagnostic Results at Tallahassee Memorial
Though the exact nature of the incident at Tallahassee Memorial HealthCare has not been divulged, hospital officials did report the incident to law enforcement, which suggests a cyberattack had occurred.
Electronic laboratory test results were among the casualties of the IT difficulties at TMH. “Staff have been unable to access digital patient records and lab results because of the shutdown,” a source told CNN.
Attempts by Dark Daily to reach a medical laboratory manager for comment at TMH were unsuccessful. However, in a news release posted online shortly after the cyberattack, the health system advised staff members on dealing with the IT outages.
“Patients and families may notice the switch to paper documentation during registration, admission, or during their care, as our providers will be using paper forms, prescription pads, handwritten notes, or other similar paper methods where they may usually use an electronic process,” the news release stated. “We apologize for any delays this may create. We practice for situations like this, and we are prepared to provide safe, high-quality care to our patients during computer system downtimes.”
Atlantic General Hospital Reports Ransomware Incident to the FBI
At Atlantic General Hospital, the outpatient walk-in laboratory and outpatient imaging department both temporarily closed because of the ransomware attack.
Staff members throughout the hospital were “forced to manually check patients in and out of appointments and record all other information by hand instead of online,” Ocean City Today reported.
The hospital immediately informed the FBI of the ransomware incident and continues to work with an incident response team to determine whether criminals accessed any sensitive data. It was not clear whether the organization ultimately paid a ransom to unlock its systems.
The hospital’s medical laboratory director did not respond to an email from Dark Daily seeking further comment.
Healthcare Cyberattacks Attempt to Gain Access to Data
Therefore, it is critical that clinical laboratory and hospital staff work with their IT counterparts to verify that technology and processes are in place to protect access to patient data.
In “Labs Must Audit Their Cybersecurity Measures,” Ben Denkers, who at that time was Chief Innovation Officer at CynergisTek, a cybersecurity firm based in Austin, Texas, told The Dark Report, “Testing, validating, and auditing whether measures are working as designed is a change of mentality for a lot of organizations.” (If you don’t subscribe to The Dark Report, try our free trial.)
An IT network attack is an attempt by a cybercriminal to gain unauthorized access to devices that contain and exchange data within an organization. Although this information may be on individual devices or on servers, network attacks are often only possible after a hacker enters a system through an endpoint, such as an individual’s email inbox.
“It’s important to understand that while the network server itself might have ultimately been the target, that doesn’t necessarily mean that it was compromised first,” Denkers told The Dark Report. “Phishing is a perfect example of a way an attacker could first gain access to a workstation, and then from there move laterally to a server.”
The final cost of a healthcare cyberattack often exceeds the ransom. Media coverage can lead to an organization’s diminished reputation within the community, and if protected health information (PHI) is accessed by the criminals, a hospital or health system may need to pay for identity theft monitoring for affected patients.
There also are regulatory repercussions that can be costly depending on the circumstances surrounding a cyberattack. For example, on Feb. 2, the US Department of Health and Human Services’ Office for Civil Rights announced a settlement with Banner Health Affiliated Covered Entities (Banner Health), a nonprofit health system headquartered in Phoenix, to resolve a data breach resulting from a hacking incident in 2016. That incident disclosed PHI for 2.81 million patients.
As part of the settlement, Banner Health paid a $1.25 million penalty and will carry out a corrective action plan to protect PHI in the future and resolve any alleged HIPAA violations, according to the HHS Office for Civil Rights.
This hefty penalty is a reminder to pathologists and clinical laboratory managers that—when it comes to cyberattacks—the classic adage “an ounce of prevention is worth a pound of cure” is appropriate advice.
Sophisticated cyberattacks have already hit hospitals and healthcare networks in Oregon, California, New York, Vermont, and other states
Attention medical laboratory managers and pathology group administrators: It’s time to ramp up your cyberdefenses. The FBI, the federal Department of Health and Human Services (HHS), and the federal Cybersecurity and Infrastructure Security Agency (CISA) issued a joint advisory (AA20-302A) warning US hospitals, clinical laboratories, and other healthcare providers to prepare for impending ransomware attacks, in which cybercriminals use malware, known as ransomware, to encrypt files on victims’ computers and demand payment to restore access.
The joint advisory, titled, “Ransomware Activity Targeting the Healthcare and Public Health Sector,” states, “CISA, FBI, and HHS have credible information of an increased and imminent cybercrime threat to US hospitals and healthcare providers.” It includes technical details about the threat—which uses a type of ransomware known as Ryuk—and suggests best practices for preventing and handling attacks.
In his KrebsOnSecurity blog post, titled, “FBI, DHS, HHS Warn of Imminent, Credible Ransomware Threat Against U.S. Hospitals,” former Washington Post reporter, Brian Krebs, wrote, “On Monday, Oct. 26, KrebsOnSecurity began following up on a tip from a reliable source that an aggressive Russian cybercriminal gang known for deploying ransomware was preparing to disrupt information technology systems at hundreds of hospitals, clinics, and medical care facilities across the United States. Today, officials from the FBI and the US Department of Homeland Security hastily assembled a conference call with healthcare industry executives warning about an ‘imminent cybercrime threat to US hospitals and healthcare providers.’”
Krebs went on to reported that the threat is linked to a notorious cybercriminal gang known as UNC1878, which planned to launch the attacks against 400 healthcare facilities.
Clinical Labs, Pathology Groups at Risk Because of the Patient Data They Keep
Hackers initially gain access to organizations’ computer systems through phishing campaigns, in which users receive emails “that contain either links to malicious websites that host the malware or attachments with the malware,” the advisory states. Krebs noted that the attacks are “often unique to each victim, including everything from the Microsoft Windows executable files that get dropped on the infected hosts to the so-called ‘command and control’ servers used to transmit data between and among compromised systems.”
Charles Carmakal, SVP and Chief Technology Officer of cybersecurity firm Mandiant told Reuters, “UNC1878 is one of the most brazen, heartless, and disruptive threat actors I’ve observed over my career,” adding, “Multiple hospitals have already been significantly impacted by Ryuk ransomware and their networks have been taken offline.”
John Riggi (above), senior cybersecurity adviser to the American Hospital Association (AHA), told the AP, “We are most concerned with ransomware attacks which have the potential to disrupt patient care operations and risk patient safety. We believe any cyberattack against any hospital or health system is a threat-to-life crime and should be responded to and pursued as such by the government.” Hospital-based medical laboratories and independent clinical laboratories that interface with hospital networks should be assess their vulnerability to cyberattacks and take appropriate steps to protect their patients’ data. (Photo copyright: American Hospital Association.)
Multiple Healthcare Provider Networks Under Attack
Hospitals in Oregon, California, and New York have already been hit by the attacks, Reuters reported. “We can still watch vitals and getting imaging done, but all results are being communicated via paper only,” a doctor at one facility told Reuters, which reported that “staff could see historic records but not update those files.”
Some of the hospitals that have reportedly experienced cyberattacks include:
In October, the Associated Press (AP) reported that a recent cyberattack disrupted computer systems at six hospitals in the University of Vermont (UVM) Health Network. The FBI would not comment on whether that attack involved ransomware, however, it forced the UVM Medical Center to shut down its computer system and reschedule elective procedures.
Threat intelligence analyst Allan Liska of US cybersecurity firm Recorded Future told Reuters, “This appears to have been a coordinated attack designed to disrupt hospitals specifically all around the country.”
He added, “While multiple ransomware attacks against healthcare providers each week have been commonplace, this is the first time we have seen six hospitals targeted in the same day by the same ransomware actor.”
An earlier ransomware attack in September targeted 250 healthcare facilities operated by Universal Health Services Inc. (UHS). A clinician at one facility reported “a high-anxiety scramble” where “medical staff could not easily see clinical laboratory results, imaging scans, medication lists, and other critical pieces of information doctors rely on to make decisions,” AP reported.
Outside of the US, a similar ransomware attack in October at a hospital in Düsseldorf, Germany, prompted a homicide investigation by German authorities after the death of a patient being transferred to another facility was linked to the attack, the BBC reported.
CISA, FBI, HHS, Advise Against Paying Ransoms
To deal with the ransomware attacks, CISA, FBI, and HHS advise against paying ransoms. “Payment does not guarantee files will be recovered,” the advisory states. “It may also embolden adversaries to target additional organizations, encourage other criminal actors to engage in the distribution of ransomware, and/or fund illicit activities.” The federal agencies advise organizations to take preventive measures and adopt plans for coping with attacks.
The advisory suggests:
Training programs for employees, including raising awareness about ransomware and phishing scams. Organizations should “ensure that employees know who to contact when they see suspicious activity or when they believe they have been a victim of a cyberattack.”
Regular backups of data and software. These should be “maintained offline or in separated networks as many ransomware variants attempt to find and delete any accessible backups.” Personnel should also test the backups.
Continuity plans in case information systems are not accessible. For example, organizations should maintain “hard copies of digital information that would be required for critical patient healthcare.”
“Without planning, provision, and implementation of continuity principles, organizations may be unable to continue operations,” the advisory states. “Evaluating continuity and capability will help identify continuity gaps. Through identifying and addressing these gaps, organizations can establish a viable continuity program that will help keep them functioning during cyberattacks or other emergencies.”
Dark Daily Publisher and Editor-in-Chief, Robert Michel, suggests that clinical laboratories and anatomic pathology groups should have their cyberdefenses assessed by security experts. “This is particularly true because the technologies and methods used by hackers change rapidly,” he said, “and if their laboratory information systems have not been assessed in the past year, then this proactive assessment could be the best insurance against an expensive ransomware attack a lab can purchase.”
