Maintaining the Security and Integrity of Electronic Health Record Systems

The Tripwire EHR Solution

The value of electronic health record (EHR) systems is immense. These digital records are designed to be available anytime and anywhere, connecting healthcare providers with patient data. EHRs are a central repository of patient medical histories, medications, diagnoses, immunization dates, allergies, lab results and radiology images. With access to this accurate patient information, providers can offer optimal care, automate the provider’s workflow, support changes in payer requirements, and address patient needs.

Beyond those benefits, by using EHRs providers can access and consult with data sets related to the patient’s diagnosis and implement best care practices. On the compliance front, EHRs are intended to meet “meaningful use” standards to measure improved health care quality and efficiency. These metrics are focused on patient centered, evidence based, and prevention oriented efficiency. In the United States, eligible hospitals and critical care providers have been given financial incentives to move to EHRs. The Office of the National Coordinator (ONC) can also certify EHR providers as “meaningful use” with the Health IT Certification Program (a voluntary certification program). Some common EHR systems used are Epic, Cerner, and Allscripts. Epic is used by many large hospital systems, making it one of the top three EHR systems in the US. It is also ONC 2015 Certified, so Epic users can meet federal mandates.

EHR: Prime Targets for Cyber Attacks

Given the sensitive information EHRs contain, the need for privacy and security is a high priority. This is reflected in the US Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security rules, which state the need to protect privacy and security of individually identifiable health information found on EHRs. The HIPAA Privacy Rule covers protected health information (PHI) in any medium, while the HIPAA Security Rule covers electronic protected health information (ePHI). Healthcare is the second most common industry being targeted by hackers, just behind financial services (Verizon 2017 Data Breach Investigations Report).

For healthcare organizations, the average cost of a stolen patient record is $355, compared with $5–$30 for financial data. In other words, PHI is a more valuable cybercrime opportunity. By taking advantage of patients’ medical conditions or claim settlements, criminals can use PHI to target their victims with frauds and scams. Attackers can also create fake insurance claims, allowing for the purchase and resale of medical equipment. Or they can use PHI to illegally gain access to prescriptions for their own use or resale. If they have access to a real time database, they can change the payment directions to redirect funds. The range of attacker motives and methods in healthcare is daunting—and increasing.

Defend and Protect Your EHR

Continuous monitoring of system level configurations and data integrity are foundational controls for mitigating cyberattacks on EHR systems. They provide organizations with visibility into unauthorized or unexpected changes that may be the result of errors, omissions or—worse—malicious activity. Some EHR environments can have up to ten million changes in one month. Monitoring complex environments like these can be easier said than done, especially when monitoring affects performance or cannot be done natively due to the system architecture. Some providers monitor the database by creating scripts and running them against the database in a scheduled manner. However, scripts are inadequate because they only offer a point in time snapshot rather than continuous monitoring. This resultant monitoring gap—between two instances of when the script has been run—presents a security challenge as it provides a window of opportunity to attackers. As a result, the script approach is often unacceptable to auditors. Even in situations where the EHR system has native functionality for monitoring unauthorized access, using these features can be time consuming and cumbersome, and can quickly overwhelm an IT operations department.

The Tripwire EHR Solution

Tripwire’s EHR solution provides a tailored package of products and expertise to alleviate the challenges of monitoring EHR systems for unauthorized changes and to ensure that those systems are in compliance with HIPAA and NIST 800-53 & 171. The solution leverages Tripwire® Enterprise, a proven security configuration management (SCM) and file integrity monitoring (FIM) solution. Tripwire Enterprise provides healthcare organizations using Epic, Cerner or Allscripts EHR systems out of the box monitoring for critical file change, security configuration compliance with HIPAA, NIST 800-53 & 171, and PCI 3.2, as well as reports that provide audit ready evidence of compliance with security controls. Tripwire Enterprise provides this coverage across the entire EHR environment, including:

  • Application Delivery Platform & Business Continuity Systems (e.g. Citrix, Red Hat, Windows, HP-UX and AIX)
  • AD/LDAP (Active Directory and User & Role Management Software)
  • Database (MSSQL, Oracle, Caché (via Chronicles master files))
  • In scope network devices
  • Virtual Environment (e.g. Citrix, Hyper-V, VMware)

To ensure effective tailoring and deployment of Tripwire products to the specific EHR system, Tripwire’s EHR solution provides consulting from Tripwire Professional Services. These experienced consultants work with healthcare organizations to create targeted rules for monitoring the EHR application and EHR database content, as well as hardening policies. The Tripwire EHR Solution also provides enhanced automation through integrations with change management practices, ITSM and analytics tools (e.g. Splunk, QRadar and ServiceNow).

Tripwire Enterprise’s file integrity monitoring and secure configuration management capabilities are foundational security controls that allow healthcare organizations to achieve and maintain compliance while gaining operational efficiencies in managing their Epic, Cerner or Allscripts infrastructure. By minimizing the risk of malicious attacks, fraudulent activity and unauthorized changes, and by gaining exceptional system availability, healthcare providers can depend on Tripwire’s integrity assurance solutions for robust EHR security.