Data protection and cybersecurity in the healthcare system

The digitalization of our healthcare system is progressing massively: The German federal government is promoting the networking of medical facilities through the so-called telematics infrastructure Telematik Infrastruktur, TI). As a result of the corona crisis, the need for online communication between doctors and patients has increased. In addition to these developments, the electronic patient file will be introduced in January 2021.

With such networking of our healthcare system, it is time to take a critical look at the security of the systems and thus of our data. The importance of cybersecurity for the protection of patient records is unfortunately demonstrated by those cases in which attackers have succeeded in penetrating an institution’s system, paralyzing it, or – in the worst case – even stealing data records.

There have also been many reports of major attacks on hospital IT worldwide in recent times. However, it should not be forgotten that cyberattacks can affect not only large medical institutions. It also affects small, independent doctor’s offices – such a singular attack can threaten their existence for various reasons. And it also involves risks for us consumers.

Securing IT structures in the healthcare system properly

Basics of secure IT systems

First of all, medical institutions, more than any other, must carefully select and maintain their IT infrastructure. An up-to-date operating system with all relevant security updates, a functioning hardware firewall, and an up-to-date and intelligent anti-virus program should be standard. Besides, there should be regular security updates and, ideally, daily backups that cannot be processed from the system. In this way, facilities can be up and running again quickly in the event of a ransomware attack. And the loss of data in your own systems is at least limited.

But password security is also an important point that all too often gets lost in everyday professional life: For many physicians in private doctor’s office, it is necessary to find a compromise between security and practicability. Especially because computers at reception or in laboratories may be used by several people. Nevertheless, even these shared passwords should comply with security standards and be renewed regularly. We also recommend the introduction of a practicable multi-factor authentication.

Since this is a sensitive infrastructure, clear rules for IT use in the workplace should also be established: May private mails be checked? Are online purchases or other surfing behavior allowed? May own storage media be brought and used? Are there special devices that are not connected to the doctor’s office network? It is important here to increase awareness of possible security gaps that could arise from this behavior. Employee training courses on cybersecurity, phishing, or social engineering should therefore be held regularly.

Cyber insurance can also minimize the (financial) risks that arise after an attack has taken place. Often good security concepts ensure that the contribution is minimized, and only the compulsion to deal with this topic creates good conditions for the actual implementation of plans.

Increased security thanks to telematics infrastructure (TI)?

With the large-scale introduction of the telematics infrastructure (TI) in German medical doctor’s offices since 2018, the security of the systems was to be further increased. Patient information was to be made available quickly and securely via this secure channel to reduce treatment costs through repeated examinations. However, reports are accumulating that the connection to the network is not as secure as announced.

Which security gaps in TI are described?

Although the TI has been forced to connect to the network, liability in the event of cyber-attacks in particular – and thus for data protection issues – has not been sufficiently clarified. Last year, the IT-expert Jens Ernst from happycomputer already revealed considerable data protection deficiencies when connecting to the telematics infrastructure.

This starts with the way the TI connector is integrated into the network of doctor’s offices. This is where you have the option of choosing between serial and parallel integration. Although serial integration initially requires more installation effort, it offers the advantage that all devices in the doctor’s offices are included in the federal security network. Extra protection on the part of the doctor’s office owners is not necessary according to information of the Gematik. Parallel integration, on the other hand, requires that the physicians make their own efforts to secure their existing systems and devices. This actually only makes sense for larger units that have already integrated many devices into their system before.

Nevertheless, it seems that most units were connected in parallel operation. In this case, the doctor’s office owners themselves would now have to ensure that their own systems were secured. However, many claims that they have not been sufficiently informed about this by their IT provider. Ernst describes that even with the few facilities that have been connected serially, security systems do not function correctly. This is because the firewall of the TI connector in use would not be sufficient to detect an anti-virus test file that he had installed. This means that even in this case there is no security against access by third parties without further security measures. In the vast majority of doctor’s offices, there is therefore no hardware firewall, regardless of how they are integrated. Besides, the virus protection on the computer and the software firewall, which every computer has today, was often switched off.

How can the healthcare system guarantee cybersecurity?

Ernst calls for an open approach to the topic of cybersecurity, which basically rests on three pillars:

1. A doctor’s office needs a higher security level than just a router, as is often the case today.
2. Sensitive data should not be sent via a WIFI network. The connector’s LAN network sends data unencrypted; by intruding into the WIFI, it is possible to “listen in”.
3. Devices that cannot be sufficiently protected due to their design should not be used or operated in a DMZ (Demilitarized Zone).

He also proposes the development of a DMZ in which all TI systems are included. This is currently not even the case for the telematics infrastructure itself. He also criticizes the fact that IT specialists do not need a separate certificate from Gematik to connect the TI. This would ensure that only trained personnel are allowed to carry out the installation and that sufficient educational work is done with the liable physicians.

In summary, Ernst states that the security of all systems can only be guaranteed if the vast majority of surgeries completely remove their computers and devices from the network. Neither the TI connectors nor their own systems would offer any protection whatsoever to safely store consumer data.

As security experts, we too say that security should clearly be the most important starting point for digitization. The security of the systems must be guaranteed before any equipment is connected.

What do you think? Discuss with us.