Presented at the Health Systems Research Institute's WHO Fellowship Program on June 19, 2017 in Bangkok, Thailand

1. Health Information Security and Privacy
Nawanan Theera-Ampornpunt, M.D., Ph.D.
June 19, 2017
SlideShare.net/Nawanan

2. • Overview of Information Security &
Privacy
• Protecting Information Security &
Privacy
Outline

3. Overview of Information
Security & Privacy

4. Malware
Threats to Information Security

5. Sources of the Threats
 Hackers
 Viruses & Malware
 Poorly-designed systems
 Insiders (Employees)
 People’s ignorance & lack of knowledge
 Disasters & other incidents affecting information
systems

6.  Information risks
 Unauthorized access & disclosure of confidential information
 Unauthorized addition, deletion, or modification of information
 Operational risks
 System not functional (Denial of Service - DoS)
 System wrongly operated
 Personal risks
 Identity thefts
 Financial losses
 Disclosure of information that may affect employment or other
personal aspects (e.g. health information)
 Physical/psychological harms
 Organizational risks
 Financial losses
 Damage to reputation & trust
 Etc.
Consequences of Security Attacks

7.  Privacy: “The ability of an individual or group to
seclude themselves or information about
themselves and thereby reveal themselves
selectively.” (Wikipedia)
 Security: “The degree of protection to safeguard
... person against danger, damage, loss, and
crime.” (Wikipedia)
 Information Security: “Protecting information
and information systems from unauthorized
access, use, disclosure, disruption,
modification, perusal, inspection, recording or
destruction” (Wikipedia)
Privacy & Security

8. Confidentiality
• การรักษาความลับของข้อมูล
Integrity
• การรักษาความครบถ้วนและความ
ถูกต้องของข้อมูล
• ปราศจากการเปลี่ยนแปลงแก้ไข ทา
ให้สูญหาย ทาให้เสียหาย หรือถูก
ทาลายโดยมิชอบ
Availability
• การรักษาสภาพพร้อมใช้งาน
Information Security Principles & Goals

9. Examples of Confidentiality Risks
http://usatoday30.usatoday.com/life/people/2007-10-10-clooney_N.htm

10. Examples of Integrity Risks
http://www.wired.com/threatlevel/2010/03/source-code-hacks/
http://en.wikipedia.org/wiki/Operation_Aurora
“Operation Aurora”
Alleged Targets: Google, Adobe, Juniper Networks,
Yahoo!, Symantec, Northrop Grumman, Morgan Stanley,
Dow Chemical
Goal: To gain access to and potentially modify source
code repositories at high tech, security & defense
contractor companies

11. Examples of Integrity Risks
http://news.softpedia.com/news/700-000-InMotion-Websites-Hacked-by-TiGER-M-TE-223607.shtml
Web Defacements

12. Examples of Availability Risks
http://en.wikipedia.org/wiki/Blaster_worm
Viruses/worms that led to instability &
system restart (e.g. Blaster worm)

13. Examples of Availability Risks
http://en.wikipedia.org/wiki/Ariane_5_Flight_501
Ariane 5 Flight 501 Rocket Launch Failure
Cause: Software bug on rocket acceleration due to data conversion
from a 64-bit floating point number to a 16-bit signed integer without
proper checks, leading to arithmatic overflow

14. Protecting Information
Privacy & Security

15. http://www.aclu.org/ordering-pizza
Privacy Protections: Why?

16. Security & Privacy
http://en.wikipedia.org/wiki/A._S._Bradford_House

17. Ethical Principles Related to Privacy
• Autonomy
• Beneficence
• Non-maleficence
– “First, Do No Harm.”

18. Hippocratic Oath
...
What I may see or hear in the course of
treatment or even outside of the treatment
in regard to the life of men, which on no
account one must spread abroad, I will
keep myself holding such things shameful
to be spoken about.
...
http://en.wikipedia.org/wiki/Hippocratic_Oath

19.  Attack
 An attempt to breach system security
 Threat
 A scenario that can harm a system
 Vulnerability
 The “hole” that is used in the attack
Common Security Terms

20.  Identify some possible means an
attacker could use to conduct a
security attack
Class Exercise

21. Alice
Simplified Attack Scenarios
Server Bob
Eve/Mallory

22. Alice
Simplified Attack Scenarios
Server Bob
- Physical access to client computer
- Electronic access (password)
- Tricking user into doing something
(malware, phishing & social
engineering)
Eve/Mallory

23. Alice
Simplified Attack Scenarios
Server Bob
- Intercepting (eavesdropping or
“sniffing”) data in transit
- Modifying data (“Man-in-the-middle”
attacks)
- “Replay” attacks
Eve/Mallory

24. Alice
Simplified Attack Scenarios
Server Bob
- Unauthorized access to servers through
- Physical means
- User accounts & privileges
- Attacks through software vulnerabilities
- Attacks using protocol weaknesses
- DoS / DDoS attacks Eve/Mallory

25. Alice
Simplified Attack Scenarios
Server Bob
Other & newer forms of
attacks possible
Eve/Mallory

26. Alice
Safeguarding Against Attacks
Server Bob
Administrative Security
- Security & privacy policy
- Governance of security risk management & response
- Uniform enforcement of policy & monitoring
- Disaster recovery planning (DRP) & Business continuity
planning/management (BCP/BCM)
- Legal obligations, requirements & disclaimers

27. Alice
Safeguarding Against Attacks
Server Bob
Physical Security
- Protecting physical access of clients & servers
- Locks & chains, locked rooms, security cameras
- Mobile device security
- Secure storage & secure disposition of storage devices

28. Alice
Safeguarding Against Attacks
Server Bob
User Security
- User account management
- Strong p/w policy (length, complexity, expiry, no meaning)
- Principle of Least Privilege
- “Clear desk, clear screen policy”
- Audit trails
- Education, awareness building & policy enforcement
- Alerts & education about phishing & social engineering

29. Alice
Safeguarding Against Attacks
Server Bob
System Security
- Antivirus, antispyware, personal firewall, intrusion
detection/prevention system (IDS/IPS), log files, monitoring
- Updates, patches, fixes of operating system vulnerabilities &
application vulnerabilities
- Redundancy (avoid “Single Point of Failure”)
- Honeypots

30. Alice
Safeguarding Against Attacks
Server Bob
Software Security
- Software (clients & servers) that is secure by design
- Software testing against failures, bugs, invalid inputs,
performance issues & attacks
- Updates to patch vulnerabilities

31. Alice
Safeguarding Against Attacks
Server Bob
Network Security
- Access control (physical & electronic) to network devices
- Use of secure network protocols if possible
- Data encryption during transit if possible
- Bandwidth monitoring & control

32. Alice
Safeguarding Against Attacks
Server Bob
Database Security
- Access control to databases & storage devices
- Encryption of data stored in databases if necessary
- Secure destruction of data after use
- Access control to queries/reports
- Security features of database management systems (DBMS)

33. Privacy Safeguards
Image: http://www.nurseweek.com/news/images/privacy.jpg
 Security safeguards
 Informed consent
 Privacy culture
 User awareness building & education
 Organizational policy & regulations
 Enforcement
 Ongoing privacy & security assessments, monitoring,
and protection

34. User Security

35.  Access control
 Selective restriction of access to the system
 Role-based access control
 Access control based on the person’s role
(rather than identity)
 Audit trails
 Logs/records that provide evidence of
sequence of activities
User Security

36.  Identification
 Identifying who you are
 Usually done by user IDs or some other unique codes
 Authentication
 Confirming that you truly are who you identify
 Usually done by keys, PIN, passwords or biometrics
 Authorization
 Specifying/verifying how much you have access
 Determined based on system owner’s policy & system
configurations
 “Principle of Least Privilege”
User Security

37.  Nonrepudiation
 Proving integrity, origin, & performer of an
activity without the person’s ability to refute
his actions
 Most common form: signatures
 Electronic signatures offer varying degrees of
nonrepudiation
 PIN/password vs. biometrics
 Digital certificates (in public key infrastructure
- PKI) often used to ascertain nonrepudiation
User Security

38.  Multiple-Factor Authentication
 Two-Factor Authentication
 Use of multiple means (“factors”) for authentication
 Types of Authentication Factors
 Something you know
 Password, PIN, etc.
 Something you have
 Keys, cards, tokens, devices (e.g. mobile phones)
 Something you are
 Biometrics
User Security

39. Need for Strong Password Policy
So, two informaticians
walk into a bar...
The bouncer says,
"What's the password."
One says, "Password?"
The bouncer lets them
in.
Credits: @RossMartin & AMIA (2012)

40. Unknown Internet sources, via
http://pikabu.ru/story/interesno_kakoy_zhe_u_nikh_parol_4274737,
via Facebook page “สอนแฮกเว็บแบบแมวๆ”
What’s the Password?

41. Written Password

42. Recommended Password Policy
 Length
 8 characters or more (to slow down brute-force attacks)
 Complexity (to slow down brute-force attacks)
 Consists of 3 of 4 categories of characters
 Uppercase letters
 Lowercase letters
 Numbers
 Symbols (except symbols that have special uses by the
system or that can be used to hack system, e.g. SQL
Injection)
 No meaning (“Dictionary Attacks”)
 Not simple patterns (12345678, 11111111) (to slow down brute-
force attacks & prevent dictionary attacks)
 Not easy to guess (birthday, family names, etc.) (to prevent
unknown & known persons from guessing)Personal opinion. No legal responsibility assumed.

43. Recommended Password Policy
 Expiration (to make brute-force attacks not possible)
 6-8 months
 Decreasing over time because of increasing computer’s
speed
 But be careful! Too short duration will force users to write
passwords down
 Secure password storage in database or system
(encrypted or store only password hashes)
 Secure password confirmation
 Secure “forget password” policy
 Different password for each account. Create variations
to help remember. If not possible, have different sets of
accounts for differing security needs (e.g., bank
accounts vs. social media sites) Personal opinion. No legal responsibility assumed.

44. Techniques to Remember Passwords
 http://www.wikihow.com/Create-a-Password-You-Can-
Remember
 Note that some of the techniques are less secure!
 One easy & secure way: password mnemonic
 Think of a full sentence that you can remember
 Ideally the sentence should have 8 or more words, with
numbers and symbols
 Use first character of each word as password
 Sentence: I love reading all 7 Harry Potter books!
 Password: Ilra7HPb!
 Voila!
Personal opinion. No legal responsibility assumed.

45. Dear mail.mahidol.ac.th Email Account User,
We wrote to you on 11th January 2010 advising that you change the password on
your account in order to prevent any unauthorised account access following
the network instruction we previously communicated.
all Mailhub systems will undergo regularly scheduled maintenance. Access
to your e-mail via the Webmail client will be unavailable for some time
during this maintenance period. We are currently upgrading our data base
and e-mail account center i.e homepage view. We shall be deleting old
[https://mail.mahidol.ac.th/l accounts which are no longer active to create
more space for new accountsusers. we have also investigated a system wide
security audit to improve and enhance
our current security.
In order to continue using our services you are require to update and
re-comfirmed your email account details as requested below. To complete
your account re-comfirmation,you must reply to this email immediately and
enter your account
details as requested below.
Username :
Password :
Date of Birth:
Future Password :
Social Engineering Examples
Real social-engineering e-mail received by Speaker

46. Phishing
Real phishing e-mail received by Speaker

47.  Poor grammar
 Lots of typos
 Trying very hard to convince you to open
attachment, click on link, or reply without
enough detail
 May appear to be from known person (rely on
trust & innocence)
Signs of a Phishing Attack

48.  Don’t be too trusting of people
 Always be suspicious & alert
 An e-mail with your friend’s name & info doesn’t have to
come from him/her
 Look for signs of phishing attacks
 Don’t open attachments unless you expect them
 Scan for viruses before opening attachments
 Don’t click links in e-mail. Directly type in browser using
known & trusted URLs
 Especially cautioned if ask for passwords, bank
accounts, credit card numbers, social security numbers,
etc.
Ways to Protect against Phishing

49. Malware

50.  Malicious software - Any code with intentional,
undesirable side effects
 Virus
 Worm
 Trojan
 Spyware
 Logic Bomb/Time Bomb
 Backdoor/Trapdoor
 Rootkit
 Botnet
Malware

51.  Virus
 Propagating malware that requires user action
to propagate
 Infects executable files, data files with
executable contents (e.g. Macro), boot
sectors
 Worm
 Self-propagating malware
 Trojan
 A legitimate program with additional, hidden
functionality
Malware

52.  Spyware
 Trojan that spies for & steals personal
information
 Logic Bomb/Time Bomb
 Malware that triggers under certain conditions
 Backdoor/Trapdoor
 A hole left behind by malware for future
access
Malware

53.  Rogue Antispyware
 Software that tricks or forces users to pay before
fixing (real or hoax) spyware detected
 Rootkit
 A stealth program designed to hide existence of
certain processes or programs from detection
 Botnet
 A collection of Internet-connected computers that
have been compromised (bots) which controller of the
botnet can use to do something (e.g. do DDoS
attacks)
Malware

54. Ransomware Outbreak in Healthcare
Top: http://www.healthcareitnews.com/news/more-half-hospitals-hit-ransomware-last-12-months
Bottom: http://www.mirror.co.uk/news/uk-news/ransomware-nhs-cyber-attack-live-10409420

55.  Installed & updated antivirus, antispyware, &
personal firewall
 Check for known signatures
 Check for improper file changes (integrity failures)
 Check for generic patterns of malware (for unknown
malware): “Heuristics scan”
 Firewall: Block certain network traffic in and out
 Sandboxing
 Network monitoring & containment
 User education
 Software patches, more secure protocols
Defense Against Malware

56.  Social media spams/scams/clickjacking
 Social media privacy issues
 User privacy settings
 Location services
 Mobile device malware & other privacy risks
 Stuxnet (advanced malware targeting certain
countries)
 Advanced persistent threats (APT) by
governments & corporations against specific
targets
Newer Threats