Information Security & Privacy in Healthcare (February 9, 2021)

Information Security
& Privacy in Healthcare
SlideShare.net/Nawanan
นพ.นวนรรน ธีระอัมพรพันธุ์
9 กุมภาพันธ์ 2564

2003 M.D. (First-Class Honors) (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
• Faculty of Medicine Ramathibodi Hospital
Mahidol University
o Deputy Dean for Operations
o Lecturer, Department of Clinical Epidemiology
& Biostatistics
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
Facebook.com/NawananT
Line ID: NawananT
Introduction

Overview of IT Security
& Privacy

Malware
Threats to Information Security

ภัย Security กับเมืองไทย
(Top) http://deadline.com/2014/12/sony-hack-timeline-any-pascal-the-interview-north-korea-1201325501/
(Bottom) http://www.bloomberg.com/news/articles/2014-12-07/sony-s-darkseoul-breach-stretched-from-thai-hotel-
to-hollywood

https://www.it24hrs.com/2016/anonymous-hack-id-cards-ministry-of-foreign-affairs-tica/

Privacy Threats in Thailand
https://www.posttoday.com/it/548240

http://news.sanook.com/1262964/
Privacy Threats in Thai Health Care

https://www.blognone.com/node/79473

Security Threats by Poor Software

Why Software Testing is Important

National Healthcare’s Worst Nightmare
https://www.straitstimes.com/singapore/personal-info-of-15m-singhealth-
patients-including-pm-lee-stolen-in-singapores-most

Ransomware Attack in Thai Hospitals
https://www.facebook.com/SaraburiHospital/photos/a.255929423747
8100/4366815263392646/

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

▪ 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

▪ 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

Confidentiality
• การรักษาความลับของข้อมูล
Integrity
• การรักษาความครบถ้วนและความ
ถูกต้องของข้อมูล
• ปราศจากการเปลี่ยนแปลงแก้ไข ทา
ให้สูญหาย ทาให้เสียหาย หรือถูก
ทาลายโดยมิชอบ
Availability
• การรักษาสภาพพร้อมใช้งาน
หลักการของ Information Security

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

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

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

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

Interesting Resources
▪ http://en.wikipedia.org/wiki/List_of_software_bugs
▪ http://en.wikipedia.org/wiki/Notable_computer_viruses_an
d_worms
▪ http://en.wikipedia.org/wiki/Hacktivism
▪ http://en.wikipedia.org/wiki/Website_defacement
▪ http://en.wikipedia.org/wiki/Hacker_(computer_security)
▪ http://en.wikipedia.org/wiki/List_of_hackers

Personnel Safety Goals: SIMPLE

S: Security and Privacy of Information
and Social Media
S 1 Security and Privacy of Information
S 2 Social Media and
Communication Professionalism
Personnel Safety Goals: S in SIMPLE

Protecting Information
Privacy & Security

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

Privacy Case Studies
http://pantip.com/topic/35330409/

แนวทางการคุ้มครอง Privacy
• Informed consent
• Privacy culture
• User awareness building & education
• Organizational policy & regulations
▪ Enforcement
▪ Ongoing privacy & security
assessments, monitoring, and protection

▪ 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

▪ Identify some possible means an
attacker could use to conduct a
security attack
▪ Identify measures to prevent or
mitigate the risk of attack
Class Exercise

Alice
Simplified Attack Scenarios
Server Bob
Eve/Mallory

Alice
Server Bob
Eve/Mallory
1. “ต้นทาง & ปลายทาง” (Users)
2. “ระหว่างทาง” (Network)
3. “กลางหัวใจ” (Servers)

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

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

Alice
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

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

Alice
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

Alice
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

Alice
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

Alice
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

Alice
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

Alice
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)
- Data backups (online vs. offline)

มาตรฐาน Security ตามวิธีการแบบปลอดภัย แต่ละระดับ
หมวด (Domain) ระดับพื้นฐาน ระดับกลาง
(เพิ่มเติมจากระดับพื้นฐาน)
ระดับสูง
(เพิ่มเติมจากระดับกลาง)
Security policy 1 ข้อ 1 ข้อ -
Organization of information security 5 ข้อ 3 ข้อ 3 ข้อ
Asset management 1 ข้อ 4 ข้อ -
Human resources security 6 ข้อ 1 ข้อ 2 ข้อ
Physical and environmental security 5 ข้อ 2 ข้อ 6 ข้อ
Communications & operations management 18 ข้อ 5 ข้อ 9 ข้อ
Access control 9 ข้อ 8 ข้อ 8 ข้อ
Information systems acquisition,
development and maintenance
2 ข้อ 6 ข้อ 8 ข้อ
Information security incident management 1 ข้อ - 3 ข้อ
Business continuity management 1 ข้อ 3 ข้อ 1 ข้อ
Regulatory compliance 3 ข้อ 5 ข้อ 2 ข้อ
รวม 52 ข้อ 38 ข้อ (รวม 90 ข้อ) 42 ข้อ (รวม 132 ข้อ)

คาถา #1:
Multiple Domains of Security
(“Defense in Depth”)

▪ 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

▪ 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

▪ 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

▪ 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

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)

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

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.

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.

Clear Desk, Clear Screen Policy
http://pixabay.com/en/post-it-sticky-note-note-corner-148282/

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.

Dictionary Attack:
A story from
a computer security
course

Keylogger Attack:
A story from
a medical student’s life

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

Phishing
Real phishing e-mail received by Speaker

Checking for Encryption for Website Connections
Microsoft Edge

Google Chrome

Mozilla Firefox
Google Chrome
1

Mozilla Firefox
Google Chrome
2
1

Mozilla Firefox
Google Chrome
2
1
3

1
Mozilla Firefox
Google Chrome
2
3
4

▪ 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

▪ 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

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

▪ 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

▪ 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

▪ 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

▪ 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

▪ 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

Ransomware ระบาดใน 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

Infected with WannaCry
https://cdn.securelist.com/files/2017/05/wannacry_05.png

WannaCry: Infection Flow
http://blog.trendmicro.com/trendlabs-security-intelligence/files/2017/05/WannaCry-infection-flow02.jpg

WannaCry
Prevention
for Users
https://www.thaicert.or.th/downloads/files/info_WannaCry-User.png

WannaCry
Prevention
for Admins
https://www.thaicert.or.th/downloads/files/info_WannaCry-Admin.png

WannaCry
WannaCry &
Medical Devices

Petya/Petwrap/NotPetya
https://www.bleepstatic.com/images/news/ransomware/p/notpetya/mbr-ransom-note.jpg

Petya/Petwrap/NotPetya
ThaiCERT

Preventing from Ransomware
https://us-cert.cisa.gov/sites/default/files/publications/Ransomware_Executive_One-
Pager_and_Technical_Document-FINAL.pdf

▪ Most common reason for security bugs is
invalid programming assumptions that attackers
will look for
▪ Weak input checking
▪ Buffer overflow
▪ Integer overflow
▪ Race condition (Time of Check / Time of Use
vulnerabilities)
▪ Running programs in new environments
Software Security
Adapted from Nicholas Hopper’s teaching slides for UMN Computer Security Class Fall 2006 CSCI 5271

▪ Defense in Depth
▪ Multiple layers of security defense are
placed throughout a system to provide
redundancy in the event a security
control fails
▪ Secure the weakest link
▪ Promote privacy
▪ Trust no one
Secure Software Design Principles
Saltzer & Schroeder (1975), Viega & McGraw (2000)
http://en.wikipedia.org/wiki/Defense_in_depth_(computing)

▪ Modular design
▪ Check error conditions on return values
▪ Validate inputs (whitelist vs. blacklist)
▪ Avoid infinite loops, memory leaks
▪ Check for integer overflows
▪ Language/library choices
▪ Development processes
Secure Software Best Practices

▪ Consider a log-in form on a web page
Example of Weak Input Checking:
SQL Injection
▪ Source code would look
something like this:
statement = "SELECT * FROM users
WHERE name = '" + userName + "';"
▪ Attacker would enter as username:
' or '1'='1
▪ Which leads to this always-true query:
▪ statement = "SELECT * FROM users
WHERE name = '" + "' or '1'='1" + "';"
statement = "SELECT * FROM users WHERE name = '' or '1'='1';"
http://en.wikipedia.org/wiki/SQL_injection

U.S. National Institute of Standards and Technology (NIST)
Cybersecurity Framework

คาถา #2: Not Just Protect, But Also
Detect, Respond & Recover
(NIST Cybersecurity Framework)

Technology
Process
People
Balanced IT Security Management

คาถา #3: Balancing People,
Process & Technology

Social Media (เช่น LINE Application)
กับ Patient Care
ประเด็นที่เถียงกันไม่รู้จบ

คาถา #4: Risk-Based Approach

Cybersecurity Act & Personal Data Protection Act (PDPA)
Critical Information
Infrastructure (CII)
Data Controllers &
Data Processors

Information Security & Privacy in Healthcare (February 9, 2021)

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