Secure Cloud Computing
for the Health Enterprise
  By Joel Amoussou, CEO, Efasoft Inc.
Contents



                  1   Regulatory Framework

                  2   Cloud Security Practices

                  3    Security Management

                  4   Auditing & Compliance




www.efasoft.com
Healthcare Apps in the Cloud


                  Cloud Services: IaaS, SaaS, PaaS
                  Cloud Services: IaaS, SaaS, PaaS




          CDSS          EMR            5010          Analytics
                                      ICD10



www.efasoft.com
Drivers




                                          t
                                       en
                                     ym
                                Pa
                                ed
                              as
                                                     ity
                                                  bil




                            -B
                                               ala



                       ge
                                          Sc


                       sa
                                        e

                      U
                                     siv
                               Mas
                                             ty
                                     Elastici
                                                         e
                                               nin g Tim
                                         ovisio

                  $
                                       r
                               Q uick P

                                Low Capital Costs

www.efasoft.com
Regulatory Framework



                                 HIPAA


                    HITECH Act – HIPAA Security Updates


                          State and Federal Laws


                             Meaningful Use


                    Recommendations on Patient Consent




www.efasoft.com
Impact of Regulations


                  HITECH Act
                                         US Patriot Act
   •HIPAA applies to Cloud Service
   Providers (CSPs) and online PHR
                                       •Canada Health Infoway
   vendors as Business Associates???
                                       certification requirements refer
   •Breach Notification                to HIPAA

   •Accounting of disclosure           •British Columbia and Nova
                                       Scotia prohibit storing patient
   •Marketing and sale of PHI          data at providers (including
                                       CSPs) located in the US
   •Patient access and disclosure
   restrictions

   •Minimum data set



www.efasoft.com
Tiger Team Recommendations


  Collection, Use and Disclosure
  Limitation: Third party service      When the decision to disclose or
organizations may not collect, use    exchange the patient's identifiable
or disclose personally identifiable      health information from the
    health information for any          provider's record is not in the
purpose other than to provide the       control of the provider or that
services specified in the business     provider's organized health care
  associate or service agreement       arrangement ("OHCA"), patients
    with the data provider, and           should be able to exercise
     necessary administrative            meaningful consent to their
 functions, or as required by law.               participation.




www.efasoft.com
Addressing HIPAA in the Cloud

 Access                                                          Disaster
 Control                 Audit              Backup
                                                                 Recovery




•SSH Keys                                •Snapshot of
                                         block storage        •Monitoring
•No password-based                       volumes
                        •Event logs to                        •Availability
shell access
                        secured          •Encrypt and         Zones
                        dedicated        Keep backups out     (geographic
•Strong Encryption of
                        server           of the cloud         redundancy)
data and filesystems
                        •Backup log      •Cloud storage is    •Clustering
•Private decryption
                        files            replicated across
keys out of the cloud
                                         multiple             •Replication
•Security groups                         availability zones

•Secure Transport

www.efasoft.com
Security Issues in the Cloud


                  1                      2                        3

       •Reassigned IP          •CSP staff access to VM
       addresses               instances and guest OS    •Isolation in
                                                         multitenancy
       •BGP Prefix Hijacking   •Encryption not always
                               possible while            •OWASP Top 10
       •DNS Attacks            processing data in the
                               cloud (as opposed to      •Data Lineage
       •DoS and DDoS Attacks   data at rest)
                                                         •Data Provenance
       •Security groups not
       physically separated                              •Data Remanence
                                                         (NIST 800-88)




www.efasoft.com
Security Controls in the Cloud


          1
          1       Image hardening and patching

           2
           2        Host based IDS/IPS such as OSSEC


           3
           3      Health Monitoring & Security event logs


           4
           4      Effective Key Management (NIST 800-57)


           5
           5        Default deny-all mode, Host Firewall




www.efasoft.com
Identity and Access Management
                 (IAM)
                                   SPML
                                Provisioning

                                   B



    SAML 2.0            A                          C      XACML
     Identity                                           Authorization
 Federation/SSO
                                   IAM




      WS-I Security         E                  D       Oauth
      Profile (SOA in                              Authentication
        the Cloud)                                  across CSPs
www.efasoft.com
Security Management Standards


                  ITIL: IT Service Management


                      ISO 17799: Code of Practice


                        ISO 20000: Security Techniques Overview


                       ISO 27001: Security Techniques Requirements


                   ISO 27002: Code of Practice



www.efasoft.com
Auditing & Compliance

                          COBIT                ISO 27001




               SAS 70                GRC*                 ISO 27002




                        SysTrust               WebTrust



*Governance, Risk Management, and Compliance

 www.efasoft.com
Collaboration




        Health Enterprise            Cloud Service
                                     Provider
        Understand
        responsibilities (who does   Provide transparency into
        what about security?)        security practices and
                                     policies.




www.efasoft.com
www.efasoft.com
joel@efasoft.com

Secure Cloud Computing for the Health Enterprise

  • 1.
    Secure Cloud Computing forthe Health Enterprise By Joel Amoussou, CEO, Efasoft Inc.
  • 2.
    Contents 1 Regulatory Framework 2 Cloud Security Practices 3 Security Management 4 Auditing & Compliance www.efasoft.com
  • 3.
    Healthcare Apps inthe Cloud Cloud Services: IaaS, SaaS, PaaS Cloud Services: IaaS, SaaS, PaaS CDSS EMR 5010 Analytics ICD10 www.efasoft.com
  • 4.
    Drivers t en ym Pa ed as ity bil -B ala ge Sc sa e U siv Mas ty Elastici e nin g Tim ovisio $ r Q uick P Low Capital Costs www.efasoft.com
  • 5.
    Regulatory Framework HIPAA HITECH Act – HIPAA Security Updates State and Federal Laws Meaningful Use Recommendations on Patient Consent www.efasoft.com
  • 6.
    Impact of Regulations HITECH Act US Patriot Act •HIPAA applies to Cloud Service Providers (CSPs) and online PHR •Canada Health Infoway vendors as Business Associates??? certification requirements refer •Breach Notification to HIPAA •Accounting of disclosure •British Columbia and Nova Scotia prohibit storing patient •Marketing and sale of PHI data at providers (including CSPs) located in the US •Patient access and disclosure restrictions •Minimum data set www.efasoft.com
  • 7.
    Tiger Team Recommendations Collection, Use and Disclosure Limitation: Third party service When the decision to disclose or organizations may not collect, use exchange the patient's identifiable or disclose personally identifiable health information from the health information for any provider's record is not in the purpose other than to provide the control of the provider or that services specified in the business provider's organized health care associate or service agreement arrangement ("OHCA"), patients with the data provider, and should be able to exercise necessary administrative meaningful consent to their functions, or as required by law. participation. www.efasoft.com
  • 8.
    Addressing HIPAA inthe Cloud Access Disaster Control Audit Backup Recovery •SSH Keys •Snapshot of block storage •Monitoring •No password-based volumes •Event logs to •Availability shell access secured •Encrypt and Zones dedicated Keep backups out (geographic •Strong Encryption of server of the cloud redundancy) data and filesystems •Backup log •Cloud storage is •Clustering •Private decryption files replicated across keys out of the cloud multiple •Replication •Security groups availability zones •Secure Transport www.efasoft.com
  • 9.
    Security Issues inthe Cloud 1 2 3 •Reassigned IP •CSP staff access to VM addresses instances and guest OS •Isolation in multitenancy •BGP Prefix Hijacking •Encryption not always possible while •OWASP Top 10 •DNS Attacks processing data in the cloud (as opposed to •Data Lineage •DoS and DDoS Attacks data at rest) •Data Provenance •Security groups not physically separated •Data Remanence (NIST 800-88) www.efasoft.com
  • 10.
    Security Controls inthe Cloud 1 1 Image hardening and patching 2 2 Host based IDS/IPS such as OSSEC 3 3 Health Monitoring & Security event logs 4 4 Effective Key Management (NIST 800-57) 5 5 Default deny-all mode, Host Firewall www.efasoft.com
  • 11.
    Identity and AccessManagement (IAM) SPML Provisioning B SAML 2.0 A C XACML Identity Authorization Federation/SSO IAM WS-I Security E D Oauth Profile (SOA in Authentication the Cloud) across CSPs www.efasoft.com
  • 12.
    Security Management Standards ITIL: IT Service Management ISO 17799: Code of Practice ISO 20000: Security Techniques Overview ISO 27001: Security Techniques Requirements ISO 27002: Code of Practice www.efasoft.com
  • 13.
    Auditing & Compliance COBIT ISO 27001 SAS 70 GRC* ISO 27002 SysTrust WebTrust *Governance, Risk Management, and Compliance www.efasoft.com
  • 14.
    Collaboration Health Enterprise Cloud Service Provider Understand responsibilities (who does Provide transparency into what about security?) security practices and policies. www.efasoft.com
  • 15.