Data safety is a vital part of modern medical care, and anyone in
healthcare today has to acknowledge it. More and more digital
solutions are used to process highly sensitive medical information, so
the secured storage of data is key for patient confidence in the
institution. Security breaches and hacker threats can have
catastrophic consequences not only for patients but also for
healthcare providers as a whole.
Healthcare software relies on the integrity of the servers that store
sensitive patient data, and they need to adhere to strict rules like
the Health Insurance Portability and Accountability Act (HIPAA).
Without reliable security measures, the integrity of electronic health
records (EHRs), personal health information (PHI), and other crucial
data would be at risk. Medical facilities could end up thrust into the
spotlight if they don’t follow the strict rules protecting patient
data, exposing themselves to huge fines and tarnishing their
reputations. Worse yet, they may compromise patient safety.
In this article, topics related to the most important issues in data
security in healthcare software development will be discussed. These
topics include the basics of data security, the important elements of
data security such as encryption, access controls, and audit trails,
the challenges in data security enhancement, common issues in data
security maintenance including technical difficulties, financial cost,
and the ever-changing nature of security threats, best practices to
enhance the security of healthcare software, some real-world case
studies in the field of healthcare, and the prospect of security
technology.
Personal Health Information (PHI) is identifiable information about an individual that relates to the person’s past, present, or future physical or mental health, health care, or payment for health care. PHI contains a wide array of information, such as your past and current medical history, as well as your test results, diagnoses, treatment plans, you name it. There are also personal identifiers, such as your name, address, Social Security number, and account number. PHI needs to be protected to ensure personal privacy and the trust placed in your healthcare provider by you.
Electronic Health Records (EHRs) are digital representations of patients' records that healthcare providers keep. Data structure of an EHR includes patient care information such as diagnosis, medication, risk and allergies, vital signs, immunization dates, laboratory test results, radiology images and scans. Because unrestricted access to EHRs may lead to unethical treatment, fraudulent activities, or identity theft for patients, it is important to implement protective and encryption methods. This will help to enhance and maintain the freshness of patient medical records and, therefore, support by standard regulatory bodies.
Payment and billing information concerns financial data produced in relation to healthcare services, eg, insurance details, billing records and payment transactions. It qualifies as sensitive information because it involves a person’s financial details that are often linked to PHI, and this information must be secured from fraud, theft and data access that does not comply with financial and data protection regulations.
Storing data in an encrypted database is one method of protecting sensitive data. This refers to encryption at rest. However, another means of protection is what’s known as encryption in transit, wherein data is encrypted as it’s transmitted from one location to another across a network, such as the flow of information between a hospital’s system and some external entity (for example, Dell in an electronic health record request). Technologies such as Transport Layer Security (TLS) and Secure Socket Layer (SSL) are used to encrypt data as it’s shared with external parties, protecting it from interception or ‘eavesdropping’ and from man-in-the-middle attacks (MITM).
Data 'at rest’ means data stored, which means that protection from prying eyes requires encryption. Encryption at rest from unauthorized access This means protecting data that is saved to servers, databases, or any other storage device. The goal is to ensure that the data remains safe in case of physical security breaches. Technologies like Advanced Encryption Standard (AES) are used to encrypt data at rest. This way, the data is unreadable without the correct decryption key and cannot be used by a breaching entity.
User identity must be able to interact with the healthcare system, and only authorized individuals should be able to see or modify sensitive health data. User identity, or authentication, refers to end-user validation based on a credential, such as a username and password. This validation authenticates a user through multiple checks and balances to ensure authorized access. Examples include biometrics, MFA, and other mechanisms for protecting consumer identities. Authorization refers to controlling access across functions and data based on the user identity. In the context of healthcare, it’s important to authenticate the identity of the user first before granting access to specific functionalities.
In Role-Based Access Controls (RBAC), access rights and permissions are assigned based on an organization’s role structures. Persons associated with an organization have access only to the required data and systems based on their role. This level of control can significantly minimize the risk of access from within the organization. For example, say the staff of a hospital have access to the patient's medical records, but the administrative staff access only the bills generated. RBAC helps enforce the rule of least privilege and reduces an organization’s risk of internal threat.
Maintain a detailed log: This is essential. Every access and change to sensitive data in health care should be written in an audit log. An audit trail reports who accessed what data, when, and what changes were made. This helps to track and keep everyone in line. It offers proof of who accessed what data and also reveals security incidents or laws or regulations you may have violated.
A regular audit of their audit trail and security logs is essential to detect and swiftly address issues. Audits involve examination of the records of all activities that occur while using a computer system, such as logs. They serve as a means to identify or extinguish any unauthorized functionality and unapproved actions. Furthermore, they ensure regular compliance with the security policies in place and compliance with the relevant needs of the DPA. Scheduled audits help detect irregularities or unusual activities in operations to close potential threats, improve or detect vulnerabilities inherent to the system, and efficiently ensure compliance with the regulations of the DPA.
One of the major technical hurdles to data security in healthcare software is integrating new security changes with older systems. Many healthcare facilities use a lot of legacy systems and applications that were initially designed using different architectures and had tailored requirements. New security changes to any of these applications will have to consider all these considerations. It might expose sensitive data to the surface of the internet, where hackers can easily access it. Unless new security changes are compatible with all these legacy systems or carefully planned in a way that avoids disruption to the existing work process, the data integrity of the system or the functionality of the system itself might be compromised.
An additional major challenge is working with other software and platforms. Clinical sites utilizing EHRs or any type of health IT often contain some degree of proprietary or third-party applications with different or unknown security schemes and data formats. Creating systems that can interoperate while still providing robust security is difficult, as multiple incompatible systems should be able to work with each other, maintain each other’s security, and efficiently communicate. This requires a deep understanding of exactly what the threats are, what the security requirements are, and what the technical specifications for all of the systems are.
Because of these costs, providing full data security is expensive. Purchasing or creating software, upgrading the infrastructure, and staffing a specialized security team all add to the expenses of providing a secure infrastructure for health data. Particularly among small, independent practices or those simply on tighter budgets, providing full data security presents a significant challenge in balancing expense with need.
A national security platform kept in a silo throughout its existence rarely needs to be maintained or updated. A part of what makes data security challenging is that it’s never over. As soon as DefCon lasts, zero days are discovered, and employees go to breakfast. New threats start emerging, vulnerabilities begin existing in new products, and regulations shift again, requiring maintenance, patches, and other forms of security updates to be provided. Keeping a security posture at all times is a drain on resources as personnel monitor security systems, apply patches, and update security measures. Maintaining an adequate security posture with limited staffing capacity can bring intensive pressure.
This complex landscape of regulations – from HIPAA and the countrywide protections of HITECH to GDPR – has detailed lists of safeguards necessary to help organizations maintain compliance. Depending on the size of the healthcare organization, employees can have limited or no dedicated time to consider or comprehend those deep and detailed lists of safeguards, which can number in the ‘dozens’ (Modern Healthcare 2015) and take multiple seasons to complete.
Cybersecurity is a dynamic situation, with new threats and technologies emerging frequently. Healthcare organizations need to continually alter their practices to work against incremental or disruptive changes to security risks, such as using new or improved cyberattacks or introducing a zero-day vulnerability. Information about such threats will need to be shared among organizations. Breaching organizations will need to stay on top of regular advice on security trends and incur the costs associated with developing and procuring the most advanced technologies and implementing frequent iterations of their security practice. A key attribute will be vigilance, altering practices, and having a proactive stance on threat management and technology adoption.
To protect personal health information, strict cybersecurity protocols
need to be enforced in the development of health IT software to give
confidence and trust that healthcare providers' and patients’ data are
not being compromised by bad actors. Strong encryption used in data
transmission will help protect data over the network and keep stolen
or inappropriately obtained personnel health information safe. Routine
vulnerability scanning will identify weaknesses in software security,
and such scans can be performed either as a fully automated service or
manually with a trained and knowledgeable IT professional. Creating an
operational plan for incident response and recovery will help to
improve response times and minimize the subsequent recovery cost or
the damage that can result from security breaches. Integrating
security principles into the development lifecycle will also ensure
that security mechanisms are developed from concept rather than as an
afterthought, reducing the risk of vulnerabilities that hackers may
exploit.
Such remedies can ensure that healthcare institutions obtain
state-of-the-art cybersecurity systems that remain in line with
regulatory expectations and the evolving nature of global security
risks. Through continued vigilance, healthcare institutions can then
stand a better chance of securing all their data from the increasing
risks to cybersecurity to ensure the honest, secure, and holistic
delivery of health services.