skip to main content
10.1145/3465481.3470033acmotherconferencesArticle/Chapter ViewAbstractPublication PagesaresConference Proceedingsconference-collections
research-article

The landscape of cybersecurity vulnerabilities and challenges in healthcare: Security standards and paradigm shift recommendations

Published:17 August 2021Publication History

ABSTRACT

Digital technology provides unique opportunities to revolutionize the healthcare ecosystem and health research. However, this comes with serious security, safety, and privacy threats. The healthcare sector has been proven unequipped and unready to face cyberattacks while its vulnerabilities are being systematically exploited by attackers. The growing need and use of medical devices and smart equipment, the complexity of operations and the incompatible systems are leaving healthcare organizations exposed to various malware, including ransomware, which result in compromised healthcare access, quality, safety and care. To fully benefit from the advantages of technology, cybersecurity issues need to be resolved. Cybersecurity measures are being suggested via a number of healthcare standards which are often contradicting and confusing, making these measures ineffective and difficult to implement. To place a solid foundation for the healthcare sector, in improving the understanding of complex cybersecurity issues, this paper explores the existing vulnerabilities in the health care critical information infrastructures which are used in cyberattacks and discusses the reasons why this sector is under attack. Furthermore, the existing security standards in healthcare are presented alongside with their implementation challenges. The paper also discusses the use of living labs as a novel way to discover how to practically implement cybersecurity measures and also provides a set of recommendations as future steps. Finally, to our knowledge this is the first paper that analyses security in the context of living labs and provides suggestions relevant to this context.

References

  1. SIEMENS. 2021. Digitalizing healthcare: How to build a digital enterprise. Retrieved from https://www.siemens-healthineers.com/insights/digitalizing-healthcareGoogle ScholarGoogle Scholar
  2. Stephen O. Agboola, David W. Bates, Joseph C. Kvedar. 2016. Digital health and patient safety. JAMA 315, 16 (April 2016), 1697-1698. DOI: 10.1001/jama.2016.2402Google ScholarGoogle ScholarCross RefCross Ref
  3. Arash Keshavarzi Arshadi, Julia Webb, Milad Salem, Emmanuel Cruz, Stacie Calad-Thomson, Niloofar Ghadirian, Jennifer Collins, Elena Diez-Cecilia, Brendan Kelly, Hani Goodarzi, Jian Shiun Yuan. 2020. Artificial intelligence for Covid-19 drug discovery and vaccine development. Front Artif Intell 3, 65 (August 2020), 1-13. DOI: 10.3389/frai.2020.00065Google ScholarGoogle ScholarCross RefCross Ref
  4. World Economic Forum. 2018. Value in healthcare: laying the foundation for health system transformation. Retrieved from http://www3.weforum.org/docs/WEF_Insight_ Report_Value_Healthcare_Laying_Foundation.pdfGoogle ScholarGoogle Scholar
  5. Hassane Alami, Marie-Pierre Gagnon, Mohamed Ali Ag Ahmed, Jean-Paul Fortin. 2019. Digital Health: Cybersecurity is a value creation lever, not only a source of expenditure. Health Policy and Technology 8, 4 (December 2019), 319-321. DOI: 10.1016/j.hlpt.2019.09.002Google ScholarGoogle ScholarCross RefCross Ref
  6. ENISA. 2020. Procurement guidelines for cybersecurity in hospitals. Retrieved from https://www.enisa.europa.eu/publications/good-practices-for-the-security-of-healthcare-servicesGoogle ScholarGoogle Scholar
  7. Department of Health and Human Services. 2013. Summary of the HIPAA privacy rule. Retrieved from https://www.hhs.gov/hipaa/ for-professionals/privacy/laws-regulations/Google ScholarGoogle Scholar
  8. Barbara Filkins. 2014. Health Care Cyberthreat report: Widespread compromises detected, compliance nightmare on horizon. SANS Norse. Retrieved from https://www.sans.org/reading-room/ whitepapers/analyst/health-care-cyberthreat-report-widespread-compromises-detected-compliance-nightmare-horizon-34735Google ScholarGoogle Scholar
  9. Daniel Berger. 2016. Breach Report 2015: Protected health information (PHI). Retrieved from https://www.redspin.com/ resources/download/breach-report-2015-protected-health- information-phi/Google ScholarGoogle Scholar
  10. Verizon. 2018. Data Breach Investigations Report. Retrieved from https://enterprise.verizon.com/resources/reports/DBIR_2018_Report_execsummary.pdfGoogle ScholarGoogle Scholar
  11. Infoguard Cyber Security. 2017. 5 industries that top the hit list of cyber criminals in 2017. Retrieved from http://www.infoguardsecurity.com/5-industries-top-hit-list- cyber-criminals-2017/Google ScholarGoogle Scholar
  12. IBM. 2018. Cost of a data breach study: global overview. Retrieved from https://www- 01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=55017055USEN&Google ScholarGoogle Scholar
  13. Menaka Muthupalapania, Kerrie Stevenson. 2021. Healthcare cyber-attacks and the Covid-19 pandemic: an urgent threat to global health. Int J Qual Health Care 33, 1 (February 2021), 1-12 DOI: 10.1093/intqhc/mzaa117Google ScholarGoogle Scholar
  14. ENISA. 2020. Cybersecurity in the healthcare sector during Covid-19 pandemic. Retrieved from https://www.enisa.europa.eu/news/enisa-news/cybersecurity-in-the-healthcare-sector-during-covid-19-pandemicGoogle ScholarGoogle Scholar
  15. The CyberPeace Institute. 2021. Playing with lives: Cyberattacks on healthcare are attacks on people. Retrieved from https://cyberpeaceinstitute.org/report/2021-03-CyberPeaceInstitute-SAR001-Healthcare.pdfGoogle ScholarGoogle Scholar
  16. Lynne Coventry, Dawn Branley. 2018. Cybersecurity in healthcare: A narrative review of trends, threats and ways forward. Maturitas 113, 1 (July 2018), 48-52. DOI: 10.1016/j.maturitas.2018.04.008Google ScholarGoogle ScholarCross RefCross Ref
  17. Aatif Sulleyman. 2017. NHS cyber-attack: why stolen medical information is so much more valuable than financial data. Retrieved from https://www.independent.co.uk/life-style/gadgets-and-tech/news/nhs-cyber-attack-medical-data-records-stolen-why-so-valuable-sell-financial-a7733171.htmlGoogle ScholarGoogle Scholar
  18. Joshua Berlinger. 2018. Justice Department Files Record $900 Million Healthcare Fraud Case. Retrieved from https://edition.cnn.com/2016/06/23/health/health-care-fraud-takedown/index.htmlGoogle ScholarGoogle Scholar
  19. LUXSCI. 2017. Why Are Hackers Targeting Your Medical Records? Retrieved from https://luxsci.com/blog/hackers-targeting-medical-records.htmlGoogle ScholarGoogle Scholar
  20. Kim Sengupta. 2017. Isis-linked hackers attack NHS websites to show gruesome Syrian civil war images. Retrieved from http://www.independent.co.uk/news/uk/crime/isis- islamist-hackers-nhs-websites-cyber-attack-syrian-civil-war-images-islamic-state- a7567236.html.Google ScholarGoogle Scholar
  21. Fred Donovan. 2018. Healthcare data security programs get short shrift in IT budgets. Health IT Security. Retrieved from https://healthitsecurity.com/news/healthcare-data- security-programs-get-short-shrift-in-it-budgetsGoogle ScholarGoogle Scholar
  22. Fred Donovan. 2018. NIST warns about cybersecurity vulnerabilities in healthcare IoT. Retrieved from https://healthitsecurity.com/news/nist-warns-about-cybersecurity-vulnerabilities-in-healthcare-iotGoogle ScholarGoogle Scholar
  23. Piotr Kaminski, Chris Rezek, Wolf Richter, Marc Sorel. 2017. Protecting your critical digital assets: Not all systems and data are created equal. Retrieved from https:// www.mckinsey.com/business-functions/risk/our-insights/ protecting-your-critical-digital-assets-not-all-systems-and- data-are-created-equalGoogle ScholarGoogle Scholar
  24. Klon Kitchen, Megan Reiss. 2018. Ransomware is coming; It'll make you wannacry. Retrieved from https://www.heritage.org/technology/commentary/ransomware-coming-itll-make-you-wannacryGoogle ScholarGoogle Scholar
  25. Ying He, Aliyu Aliyu, Mark Evans, Cunjin Luo. 2021. Health care cybersecurity challenges and solutions under the climate of covid-19: Scoping Review. J Med Internet Res 23, 4 (April 2021), 21-47. DOI: 10.2196/21747Google ScholarGoogle Scholar
  26. Kitty Kioskli, Nineta Polemi. 2020. A socio-technical approach to cyber risk assessment. International Journal of Electrical Computer Engineering 14, 10 (December 2020), 305-309.Google ScholarGoogle Scholar
  27. Kayla Matthews. 2018. Exciting IoT use cases in healthcare. IoT for all. Retrieved from https://theinternetofthings.report/blogs/6-exciting-iot-use-cases-in-healthcare/5382Google ScholarGoogle Scholar
  28. Nate Lord. 2018. Information security: The top INFOSEC considerations for healthcare organizations today. Retrieved from https://digitalguardian.com/blog/healthcare-information-security-top-infosec-considerations-healthcare-organizations-todayGoogle ScholarGoogle Scholar
  29. Saira Ghafur, Emilia Grass, Nick R Jennings, Ara Darzi. 2019. The challenges of cybersecurity in health care: the UK National Health Service as a case study. Lancet Digit Health 1, 1 (May 2019), 10-12. DOI: 10.1016/S2589-7500(19)30005-6Google ScholarGoogle Scholar
  30. National Health Service. 2019. Preparing the healthcare workforce to deliver the digital future. Retrieved from https://topol.hee.nhs.uk/Google ScholarGoogle Scholar
  31. William J. Mitchell. 2003. Me++ The Cyborg self and the networked city. Retrieved from https://mitpress.mit.edu/books/meGoogle ScholarGoogle Scholar
  32. European Network of Living Labs. 2020. What are the living labs. Retrieved from https://enoll.org/about-usGoogle ScholarGoogle Scholar
  33. Mokter Hossain, Seppo Leminen, Mika Westerlund. 2019. A systematic review of living lab literature. Journal of Cleaner Production 213, 1 (March 2019), 976-988. DOI: 10.1016/j.jclepro.2018.12.257Google ScholarGoogle ScholarCross RefCross Ref
  34. European Institute of Innovation and Technology. 2015. EIT ICT labs: An entire testing platform of SMEs to boost the international growth of Trilogis. Retrieved from http://eit.europa.eu/newsroom/eit-ict-labs-entire-testing-platform-smes-boost-international-growth-trilogisGoogle ScholarGoogle Scholar
  35. Kris Steen, Ellen van Bueren. 2017. Urban Living Labs: A Living Lab Way of Working. AMS Research Report, Amsterdam: AMS Institute.Google ScholarGoogle Scholar
  36. Paul Bate, Glenn Robert. 2006. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 15, 5 (October 2006), 307-310. DOI: 10.1136/qshc.2005.016527Google ScholarGoogle ScholarCross RefCross Ref
  37. Elizabeth B N Sanders, Piete Jan Stappers. 2008. Co-creation and the new landscapes of design. CoDesign 4, 1 (June 2008), 5-18. DOI: 10.1080/15710880701875068Google ScholarGoogle ScholarCross RefCross Ref
  38. Anna Ståhlbröst. 2012. A set of key principles to assess the impact of Living Labs. Int J Prod Dev 17, 1-2 (January 2012), 60-75. DOI: 10.1504/IJPD.2012.051154Google ScholarGoogle ScholarCross RefCross Ref
  39. Anand Sundaralingam, Theo Fotis. 2019. Making the case for responsible innovation. The Journal of mHealth 6, 5 (September 2019), 25-26.Google ScholarGoogle Scholar
  40. U4IoT. 2017. Living Labs Methodology Handbook. Retrieved from https://u4iot.eu/pdf/D2.2_LivingLabsMethodologyHandbook.pdfGoogle ScholarGoogle Scholar
  41. Cristina B Gibson, Julian Birkinshaw. 2004. The antecedents, consequences and mediating role of organizational ambidexterity. Academy of Management Journal 47, 2 (April 2004), 209-226. DOI: 10.2307/20159573Google ScholarGoogle ScholarCross RefCross Ref
  42. Antonio Capaldo. 2007. Network structure and innovation: The leveraging of a dual network as a distinctive relational capability. Strategic Management Journal 28, 6 (June 2007), 585-608. DOI: 10.1002/smj.621Google ScholarGoogle ScholarCross RefCross Ref
  43. Javier Garcia Guzman, Alvaro Fernandez del Carpio, Ricardo Colomo-Palacios, Manuel Velasco de Diego. 2015. Living labs for user-driven innovation: a process reference model. Res Technol Manag 56, 3 (Decemver 2015), 1-12. DOI: 10.5437/08956308X5603087Google ScholarGoogle Scholar
  44. Kristian Moller, Arto Rajala, Senja Svahn. 2005. Strategic business nets-their type and management. Journal of Business Research 58, 9 (September 2005), 1274-1284. DOI: 10.1016/j.jbusres.2003.05.002Google ScholarGoogle ScholarCross RefCross Ref
  45. Linus Dahlander, David M. Gann. 2010. How open is innovation? Res Pol 39, 6 (July 2010), 699-709. DOI: 10.1016/j.respol.2010.01.013Google ScholarGoogle ScholarCross RefCross Ref
  46. Seppo Leminen, Mika Westerlund. 2017. Categorization of innovation tools in living labs. Technol Innovat Manag Rev 7, 1 (January 2017), 15-25. DOI: 10.22215/timreview/1046Google ScholarGoogle Scholar
  47. James Evans, Ross Jones, Andrew Karvonen, Lucy Millard, Jana Wendler. 2015. Living labs and co- production: university campuses as platforms for sustainability science. Curr Opin Environ Sustain 16, 1 (October 2015), 1-6. DOI: 10.1016/j.cosust.2015.06.005Google ScholarGoogle ScholarCross RefCross Ref
  48. ANSI/CTA. 2020. Definitions/Characteristics Of Artificial Intelligence In Health Care. Retrieved from https://webstore.ansi.org/Standards/ANSI/ANSICTA20892020Google ScholarGoogle Scholar
  49. Declaration of Helsinki (1964). BMJ 313, 7070 (December 1996), 1448-1449. DOI: 10.1136/bmj.313.7070.1448a Google ScholarGoogle Scholar
  50. World Medical. 2001. World Medical Association Declaration of Helsinki. Retrieved from http://www.hl7.org/implement/standards/fhirGoogle ScholarGoogle Scholar
  51. interoEHRate Consortium. 2020. D2.7 FHIR Profile for EHR interoperability-V1. Retrieved from https://www.interopehrate.eu/wp-content/uploads/2019/11/InteropEHRate-D2.7-FHIR-profile-for-EHR-interoperability-V1.pdfGoogle ScholarGoogle Scholar
  52. Chon Abraham, Dave Chatterjee, Ronald S. Sims. 2019. Muddling through cybersecurity: Insights from the U.S. healthcare industry. Business Horizons 62, 4 (July-August 2019), 539-548. DOI: 10.1016/j.bushor.2019.03.010Google ScholarGoogle ScholarCross RefCross Ref
  53. Sati Gürdas ̧ Topkaya, Nurten Kaya. 2015. Nurses’ computer literacy and attitudes towards the use of computers in health care. Int J Nurs Pract 21, 1 (May 2015), 141-149. DOI: 10.1111/ijn.12350Google ScholarGoogle Scholar
  54. Henry G. Torres, Saurabh Gupta. 2018. The misunderstood link: information security training strategy. Retrieved from https://aisel.aisnet.org/amcis2018/Security/Presentations/16/Google ScholarGoogle Scholar
  55. Kitty Kioskli, Nineta Polemi. 2020. Psychosocial approach to cyber threat intelligence. International Journal of Chaotic Computing 7, 1 (February 2021), 159-165. DOI: 10.20533/ijcc.2046.3359.2020.0021Google ScholarGoogle ScholarCross RefCross Ref

Recommendations

Comments

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Sign in
  • Published in

    cover image ACM Other conferences
    ARES '21: Proceedings of the 16th International Conference on Availability, Reliability and Security
    August 2021
    1447 pages
    ISBN:9781450390514
    DOI:10.1145/3465481

    Copyright © 2021 ACM

    Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]

    Publisher

    Association for Computing Machinery

    New York, NY, United States

    Publication History

    • Published: 17 August 2021

    Permissions

    Request permissions about this article.

    Request Permissions

    Check for updates

    Qualifiers

    • research-article
    • Research
    • Refereed limited

    Acceptance Rates

    Overall Acceptance Rate228of451submissions,51%

PDF Format

View or Download as a PDF file.

PDF

eReader

View online with eReader.

eReader

HTML Format

View this article in HTML Format .

View HTML Format