One simple way to ensure the integrity of Health IT

Several times a year, seven Guardians of the Internet check to make sure the “root zone” of this network of networks has not been violated.  Together they unlock a safe deposit box, take out a smartcard, and verify the integrity of the names, numbers and protocol parameters that reside in this root zone of the Internet’s Logical Infrastructure upon which the Internet critically depends.

This ritual, conducted under the direction of ICANN (the Internet Corporation for the Assigned Names and Numbers), underscores the incredible value of old-school security. Short of locking up patient data in the nether regions of a bank, what can Health IT do to better protect information? An answer is sorely needed.

In May CareFirst BlueCross BlueShield announced that hackers had gotten away with personal information on more than a million patients.  It was the third major break-in reported in 2015. Others involved Premera Blue Cross affecting potentially 11 million patients and Anthem, a case in which as many as 80 million records may have been compromised.

Two months later, UCLA reported a cyberattack that exposed data for more than four million people.  According to the LA Times, UCLA hadn’t so much as encrypted the patient data.

Hackers can get treasure troves of data by breaking into Health IT. Medical identification information can be used to make fraudulent charges that translate into tens, even hundreds of thousands of dollars: a woman billed for the amputation of a foot even though she still has both; identity theft that paid for the penis enlargements of a perpetrator and his friend; a physician who wrote prescriptions for drugs he then sold.

Underscoring the laxity of the situation is the failure of victims to even know they have been victimized. The BlueCross BlueShield hack occurred June 19, 2014, yet almost a year passed before it was detected.  It was another month passed the hack was publicly reported. 

Exemplified by ICANN is the value of security that not only protects core data but allows periodic surveillance to check on their integrity. Might digital keys be handed electronically to those who need access to the data?  Could a system using such keys be put in place to check that data have not been stolen?

In his July 5 column, the WSJ’s L. Gordon Crovotz floats the idea of using such keys in a realm outside Health IT.  All would have to use their keys for any to gain access to the data, much like the seven ICANN guardians of the Internet.

In health IT, two keys would suffice, substantially increasing the difficulty of unwanted entry.  Doing so, however, would require buy-in from data users.  Such a system would be cumbersome.  Many homeowners – and renters – for example, lock just one of the two locks on their front doors.  Some don’t lock either.  (The desire for convenience wins out even in the design of the locks. Go to any hardware store and you will find bolt and knob locks packaged together and designed to be opened with the same key.)

Facing the currently growing threat, IT professionals, however, might well take advantage of the added security much as an apartment dweller in a high-crime district of the city.  Perhaps more to the point, consider the company with a building or storage yard in an economically depressed area. We’re talking razor wire, roaming dogs –  and a well-secured gate.

No matter where they physically reside, health IT data exist in a “tough neighborhood.” Hacks are as likely to come from the Black Vine gang of China as the homeland of Boko Haram.

Absolutely, the basics of data protection must be taken. Cutting the shrubs in front of the windows of Health IT might dissuade some would-be robbers and expose the more brazen to scrutiny.  But only fortifying the premises will stop the determined, just as regular patrols are needed to uncover break-ins.

Might as well start with the front door.