Effective Cybersecurity Strategies for Healthcare Institutions

Recent statements by the United Nations Surgeon General to the Security Council have raised concerns about the current state of cybersecurity in hospitals. He stated that ransomware attacks against hospitals and health systems could be “a matter of life and death” and pose a serious threat to international security. Several delegates called for international cooperation to address one of today’s most destructive cyber threats. According to IBM’s Cost of a Data Breach 2024 Report, the healthcare industry has topped the list of the most expensive industries to recover from a data breach for 14 consecutive years, with an average cost of $9.77 million. These are signs that hospitals need to implement a comprehensive cybersecurity strategy and continually improve the security awareness and technical skills of their staff to meet these ever-emerging challenges.

Major Cyber Threats to Modern Hospitals

Ransomware

Ransomware is a type of malware in which an attacker blocks access to a device and its stored data by encrypting files and then demands a ransom from the organization in exchange for decryption. Ransomware attacks in healthcare are one of the most common cyberattacks that not only affect the normal operations of hospitals but can also jeopardize patient safety. Ransomware attacks in healthcare rise from 60% in 2023 to 67% in 2024. And according to Microsoft’s latest annual Digital Defense Report, July 2023 through June 2024 (Microsoft fiscal year 2024), 389 healthcare organizations in the U.S. suffered from ransomware attacks that resulted in network shutdowns, systems going offline, delays in critical medical procedures, and rescheduling of appointments, among other consequences.

Data Breach

Healthcare data systems often contain a large amount of sensitive information within them, including patients’ personal health information (PHI), financial data, medical records, and more. Once this data is compromised, it can lead to serious privacy violations and identity theft.

There is no denying that digital record-keeping has many advantages over traditional paper-based methods of retention. While technology has evolved, hospitals have reduced the potential for system intrusion, unauthorized data access, and disclosure by adopting and more accurately tracking electronic devices, as well as more widespread use of data encryption. However, the ever-increasing number of hacking incidents has led to a continued upward trend in the number of data breaches occurring over the past 14 years. And we can see that the number of data breaches is not only increasing but getting worse.

Social Engineering Attack

Attacks in which the attacker obtains sensitive information through deception, such as phishing and phone impersonation, may also pose as a trusted entity to trick hospital staff into providing login credentials or other sensitive data. Technically speaking, social engineering is not an attack technique, it is more of a “trick,” and because it focuses on people’s psychology and behavior, it has a very high success rate—after all, everyone can make a mistake, and people are the most vulnerable part of security measures. Although the victim will usually doubt the authenticity of the email or phone call, because the attacker carefully designed a complete attack process, so often people will make the wrong judgment and disposition.

Impact and Consequences of Cybersecurity Threats on Hospitals

Data Breach

Internal healthcare systems contain a lot of sensitive personal information, and any inappropriate access to these systems puts the privacy of patients and healthcare workers at risk.

Service disruptions

Hospital cyberattacks can cause emergency systems to crash, affecting the timely treatment of emergency patients, as well as compromising appointment systems and exam equipment, forcing appointments and exams to be postponed and affecting patients’ treatment plans.

Financial losses

Ransom payments and post-data recovery and maintenance costs.

Reputational damage

A sustained cybersecurity incident can diminish the public’s perception of the hospital’s credibility, and relationships between some partners may be impacted.

Legal Liability

Hospitals can face stiff fines and lawsuits for data breaches and are required to comply with relevant data protection regulations; for example, in Germany, healthcare organizations must comply with HIPAA, GDPR, Nis2, and the German Patient Data Protection Act (PSDG), and any breaches can lead to lengthy compliance reviews and corrective actions.

Why Hospitals Are High-Frequency Targets for Cyberattacks

Massive amounts of sensitive data

For hackers, hospital systems store large amounts of sensitive information of great value, including patients’ names, addresses, social security numbers, medical history, diagnostic information (HPI), and more. Whether it’s obtained illegally and sold on the dark web or ransomed to hospitals for a high ransom, the healthcare industry is increasingly becoming a target for attack.

Aging IT systems

Hospital IT systems handle large amounts of sensitive information, yet due to a lack of up-to-date security patches and updates, older IT systems are susceptible to cyberattacks and virus infections. In addition, these old systems are not compatible with modern and emerging cybersecurity tools or technologies.

IT staff challenge and inadequate training

Unlike Internet companies or manufacturing industries with specialized IT teams, hospitals typically lack specialized, qualified IT talent, making it difficult to respond to increasingly complex cybersecurity threats. And with hospital staff scrambling to save lives, budget, resource, and time constraints mean that all healthcare professionals are unlikely to be well versed in cybersecurity best practices. As a result, awareness and training on cybersecurity are not sufficient, and phishing emails may be accessed inadvertently or compromised by malware, which is a major reason why hospitals are becoming targets of cyberattacks.

Unwilling compromises fuel attacks on hospitals

When facing cyber extortion, some hospitals choose to pay the ransom to recover their systems and data as soon as possible. Indeed, this practice can solve the problem temporarily, but it neglects the long-term network security construction, and the system still has vulnerabilities and risks. Most importantly, this practice sends a signal to hackers that “ransom works,” which undoubtedly encourages the emergence of more similar attacks. And hospitals may also be classified as ‘soft targets’ by hackers after a compromise, thus becoming one of the main targets for future attacks.

Medical Device Networking

Today’s vast network of connected medical devices significantly improves the efficiency and quality of healthcare delivery, as these devices not only monitor a patient’s health status in real time but can also be controlled and adjusted remotely. Yet this connectivity also poses significant challenges. For example, patient information stored on medical devices can be accessed without authorization, and these devices can be remotely accessed and controlled by attackers who can even tamper with the transmitted data.

Best Practices for Hospital Cybersecurity

  1. Data Encryption: To better protect against data interception and tampering during transmission, hospitals should ensure that all data is encrypted during transmission.
  2. Multi-layered defense strategy: Hospitals should establish a defense-in-depth strategy that includes the use of multi-layered security controls such as firewalls, intrusion detection systems, and encryption to comprehensively protect hospital network security.
  3. Regular Security Assessments: Hospitals should conduct regular security assessments to identify and fix vulnerabilities and potential risks in their networks.
  4. Strong Authentication Measures: Use Multi-Factor Authentication (MFA) to improve system security by ensuring that only authorized personnel have access to sensitive information.
  5. Continuous Network Monitoring: Continuously monitors network traffic, detects and responds to suspicious activity in real time, ensuring that security threats are detected and addressed in a timely manner.
  6. Security Awareness Training: Hospitals should conduct regular security awareness training for their staff to prevent security accidents due to human error and to improve the overall security preparedness.
  7. Professional team support: Hospitals should remain sensitive to emerging technologies and introduce new security tools and solutions like NovaMDR in a timely manner to continuously improve their network protection capabilities.
cybersecurity for healthcare 7 best practices

Cybersecurity is not static but needs to be constantly improved and updated to address the changing threat landscape. ForeNova team has a wealth of experience and expertise in the field of cybersecurity, and we are able to customize cybersecurity strategies that are best suited to the specific needs of different hospitals. And NovaMDR can provide healthcare organizations with 7×24 comprehensive cybersecurity solutions and compliance guidance to ensure that hospitals comply with various regulations while protecting sensitive data and systems.

Contact our team of professionals today and start protecting your organization from cyber threats today.

KRITIS Requirements vs. B3S Standards for Healthcare Providers in Germany

“Like other vital public services in Germany, including water and electricity, the German government classified hospitals as critical infrastructure or KRITIS.”

The German government deemed all hospitals treating over 30,000 cases annually as critical infrastructure supporting German citizens. All KRITIS-designated hospitals were required to update their IT security by the end of 2021.

By 2021, all hospitals in Germany must meet and exceed cybersecurity standards set forth by the BSI in response to increases in attacks during the global pandemic. BSI created a new industry standard – B3S. This new method incorporated 168 standards. All hospitals, regardless of size in Germany, are required to meet B3S standards.

A significant portion of B3S standards includes monitoring, incident response, and reporting. To meet these requirements, hospitals either staff their security operations or outsource to a managed detection and response like a Nova MDR solution from ForeNova.

What are the KRITIS Requirements for Hospitals?

Hospitals that fall under the KRITIS designation should leverage the ISO 27000 framework to help meet several critical mandates, including the enablement of proper security controls defined by the BSI.

These BSI-mandated controls include:

  • Enablement of detection and response capabilities
  • Cybersecurity breach reporting to the BSI within 72 hours of the event
  • Deployment of an Information Security Management System (ISMS)
  • 24×7 security operations capability to handle all incident responses

Here are other critical components hospitals need to execute for KRITIS:

Registration with BSI

KRITIS operators must register with the BSI and provide a primary contact for compliance, cybersecurity, and breach notifications.

Implementation of Security Measures and Intrusion Detection Systems

KRITIS hospitals must enable and sustain all adaptive controls, processes, and procedures necessary to safeguard IT systems against cyberattacks, adhering to BSI’s minimum standards.

Reporting Mandates and Information Sharing With the BSI

KRITIS operators must report major IT incidents to the BSI within 72 hours and provide necessary details for incident management. All KRITIS hospitals must also share relevant information with other hospitals and BSI authorities.

The KRITIS-designated hospital needs to develop and deploy a comprehensive disaster recovery plan to include:

  • Business impact analysis (BIA)
  • Business continuity management
  • Business continuity plan
  • Recovery time objectives

Aligning KRITIS, ISMS, B3S, and ISO 270001

The BSI mandates that KRITIS hospitals deploy and sustain an ISMS that aligns with ISO 27001 standards.

The ISMS follows four principles defined within ISO 27001: plan, implement, control, and optimize. It establishes an independent structure for improving IT security, including central roles like an IT security officer and risk analysis to identify vulnerabilities.

KRITIS hospitals need to provide evidence specifically around their risk management program, proof of monitoring, demonstrate compliance, audit management, and other elements from the B3S.

These hospitals must hire external auditors and report their findings to the BSI every two years.

Understanding B3S Standards

The B3S features 168 standards for resilient IT and patient care. These standards become categorized as must, should, and optional requirements.

The standards become broken out into five categories:

  • Interoperability: Securing data access across multiple platforms
  • Data security: Enabling encryption across all data sources
  • Privacy: Meeting all privacy mandates
  • Consent Management: Enabling patent consent systems
  • Data quality: Sustain all data’s integrity, confidentiality, and availability.

Hospitals in Germany that have already implemented ISO 27001 and an ISMS are the most prepared to meet BSI and IT-SIG 2.0 security act requirements.

Key Differences Between KRITIS and B3S

KRITIS is simply a designator for a hospital based on the number of cases to enable “state-of-the-art” cybersecurity capabilities that align with BSI directives. The KRITIS directive also states that the hospital needs to deploy an ISMS system aligned with the ISO 270001 framework. B3S provides additional standards hospitals need to enable to become compliant with BSI directives.

B3S Impact on Smaller Hospitals

Smaller hospitals not classified under KRITIS have a crucial deadline of January 1, 2022, to ensure their IT security meets state-of-the-art standards. The Social Code (SGB V) § 75c introduces new IT security regulations for hospitals aligned with BSI law, effective January 1, 2022. From this date, all hospitals must adhere to strict KRITIS IT security requirements, regardless of size.

  • “Starting in January 2022, small hospitals must introduce electronic patient records (ePA), digital referrals, and e-prescriptions.”
  • These changes will raise challenges in storing and managing patient data, a common target of cyberattacks. They must implement suitable data processing systems while adhering to strict data protection guidelines.
  • KRITIS hospitals must provide evidence to the BSI, but small hospitals have no such requirement under Section 75c SGB V or the PDSG.
  • “In October 2020, Germany enacted the Patient Data Protection Act (PDSG), which affects all hospitals and refers to IT security.”

Preparing For an Attack Requires a Preventive Mindset

Aligning with B3S standards for IT security measures is crucial for compliance because most incidents lead to data protection breaches. These breaches can occur because of cyberattacks or mishandling of personal data.

  • A common breach involves inadequate role and authorization systems for patient data; for example, a hospital in The Hague was fined 460,000 euros for allowing all employees access to patient records without proper authorization.
  • Similarly, a Portuguese hospital was fined 400,000 euros in 2018 for the same issue.
  • The German States Rhineland-Palatinate also fined a hospital 105,000 euros for multiple data protection violations related to patient admissions.

Funding Availability for Hospitals

“From 2019 to 2024, 500 million euros per year—totaling four billion euros—will be allocated to meet KRITIS requirements for large hospitals. Additionally, 4.3 billion euros are available via the Hospital Future Fund for smaller hospitals, with funding applications open until December 2021.”

Operators must invest at least 15 percent of their funds in IT security improvements.

What is the Importance of IT-SIG 2.0 with German Healthcare Facilities?

IT-SIG 2.0, the German IT Security Act 2.0, is essential for healthcare facilities as it mandates stricter cybersecurity for critical infrastructure, including hospitals. This regulation ensures the protection of sensitive patient data and the availability of medical systems against cyberattacks, which could disrupt patient care and endanger lives. It compels healthcare facilities to prioritize strong cybersecurity practices for operational resilience.

IT-SIG 2.0 also plays a critical role in mandating hospitals implement required adaptive controls, including intrusion detection, or face considerable fines. This mandate also provides additional security requirements for hospitals by creating additional reporting and data protection in alignment with GDPR.

Stricter Compliance Requirements

IT-SIG 2.0 mandates hospitals to implement necessary adaptive controls like intrusion detection or risk significant fines.

Protection of Patient Data

IT-SIG 2.0 enforces strong cybersecurity to protect sensitive patient records from unauthorized access or breaches.

Operational Continuity

The act seeks to ensure IT systems’ resilience against cyberattacks, minimize downtime, and maintain access to patient data in critical healthcare services.

Increased Accountability

Healthcare facilities must show compliance with IT-SIG 2.0 regulations, facing penalties for non-compliance.

Note: Companies should leverage Security Information Event Management (SIEM) for attack detection, case management, and playbook distribution to meet IT-SIG 2.0 security operations requirements, which include continuous monitoring, incident response, and compliance notification reporting.

The Role of MDR In Assisting Hospitals With KRITIS and B3S Compliance Mandates?

KRITIS and non-KRITIS healthcare providers struggling with staffing shortages will benefit from a partnership with an MDR provider like ForeNova. MDR helps health providers regardless of size. All healthcare providers must monitor their various security controls, protecting their digital assets, patient information, and employee data.

Here are some essential points regarding the value of MDR and B3S:

  • B3S standards for healthcare require security monitoring of all healthcare-related applications, networks, devices, databases, and portals.
  • Healthcare providers required under IT-SIG 2.0 must ensure proper intrusion detection and security operations, continuous monitoring, and reporting are operational 24/7.
  • As defined within B3S, it mandates that all hospitals have incident response plans and processes for responding to all cybersecurity events, including data breaches.

Conclusion

Ultimately, hacks in healthcare endanger lives and civic society. Minimum IT security standards, such as the KRITIS requirements, can help improve hospital security. Facility operators must follow these guidelines to ensure long-term protection against threats. The primary purpose is to keep cyber attacks from affecting hospital operations.

ForeNova, an EU-based MDR supplier, knows the complexities of healthcare compliance. All health providers, including hospitals, face overlapping mandates, redundant security controls, and cost overruns. These hospitals struggle to save security operations costs while maintaining BSI, IT-SIG 2.0, and KRITIS compliance. Staying current with B3S’s continual developments will benefit greatly from having a relationship with ForeNova.

What is Computer Network Defense (CND)?

Cybersecurity is included among the top ten global issues both now and ahead in the World Economic Forum’s (WEF) 2023 Global Dangers Report. Companies have to give Computer Network Defense (CND) top priority since the cost of cybercrime is expected to reach an incredible $10.5 trillion annually by 2025 and will assist in securing assets and maintaining effective company operations in a digital environment, which is more dangerous.

Computer network defense (CND) is a computer network infrastructure designed to prevent unwanted access and secure an organization’s computer networks, systems, and data against cyberattacks. It may also be defined as a set of techniques, strategies, and technologies for detecting, preventing, and responding to cyber attacks. Firewalls, intrusion detection systems, access control, encryption, and other CND components are critical.

Why do organizations require Computer Network Defense?

In today’s digital environment, firms face an increasing variety of cyber threats, such as DDoS attacks and ransomware. To navigate these perilous seas, Computer Network Defense (CND) is essential. Organizations that prioritize CND and cybersecurity can achieve:

  • Effective risk management entails proactively detecting, analyzing, and mitigating cyber hazards.
  • Sensitive Data Protection: Protect critical information from illegal access and breaches.
  • Regulatory Compliance: Upholding industry standards while avoiding legal difficulties.
  • Reputation Management: Maintaining customer trust and corporate credibility.
  • Business continuity entails preventing operating disruptions and providing a prompt recovery from incidents.
  • Cost savings include lowering financial losses caused by cyber attacks and remediation operations.
  • Critical infrastructure protection entails defending vital systems and services against attacks.

The Components of Computer Network Defense

Firewall

A firewall is a cybersecurity technology that uses established security rules to monitor and restrict incoming and outgoing network traffic as barriers between trusted and untrusted networks, therefore protecting network security.

Intrusion Detection Systems (IDS)

An intrusion detection system detects and identifies cyber threats. Monitoring network traffic or systems can detect suspicious behavior, policy violations, and potential threats and notify administrators.

Vulnerability Management

Vulnerability management is a proactive method that serves two purposes: conducting regular security audits to check networks for vulnerabilities and patching and upgrading software and systems to protect against known defects. This strategy protects the organization’s digital assets while also assuring the overall security posture.

Endpoint Security

An endpoint is any device connected to a computer network. Endpoint security, also known as endpoint protection, is a method of securing computer networks by ensuring the connectivity of endpoint devices, or end-user devices, such as laptops, phones, and other wireless devices.

Access Control (AC)

Access Control is a component that enforces rules governing which traffic may and cannot access specific systems or sources based on IP address, port, and protocol. Organizations may secure sensitive information and ensure data security by using effective access control systems.

Incident Response (IR)

Incident Response is a rigorous process for identifying, resolving, and managing the consequences of an attack or security breach. A beneficial IR may help firms mitigate harm.

Security Information and Event Management (SIEM)

Security information and event management is a comprehensive cybersecurity approach that incorporates Security Information Management (SIM) and Security Event Management (SEM) into a unified solution. SIEM serves two purposes: one is to discover potential security issues by collecting and analyzing logs from various network devices. The other is identifying patterns and correlations in log data that might indicate a security issue.

How does Computer Network Defense work?

Computer Network Defense (CND) employs a tiered strategy to protect networks from a wide range of cyberattacks.

It starts with constant monitoring to detect and identify possible threats in real time. Regular scanning and prompt delivery of updates address vulnerabilities to prevent exploitation. Strict access restrictions guarantee that only authorized individuals have access to critical information. Data encryption safeguards information both in transit and at rest. In the case of a security incident, CND responds quickly to contain and remediate the attack while restoring regular operations, therefore protecting digital assets, ensuring business continuity, and meeting regulatory requirements through continuous monitoring and development.

Best practices for Computer Network Defense

  • Multilayered Defense
    Firewalls, intrusion detection systems, and encryption may all improve your security.
  • Regular security checks
    Regular reviews help to discover and resolve issues.
  • Improved authentication
    MFA ensures that only authorized users may access crucial data.
  • Continual network surveillance
    Monitor network traffic continually to detect and address suspicious behavior quickly.

Why ForeNova?

ForeNova‘s Managed Detection and Response (MDR) services may help firms improve Computer Network Defense (CND), save operating expenses, and ensure regulatory compliance. These services offer 24-hour monitoring, expert cybersecurity support, and advanced threat detection. Additionally, ForeNova will provide expert assistance and compliance reporting to assist organizations in meeting regulatory requirements, including Tisax, NIS2, and so on.

Want further information? Click here to schedule an MDR demo with the ForeNova team today!