Introduction to Healthcare Information Technology

Chapter Eight Advanced Healthcare Information Security

Objectives
Define encryption and explain how it can be used to secure information Describe the vulnerabilities and protections of wireless networks List the different remote access technologies Explain how to securely dispose of a document

Introduction to Healthcare Information Technology

Healthcare IT: Challenges and Opportunities

Properly disseminating protected health information
A growing concern

Solution: apply layers of defense Encrypting document contents

Second level of protection for important documents

Protecting mobile data

Growing in importance as more data is stored on portable media

Introduction to Healthcare Information Technology

Encryption
Cryptography
Transforming information into a secure form while it is being transmitted or stored Information is scrambled to prevent unauthorized persons from accessing it

Introduction to Healthcare Information Technology

Basic Cryptography
Defining cryptography
Origins date back centuries Used by Julius Caesar

Encryption
Changing the original message into a coded message

Decryption
Decoding the message back to original form

Cleartext data
Data stored or transmitted without encryption
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Basic Cryptography (contd.)

Plaintext
Cleartext data to be encrypted

Algorithm
Procedures based on a mathematical formula used to encrypt the data

Key
Mathematical value entered into the algorithm to produce ciphertext (scrambled text)

Introduction to Healthcare Information Technology

Figure 8-1 Cryptography process

Cengage Learning 2013

Basic Cryptography (contd.)

Five basic protections of cryptography
Confidentiality Integrity Availability Authenticity of the sender Nonrepudiation
Proves that a user performed an action Prevents an individual from fraudulently denying an action

Introduction to Healthcare Information Technology

Basic Cryptography (contd.)

Symmetric cryptography
Uses the same single key to encrypt and decrypt a document Also called private key cryptography Can provide strong protection as long as key is kept secure

Data Encryption Standard (DES)

One of the first widely popular symmetric cryptography algorithms

Introduction to Healthcare Information Technology

Table 8-1 Information protections by cryptography

Cengage Learning 2013

Figure 8-2 Symmetric (private key) cryptography

Cengage Learning 2013

Basic Cryptography (contd.)

Triple Data Encryption Standard (3DES)
Uses three rounds of encryption instead of one Ciphertext from one round becomes input for second iteration Employs a total of 48 iterations in its encryption Most secure versions of 3DES use different keys for each round

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Figure 8-3 3DES

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Basic Cryptography (contd.)

Advanced Encryption Standard (AES)
Symmetric algorithm approved in 2000 to replace DES Designed to be secure well into the future

Asymmetric cryptography
Also known as public key cryptography Uses two keys Public key is known to everyone and freely distributed Private key is known only to one individual
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Basic Cryptography (contd.)

Asymmetric cryptography important principles
Key pairs Public key
Does not need to be protected

Private key
Should be kept confidential

Both directions
Document encrypted with a public key can be decrypted with the corresponding private key, and vice versa
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Figure 8-4 Asymmetric (public key) cryptography

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Applying Cryptography
Cryptography frequently used to protect data in one of two states
At rest
When data is being stored

In motion
As data is transported through electronic communications

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Applying Cryptography (contd.)

Cryptography can be applied to:
Individual files Databases Removable storage devices File server and LAN storage

Network attached storage device

Connected to the network to provide storage

Storage area network

Dedicated network for storage Not directly accessible to devices through the LAN
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Applying Cryptography (contd.)

Encryption software
Can be used to encrypt or decrypt files one by one

Software products
Pretty Good Privacy (PGP) GNU Privacy Guard (GPG)

Microsofts Encrypting File System (EFS)

Used to protect groups of files in a specific folder Encrypting and decrypting processes are transparent to the user

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Applying Cryptography (contd.)

Whole disk encryption
Can be used to protect all data on a hard drive Example: BitLocker drive encryption software

Hardware encryption
Cannot be exploited like software cryptography

Self-encrypting hard disk drives:

Can protect all files stored on them If authentication process fails, drive can be configured to deny access or perform cryptographic erase on certain data
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Applying Cryptography (contd.)

Trusted Platform Module (TPM)
Chip on the computer motherboard Provides cryptographic services to all devices Prevents computer from booting if system files or data have been altered If hard drive is moved to a different computer, user must enter a recovery password to gain access

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Applying Cryptography (contd.)

Encrypting communications
Cryptography can protect data as it moves across a network

Secure Sockets Layer (SSL)

Protocol for securely transmitting documents over the Internet Uses a public key to encrypt data over an SSL connection

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Applying Cryptography (contd.)

Transport Layer Security (TLS)
An extension of SSL Guarantees privacy and data integrity between applications communicating over the Internet

Hypertext Transport Protocol over Secure Sockets Layer (HTTPS)

Encryption protocol to secure Web communications

IP Security (IPsec)
Transparent security protocol
No need to install or configure software
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Applying Cryptography (contd.)

Fax
Can be encrypted using an SSL connection Or a special stand alone fax machine that encrypts and decrypts faxes

E-mail
Encrypted using PGP or similar application

Chat
No single standard exists for encrypting chat Some clients use SSL or PGP

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Applying Cryptography (contd.)

Telephones
A model telephone exists that will encrypt and decrypt conversations

VoIP
Encrypted using standard LAN encryption technologies

Smartphone
Encrypted with an application installed on the phone

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Applying Cryptography (contd.)

Web sites
Secured using HTTPS

FTP sites
FTP using Secure Sockets Layer (FTPS) Secure FTP (SFTP)

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Wireless Security
Wireless networks have been vulnerable targets for attackers Vulnerabilities of IEEE 802.11 security
MAC address filtering Wired Equivalent Privacy (WEP) encryption

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Wireless Security (contd.)

MAC address filtering
Limits a devices access to the access point (AP) Each device has a unique media access control (MAC) address Devices address entered into the software running on the AP
Devices can be permitted or blocked

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Figure 8-5 MAC address filtering

Cengage Learning 2013

Wireless Security (contd.)

Vulnerabilities of MAC address filtering
MAC addresses are initially exchanged in unencrypted format Difficult to manage a large number of MAC addresses

Wired Equivalent Privacy (WEP)

Relies on a secret key shared between wireless client device and the AP Has security vulnerabilities No longer recommended for protecting WLAN transmissions
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Wireless Security Solutions

Initial approach to security vulnerabilities
Temporary fixes, or patches

Unified approach was needed Wi-Fi Protected Access (WPA)

Subset of 802.11i Addresses both encryption and authentication Uses preshared key technology

Wi-Fi Protected Access 2 (WPA2)

Second generation of WPA security Introduced in 2004
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Wireless Security Solutions (contd.)

Remote Authentication Dial In User Service (RADIUS)
Used for more than just dial-in networks RADIUS client can be a wireless AP or dial-up server
Responsible for sending user credentials

Detailed steps for RADIUS authentication shown in Figure 8-6

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Figure 8-6 RADIUS authentication

Cengage Learning 2013

Wireless Security Solutions (contd.)

Service Set Identifier (SSID)
Typically set to WLAN, wireless, or the name of the vendor Should be renamed to a generic word that does not give information about the owner or network location

Site surveys
In-depth examination of a proposed wireless LAN site Determine the number and placement of access points, and types of antennas needed
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Wireless Security Solutions (contd.)

Antenna placement
Should be located near the center of the coverage area Recommended to mount as high as possible

Power level controls

Adjust the power so less of the signal leaves the premises

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Wireless Security Solutions (contd.)

Rogue access points
Serious threats to network security Allow attackers to intercept the RF signal and bypass network security

Methods of detecting rogue access points

Security personnel walk the area with a protocol analyzer Continually monitor the RF airspace with a wireless probe

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Wireless Security Solutions (contd.)

Types of wireless probes
Wireless device probe Desktop probe Access point probe Dedicated probe

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Remote Access
Security for remote access connections is important Three typical types of remote access
Virtual private networks Terminal emulation Remote control applications

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Virtual Private Network

Uses an unsecured public network as if it were a secure private network
Encrypts all data transmitted between remote device and the network Encrypted packets are encapsulated in a second packet

Endpoint
End of the tunnel between VPN devices Can be software on a local computer, or a dedicated hardware device
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Virtual Private Network (contd.)

VPNs can be software or hardware-based
Software-based VPNs offer the most flexibility in managing network traffic Hardware-based VPNs are more secure and have better performance

Tunneling protocols used for VPN transmissions

Point-to-Point Tunneling Protocol (PPTP)
Illustrated in Figure 8-7

Layer 2 Tunneling Protocol (L2TP)

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Figure 8-7 Point-to-Point Tunneling Protocol

Cengage Learning 2013

Terminal Emulation
Software application that allows a desktop computer to function as a terminal Telnet protocol
One of the most widely used applications

Secure Shell (SSH)

Encrypted alternative to Telnet used to access remote computers

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Table 8-2 SSH commands

Cengage Learning 2013

Remote Control Applications

Remote Desktop Connection (RDC)
Software that allows a user to connect to a remote computer User can function as if he/she were sitting at the remote computer

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Figure 8-8 Remote Desktop Connection (RDC)

Cengage Learning 2013

Secure Disposal
Securely destroying sensitive documents:
Important to prevent unauthorized retrieval from the dumpster

Types of records
Public records Private records Legal health record
Documentation of healthcare services provided to an individual Contains various types of information
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Retention of Medical Records

Length of time for record retention varies based on regulations LHR retention by individual providers
Seven years after the last treatment date Or three years after the patients death

Hospital retention guidelines

25 years after discharge for adults Up to age 18 for children Images of the documents are sufficient
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Methods of Record Disposal

Secure shredding
Used to destroy paper documents

Sanitizing
Removing only sensitive information from a document May involve blacking out text

Degaussing
Used with electronic records Resets magnetic charge to a neutral state

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Summary
Cryptography transforms information into a secure form so that unauthorized persons cannot access it Symmetric cryptography uses a single key to encrypt and decrypt a message Asymmetric cryptography uses two keys: a public and a private key Cryptography can be applied through hardware or software Encryption can protect data that is stored or being transmitted across a network
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Summary (contd.)
WPA2 and IEEE 802.11i are foundations of wireless security protections today A virtual private network uses tunneling protocols to communicate over a public network as if it were a secure private network A legal health record is the documentation of healthcare services provided to an individual Legal health records may be disposed of by shredding, sanitizing, or degaussing (for electronic records)
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