Why Anthem Was Wrong Not to Encrypt | HIPAA Compliance for Medical Practices | Scoop.it

Being provocative isn’t always helpful. Such is the case with Fred Trotter’s recent headline ‒ Why Anthem Was Right Not To Encrypt.

His argument that encryption wasn’t to blame for the largest healthcare data breach in U.S. history is technically correct, but lost in that technical argument is the fact that healthcare organizations are notably lax in their overall security profile. I found this out firsthand last year when I logged onto the network of a 300+ bed hospital about 2,000 miles away from my home office in Phoenix. I used a chrome browser and a single malicious IP address that was provided by Norse. I wrote about the details of that here ‒ Just How Secure Are IT Network In Healthcare? Spoiler‒alert, the answer to that question is not very.

I encourage everyone to read Fred’s article, of course, but the gist of his argument is that technically ‒ data encryption isn’t a simple choice and it has the potential to cause data processing delays. That can be a critical decision when the accessibility of patient records are urgently needed. It’s also a valid point to argue that the Anthem breach should not be blamed on data that was unencrypted, but the healine itself is misleading ‒ at best.


I don’t disagree with Fred’s narrow technical argument, but there is definitely a larger issue that he chose to ignore. That larger issue ‒ and one I’ve written about frequently ‒ is what industry experts call a “culture of security.” The sheer volume of data breaches suggests a serious lack of that culture specifically in healthcare.  The SANS Institute report last year highlights the dire state of cybersecurity in healthcare. New Cyberthreat report by SANS Institute Delivers Chilling Warning to Healthcare Industry

Less than 6 months prior to the time Anthem pulicized their breach earlier this month, Community Health Systems (CHS) announced their breach of 4.5 million patient records. Some of the top security analysts have already begun to link the two (Anthem and CHS) ‒ right down to the lethal vulnerability that was discovered last April ‒ the Heartbleed bug. There’s even speculation that the actual breaches at both Anthem and CHS may have occurred in fairly close proximity to each other (after April of last year). Again, something I covered here: Are the Data Breaches at Anthem and CHS Linked?

That “culture of security” means that there’s a technical basis ‒ and logic ‒ to use the appropriate technology (both software and hardware in tandem) to ensure that adequate data (and network) security is in place. Note the use of that word ‒ adequate.

There will never be a perfect. The attack surface in increasing ‒ exponentially with IoT ‒ and the attackers have only to find one vulnerability once. Defenders, on the other hand, need to defend against all vulnerabilities ‒ all the time. That equation gives the attackers the upperhand and the gap between attacker and defenders is widening.

In the end ‒ we’ll likely see at least 2 outcomes from these new mega breaches.

  1. If it’s determined ‒ in court ‒ that the breach was the result of the Heartbleed bug,  both Anthem and CHS will have a much harder time defending against negligence ‒ which means the damage awards will be significant.
  2. Whatever the final cost of both breaches (and those yet to come), as always, they will be passed on to each of us as patients and healthcare consumers in the form of higher premiums.

This last one is simply an extension of many other perverse incentives that exist throughout our for‒profit healthcare system. Why bother paying for an expensive barn door that locks when we can simply pass the cost of the all the lost animals onto someone else? Sure there will be hits to profits and earnings, for awhile, and some heads may actually roll (the CIO at Sony was summarily dismissed), but will these mega breaches (and others yet to happen) be enough to change the “culture of security” inside healthcare? Probably not ‒ and certainly not if strong technical voices like Fred’s continue to defend what amounts to a cavalier attitude of security on the basis of a narrow argument – even if that argument is technically correct.