{"id":50617,"date":"2021-07-08T19:28:06","date_gmt":"2021-07-08T18:28:06","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50617"},"modified":"2021-07-08T19:28:06","modified_gmt":"2021-07-08T18:28:06","slug":"viral-cyber-attacks-a-threat-to-human-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/08\/viral-cyber-attacks-a-threat-to-human-health\/","title":{"rendered":"Viral cyber attacks: a threat to human health"},"content":{"rendered":"<p><i><span style=\"font-weight: 400\">Cyberattacks on health systems are not black swan events and must be addressed in a robust manner with<\/span><\/i><i><span style=\"font-weight: 400\"> comprehensive cybersecurity strategies, policy, and adequate resourcing to prevent recurrence<\/span><\/i><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Globally, healthcare professionals have been fighting a biological virus, SARS-CoV-2, for over a year. In addition to the coronavirus, the national health service in Ireland has recently been attacked by another virus, a digital virus, which crippled<\/span> <span style=\"font-weight: 400\">the provision of healthcare. However Ireland is not alone, with <\/span><a href=\"https:\/\/www.nytimes.com\/2021\/05\/20\/technology\/ransomware-attack-ireland-hospitals.html\"><span style=\"font-weight: 400\">similar viral cyber attacks<\/span><\/a><span style=\"font-weight: 400\"> happening in hospitals in New Zealand and the USA.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Digital viral threats to health systems have the potential to cause local, national, and international harm to patients, resulting in a \u201cpandemic\u201d<\/span> <span style=\"font-weight: 400\">of digital extortion. Hospitals are not exempt<\/span> <span style=\"font-weight: 400\">and are prime targets for ransomware attacks as they<\/span> <span style=\"font-weight: 400\">hold<\/span> <span style=\"font-weight: 400\">sensitive patient data. Hospital networks and medical devices are critical infrastructure for human health and therefore should have appropriate cybersecurity infrastructure to protect from cyberattacks.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The recent cyberattack that affected the Irish healthcare system was a human-operated \u2018Conti\u2019 ransomware attack that severely disabled the healthcare system\u2019s information technology (IT) capability. This necessitated the <\/span><a href=\"https:\/\/www2.hse.ie\/services\/health-service-disruptions\/hospital-appointments.html#disruptions-by-county\"><span style=\"font-weight: 400\">shutdown of the entire health IT syste<\/span><\/a><span style=\"font-weight: 400\">m<\/span><span style=\"font-weight: 400\"> to assess and limit the impact. Many Irish hospitals were forced to cancel all outpatient clinics and elective procedures, which have only just started to recover from the impact of covid-19. Inpatient teams had to revert to pen and paper.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">National healthcare systems are often vulnerable to cyberattacks due to budgetary constraints <\/span><span style=\"font-weight: 400\">and siloed, diverse legacy IT systems. Out of date computer hardware assets, unable to run contemporary operating systems and software such as web-browsers is akin to using medieval defences against a modern enemy.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ransomware attacks, a type of &#8220;digital virus,&#8221; have increased globally across all industries and sectors.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">For health systems, not only does ransomware pose the<\/span> <span style=\"font-weight: 400\">threat of sensitive data being leaked or sold, it also poses an immediate risk to patients. Health systems are heavily reliant on IT systems for daily work. While systems are inaccessible, or incomplete, patient care is significantly delayed.<\/span> <span style=\"font-weight: 400\">It severely slows diagnostics, and potentially causes an increase in patient morbidity and mortality.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Digital transformation can improve patient outcomes and deliver more cost-efficient healthcare. Therefore most health systems have moved to integrate IT systems to improve access and communication between different sectors within healthcare. In addition, there has been huge innovation and adoption of digital technologies for remote monitoring and treatments. (<\/span><a href=\"https:\/\/www.liebertpub.com\/doi\/abs\/10.1089\/dia.2014.0328\"><span style=\"font-weight: 400\">O&#8217;Keeffe D, et al<\/span><\/a><span style=\"font-weight: 400\">).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However digital transformation and cybersecurity must go hand in hand, especially when it comes to patient data and safety. Multiple studies (<\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0007681319300436\"><span style=\"font-weight: 400\">Abraham C, et al<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0378512218301658\"><span style=\"font-weight: 400\">Coventry L<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/link.springer.com\/article\/10.1007%2Fs10916-019-1507-y\"><span style=\"font-weight: 400\">Bhuyan et al.<\/span><\/a><span style=\"font-weight: 400\">,<\/span><a href=\"https:\/\/www.bmj.com\/content\/358\/bmj.j3179.full\"><span style=\"font-weight: 400\">Martin G, et al<\/span><\/a><span style=\"font-weight: 400\">)<\/span><span style=\"font-weight: 400\"> have highlighted the challenges of cybersecurity in the healthcare setting. <\/span><span style=\"font-weight: 400\">Addressing cybersecurity requires infrastructural change, behavioural change, appropriate governance, and adequate resourcing. <\/span><span style=\"font-weight: 400\">This is not the first time, nor will it likely be the last time, a health system falls victim to ransomware. <\/span><span style=\"font-weight: 400\">T<\/span><span style=\"font-weight: 400\">he WannaCry malware attack, which disrupted care in approximately 40 NHS hospitals<\/span> <span style=\"font-weight: 400\">should have served as worldwide \u201cwake up call\u201d<\/span> <span style=\"font-weight: 400\">to ensure robust cybersecurity in healthcare infrastructure, which unfortunately it appears, it did not. <\/span><span style=\"font-weight: 400\">More recently, an attempt was made to <\/span><a href=\"https:\/\/www.politico.eu\/article\/cybercriminal-extorts-finnish-therapy-patients-in-shocking-attack-ransomware-blackmail-vastaamo\/\"><span style=\"font-weight: 400\">extort mental health patients in Finland<\/span><\/a><span style=\"font-weight: 400\"> with the threat of releasing their medical records. It not only targeted the health organisation, but attempted to demand ransom from individual patients.<\/span> <span style=\"font-weight: 400\">Therefore prevention of \u201cdigital infections,\u201d<\/span> <span style=\"font-weight: 400\">via robust cybersecurity strategy, policy, and resources in the healthcare setting is as important to patient welfare as clinical care. (<\/span><a href=\"https:\/\/www.bmj.com\/content\/358\/bmj.j3179.full\"><span style=\"font-weight: 400\">Martin G, et al<\/span><\/a><span style=\"font-weight: 400\">)<\/span><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Just like the need to prepare for future pandemics, global healthcare infrastructure must plan for future cyberattacks. We would be remiss to \u201c<\/span><span style=\"font-weight: 400\">return to normal\u201d<\/span> <span style=\"font-weight: 400\">without learning from our present circumstances. It is evident by the major disruption caused by both the Covid-19 pandemic and a cyberattack in the past year, that major changes are necessary in healthcare planning to minimise negative impacts on our patients going forward, when these events happen again, which they will.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Aoife Murray<\/strong>, postgraduate physician researcher in Digital Health at the Health Innovation Via Engineering (HIVE) Laboratory, School of Medicine, National University of Ireland, Galway.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Derek O\u2019Keeffe<\/strong>, consultant physician at University Hospital Galway, Ireland; professor of Medical Device Technology at C\u00daRAM \u2013 SFI Research, Centre for Medical Devices, National University of Ireland, Galway (NUIG); Digital Health Principal Investigator at HIVE Laboratory and Lero &#8211; SFI Centre for Software Research, NUIG.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.\u00a0<\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Cyberattacks on health systems are not black swan events and must be addressed in a robust manner with comprehensive cybersecurity strategies, policy, and adequate resourcing to prevent recurrence\u00a0 Globally, healthcare [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/08\/viral-cyber-attacks-a-threat-to-human-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":50472,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-50617","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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