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How To Make It Happen
Enrico Frumento
mobiHealth Conference – Milan –15th November 2016
“which are the driving forces shaping healthcare”
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WHO AM I ?
• I am a “Security Guy” coming from a long healthcare experience
• HEALTHCARE
• Telemedicine
• Mobile health
• OFFENSIVE SECURITY
• Malware
• Social engineering
• Intrusion
• Innovative security system
• Cyber-crime/cyber-terrorism
• @ ENRICOFF
copyright © 2016 Cefriel – All rights reserved
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TWO BASE STATEMENTS
MCKINSEY
• As the price of healthcare rises and safety lapses persist, developed countries are seeking ways to lower costs and improve quality. Many are finding the solution in digital innovation.
MYSELF
• [..] healthcare operators and patients’ worlds are highly digitalized, modifying how healthcare operators and patients offer and use services.
• Today healthcare is again at the forefront: as one of the most attacked and promising areas of exploitation for cybercriminals and cyberterrorists due to the abundance of valuable information and for its role in critical infrastructure.
copyright © 2016 Cefriel – All rights reserved
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MCKINSEY REPORT
The study identifies three driving forces through which digital innovation is transforming HC
• Improve care-delivery models through seamless data and information exchange
• Harness the power of data through transparency and advanced analytics
• Process digitalization and automation
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LET ME INTRODUCE A WIDER POINT OF VIEW
copyright © 2016 Cefriel – All rights reserved
WASPWirelessly Accessible Sensor
Populations
No. 034963 No. 653618 No. 607642
MUSESMultiplatform Usable
Endpoint Security
No. 318508
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TABLE OF CONTENTS
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Society is getting older & more dynamic
Blended lifestyle
Smart Ecosystems
Future of the workforces
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BLENDED LIFESTYLE
copyright © 2016 Cefriel – All rights reserved
Society is getting older & more dynamic
BLENDED LIFESTYLE
Smart Ecosystems
Future of the workforces
Tablet PC TabletConnected car
PC TV Tablet Tablet
Breakfast Transfer Office Lunch After DinnerMeeting Office Sleep
6:30 am 11:00 pm
MobileWearable
Connected car
Mobilewearable
Shopping
Mobile
12:00pm
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SMART ECOSYSTEMS
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Society is getting older & more dynamic
Blended lifestyle
SMART ECOSYSTEMS
Future of the workforces
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• Digital experience continuity nowadays are specialized for different contexts: for example the smartcars ecosystem or the home automation ecosystem.
• Contextual Intelligent Quotient (CQ), meant as the ability to constantly analyze the surrounding reality from different, uncorrelated points of view and adjust the decision making process in a matter of days/weeks.
• Spread across a wide range of citizens of a blended style of living
ECOSYSTEMS AFFECT HOW HEALTHCARE SERVICES ARE OFFERED
SMART ECOSYSTEMS
copyright © 2016 Cefriel – All rights reserved
Society is getting older & more dynamic
Blended lifestyle
SMART ECOSYSTEMS
Future of the workforces
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FUTURE OF THE WORKFORCES
copyright © 2016 Cefriel – All rights reserved
*CLOUT = Cloud of Things
CLOUT*
Society is getting older & more dynamic
Blended lifestyle
Smart Ecosystems
FUTURE OF THE WORKFORCES
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• Moving to the humans is the new wave, a citation that represents the new trend in healthcare, of moving data and not people.
• For both patients and health operators.
MOVING TO THE HUMANS IS THE NEW WAVE
copyright © 2016 Cefriel – All rights reserved
Society is getting older & more dynamic
Blended lifestyle
Smart Ecosystems
FUTURE OF THE WORKFORCES
Society is getting older & more dynamic
Moving to the humans
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PATIENT ECOSYSTEM
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Moving to the humans
Patient ecosystem
Society is getting older & more dynamic
• The “Patient Ecosystem” consists in the evolution of the Hospital as a place of care to a network of services for patients, provided in home environments, smart cities etc.
• For healthcare operators too..
• The healthcare infrastructures are rapidly becoming a network of services
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ECOSYSTEMS IN HEALTHCARE
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ECOSYSTEMS IN HC
DIGITAL ECOSYSTEM
PATIENT ECOSYSTEM
HEALTHCARE OPERATORS ECOSYSTEM
Moving to the humans
Patient ecosystem
Society is getting older & more dynamic
• ICT Ecosystem: a network of integrated services that can interact with eachother to offer the user a unique and seamless vision.
• Human Ecosystem: a community of people who interact, exchange information,combine, evolve in terms of knowledge, skills and contacts, in order to improvetheir lives and meet their own needs.
network of interconnected ICT services
ubiquitous assistance services.
ubiquitous care giver services.
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ECOSYSTEMS IN HEALTHCARE
Moving to the humans
Patient ecosystem
Society is getting older & more dynamic
ECOSYSTEMS IN HC
DIGITAL ECOSYSTEM
PATIENT ECOSYSTEM
HEALTHCARE OPERATORS ECOSYSTEM
copyright © 2016 Cefriel – All rights reserved
Hosted by:• Hospitals, • National HC system, • as a service.
Enabled by culture, personal mindsets and habits (e.g., blending lives) and technologies, not only into the hospital (e.g., patients’ mobile apps)
Ecosystem Manager
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PERSONAL BIG DATA-SPACE
copyright © 2016 Cefriel – All rights reserved
Society is getting older & more dynamic
Moving to the humans
Patient ecosystem
Personal big data-space
KEY ELEMENTS
• Purpose of use (healthcare, wellness, profiling, …)
• Level of privacy/security (sensitive, non sensitive, …)
• Methods used to collect the data (HC/wellness professionals, medical devices, …)
• Quality of data
• Ownership of the data
• Source: “The Role of Machines in our Changing Concepts of Identity”, Talk-in-the-tower Task Force 1: Personal information space, http://mcaf.ee/5th0ug
• It is the sum of our personal data, generated by the different applications or different areas of interest, often overlapping.
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BIG-DATA ANALYSIS
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Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Society is getting older & more dynamic
• Advanced data analysis is often one of the key elements that differentiate one health service from another and healthcare is just starting to mine value from the amount of accumulated personal data.
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HEALTHCARE SYSTEM CONGESTION
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Society is getting older & more dynamic
• The congestion of the healthcare infrastructures is a consequence of the increasing number of people that need to be served
• “Population ageing is a triumph of humanity but also a challenge to society”, World Health Organization: Active Ageing: A Policy Framework. Geneva (2002)
• Source: WHO, European Health Information Gateway -http://mcaf.ee/leo7mh
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EARLY DISCHARGE FROM HOSPITALS
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Society is getting older & more dynamic
• The foreseen increasing number of people using healthcare services pushes hospitals to increase the turnover of patients favouring the access to remote healthcare services
• Source: WHO, European Health Information Gateway -http://mcaf.ee/leo7mh
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ASSISTED LIVING SYSTEMS & HOME-CARE HOUSES
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Home-care houses
Society is getting older & more dynamic
• The increasing adoption of remote assisted living systems is a consequence of the evolution of Hospitals from a place of care to a network of delocalised services
• The growth of the ecosystems also leads to a corresponding increase in the number of “hospitalised” environments
Smart environments (re)used also for HC
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PERVASIVE HEALTHCARE SOLUTIONS
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
• Pervasiveness of healthcare solutions is also a consequence of the ultra-mobile habits of people, who move more frequently, and the increasing wish of patients to continue their lives as much as possible when cured.
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HOSPITAL 2.0 (THE BLENDED HOSPITAL)
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
• Source: PRECIOUS Project, http://www.thepreciousproject.eu/
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HOSPITAL 2.0 (THE BLENDED HOSPITAL)
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
• Mobile patients
• Mobile healthcare operators
• HC service
• Smart Environment (both sides)
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SECURITY - HEALTHCARE UNDER ATTACK?
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
Source: Bitglass 2016 Healthcare Breach Report , US data
• average cost of generic identity breaches $154 (source: Ponemon)• average cost of PHI $363
EUROPE (absolute HC breaches)• 2014 : EU/WORLD = 32/448 → 29 UK, 1 DE, 1 NL, 1 IL • 2015 : EU/WORLD = 25/446 → 19 UK, 1 DE, 2 NL, 1 DK, 2 SRB• 2016 : EU/WORLD = 20/375 → 17 UK, 2 DE, 1 TR
Q3.2016 • #375 breaches, • #data stolen equals
80% of the breaches in all 2015
(Source: Gemalto, http://breachlevelindex.com/)
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Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
TODAY
• Patient Health Attack Model
• Physician Health Attack Model
(Source: Independent Security Evaluators, http://mcaf.ee/thwxza)
SECURITY - THREATS - HOW MANY WAYS TO ATTACK?
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SECURITY - THREATS
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
TODAY
• Ransomware
• casual infections
• Still haven’t seen specific ransomware e.g., targeting DICOM/HL7
• High Value of healthcare records on black-market
• High vulnerability of the Hospitals to new threats
• Easy to break software used in Healthcare (e.g., PACS)
• Branches (small hospitals) not tightly connected with main Hospital, and less prepared
• .. including also their Business Associates (BAs)
• Regulations are not enough (e.g. regulation «one size does not fit all», HIPAA)
• Low cyber-citizenship training for HC operators and patients
• Still to come regulations among states
• e.g. GDPR and its consequences for EU healthcare services
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SECURITY - THREATS
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
TOMORROW
• Cyber murder
• Combined Cybercrime and terrorism
• "Disappearing" technologies, IoT (ultra-mobile, wearable, implantable, …)
• The human side of security
• Moving to the humans is the new wave, also of the attackers
• Healthcare is more vulnerable to SE than other sectors
• Evolution of Social Engineering
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SECURITY - THREATS - HUMAN SIDE OF SECURITY
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
SOCIAL ENGINEERING 2.0
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SECURITY - THREATS - HUMAN SIDE OF SECURITY
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
Social engineering is an attack vector that relies
heavily on human interaction (also mediated)and often involves tricking
people into breaking normal security
procedures, or performingrequested actions (e.g.
clicking on links).
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SECURITY - THREATS - HUMAN SIDE OF SECURITY
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
• Situation in 2016 (Q2.2016) of attacks. • Source: "Phishing activity trends report unifying the global response to
Cybercrime," AntiPhishing Working Group (APWG), Oct. 3, 2016. [Online]. Available: http://docs.apwg.org/reports/apwg_trends_report_q2_2016.pdf
Human enabled threats: 95,22%
Automatic attacks: 4,87%
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SECURITY - THREATS - HUMAN SIDE OF SECURITY
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
• What is cybersecurity today?• From geek-driven to business-
driven.
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• www.dogana-project.eu
The DOGANA project focuses on the impact and the remediation of thehuman factor in security, which is one of the most demanding challenges oftoday’s security and for which no widely accepted and stable solutionscurrently exist.
SECURITY - THREATS - HUMAN SIDE OF SECURITY
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
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copyright © 2016 Cefriel – All rights reserved
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SECURITY - SOLUTIONS
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
• “After spending billions of dollars migrating to electronic health records, the health care industry is now looking to beef up its spending on data security” (source: Politico, 2015)
• Innovative penetration testing programs (see DOGANA)
• Innovative awareness programs (together both patients and HC operators)
• Mobile terminal management
• Secure code development
• “Immersion effect” also for security solutions (usability of security)
• Adopt best practices of other application areas (e.g., banking)
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HOW TO MAKE IT HAPPEN THEREFORE ?!?
copyright © 2016 Cefriel – All rights reserved
Moving to the humans
Patient ecosystem
Personal big data-space
Big-data analysis
Healthcare system congestion
Early discharge from hospitals
Assisted living systems
Pervasive healthcare solutions
Home-care houses
Society is getting older & more dynamic
SECURITY
HOW
MODERNIZE DATA INFRASTRUCTURES
CREATE INCENTIVES FOR NEW MINDSETS
ADJUST LEGAL FOR DATA EXCHANGE AND SOFTWARE
SECURITY
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THANKS FOR YOUR ATTENTION
copyright © 2016 Cefriel – All rights reserved
@ ENRICOFF@DOGANAproject