Corona virus Disease 2019 (COVID-19) will force many healthcare organisations to considerremote workplace options for their employees (VPN), new ways to interact with their patients (telehealth) and third-party communication (videoconferencing/file share).

Some options can be secure when implemented properly, though if implemented in a rush or not properly maintained, may pose a significant risk.

Patients First recommends healthcare organisations explicitly anticipate and mitigate the cyber security risks around the use of telework and telehealth solutions.

Technical

The following are cyber security considerations regarding telework and telehealth in the context of COVID-19.

• As more organisations use VPNs for telework, increased cyber-risk arises out of targeting by malicious cyber actors.

• As VPNs are 24/7, organizations must keep them updated with the latest security updates and patches.

• Malicious cyber actors may increase phishing emails targeting teleworkers to steal their usernames and passwords.

• Organisations that do not use multi-factor authentication (MFA) for remote access are more susceptible to phishing     attacks.

• Organisations may have a limited number of VPN connections, after which point no other employee can telework. With     decreased availability, critical business operations may suffer, including IT security personnel’s ability to perform cyber security tasks.

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Recently impacted organisations and news:

• COVID-19 Testing Center Hit By  Cyberattack
• New  Ransomware Campaign Distributes CoronaVirus Ransomware and Kpot  Infostealer
• Corona virus Phishing Attacks Are  Actively Targeting the US
• Fake Online Corona virus Map  Delivers Well-known Malware
• TrickBot Malware Targets Italy in  Fake WHO Corona virus Emails
• Practices urged to use standards-based telehealth platforms

Mitigations

Patients First recommends the following mitigating actions.

• Update VPNs, network infrastructure devices, and     devices to remote into work environments with the latest software patches     and security configurations. See CISA Tips Understanding Patches and Securing Network Infrastructure  Devices.
• Alert employees to an expected increase in phishing attempts. See CISA Tip Avoiding Social Engineering and Phishing Attacks.
• Ensure IT security personnel ramp up key remote access cyber security tasks i.e. log review, attack detection, and incident response and recovery and review the Guide to Enterprise Telework,  Remote Access, and Bring Your Own Device (BYOD) Security.

• Implement MFA on all VPN connections to increase  security. If MFA is not implemented, require teleworkers to use strong     passwords. (See CISA Tips Choosing and Protecting Passwords and Supplementing Passwords for more information.)    
• Ensure IT security personnel test VPN limitations  to prepare for mass usage and, if possible, implement modifications—such as rate limiting—to prioritise users that will require higher bandwidths.

Lastly, Patients First and our cybersecurity partner Medical IT Advisors can advise and respond to cyber security incidents, phishing, malware, and other cybersecurity concerns that may disrupt healthcare delivery during this global emergency.

References
CISA Insights: Risk Management for Novel Coronavirus (COVID-19)
CISA VPN Alert
National Security Agency Cybersecurity Advisory: Mitigating Recent VPN Vulnerabilities
Telework.gov Guidance
NZ Telehealth Resource Centre
Patients First
Medical IT Advisors