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Maybe If We Turn It Off and Then Turn It Back On Again? Exploring Health Care Reform as a Means to Curb Cyber Attacks

Published online by Cambridge University Press:  01 January 2021

Deborah R. Farringer
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Abstract

The health care industry has moved at a rapid pace away from paper records to an electronic platform across almost all sectors — much of it at the encouragement and insistence of the federal government. Such rapid expansion has increased exponentially the risk to individuals in the privacy of their data and, increasingly, to their physical well-being when medical records are inaccessible through ransomware attacks. Recognizing the unique and critical nature of medical records, the United States Congress established the Health Care Industry Cybersecurity Task Force under the Cybersecurity Information Sharing Act of 2015 for the purpose of reviewing cybersecurity risks within the health care industry and identifying who will lead and coordinate efforts to address such risks among the various agencies. The Task Force has since issued a report setting forth six high-level imperatives that the health care industry needs to achieve in order to combat cybersecurity, and, notably, many of the vulnerabilities plaguing the industry identified in the Report as requiring correction are not necessarily related to specific flaws in the current cybersecurity framework, but rather susceptibilities presented by the infrastructure and associated regulatory regime that has evolved over the last few decades over the health care industry generally. That is, the current health care infrastructure by its nature exacerbates cybersecurity risk. Between a lack of information sharing of industry threats, risks, and mitigations, disparate leadership and governance goals for cybersecurity, the confluence and contradiction of existing federal and state laws, fragmentation in the fee-for-service delivery system, lack of care coordination, and disparate resources across and among sectors, the industry suffers from heightened cyber risk. Solutions that are reactive to problems within the current infrastructure will likely have little long term impact toward reducing cybersecurity vulnerabilities because they do not address the underlying system challenges. All of these confluences causes one to wonder whether if in fact the current health care delivery infrastructure is a contributing factor to the incidents of cybersecurity attacks and the exorbitant costs associated with resolving data breaches, should Congress look not just to curb breach incidents, but to address root cause systematic challenges in the health industry infrastructure that create increased exposure of cybersecurity threats? This article argues that cybersecurity risks will continue to be heightened and more costly to the health care industry as compared to other industries unless and until some general system redesign is achieved that allows for (1) greater sharing of resources among industry participants to ensure the same protections are implemented at all levels of the industry, which can be strengthened through greater interoperability of systems across the health care industry; and (2) increased focus and attention on the importance of cybersecurity issues as a priority among system reforms.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 47 , Issue S4: Current Topics in Health Law: Papers from the 2019 ASLME Health Law Professors Conference , Winter 2019 , pp. 91 - 102
Copyright
Copyright © American Society of Law, Medicine and Ethics 2019

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This article is not suggesting that the authors of the Report intend for the Report to be a manual for industry participants to stop cyberattacks. On the contrary, the Task Force acknowledges in the Report that some of the suggested changes must be legislative and/or administrative in nature. This article is suggesting, however, that having identified the necessary issues — some of which are systemic to the health care industry more generally — other steps must be adopted that do not feature cybersecurity as the driving force.Google Scholar
While most details about Medicare for All have been very high level, there has been little mention of cybersecurity or interoperability as one of the goals. See, e.g., H.R. 676, “The United States Nat'l Health Care Act,” or “Expanded & Improved Medicare For All” (2019).Google Scholar
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This should include not just small providers, but also safety net institutions that provide services to indigent populations. Current access issues for indigent populations further reiterates the ultimate argument of this article that system reform is a necessary first step to truly addressing cybersecurity, as providers are unlikely to include these safety net providers in proposed care delivery models due to the challenges of payor mix in making such models financially viable. See Meidell, M., “ACOs Face the Demographics Dilemma of Managed Care,” Annals of Health Law Advance Directive 25 (2015): 14, 20-21.Google Scholar
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This is not to say that ACOs are the means by which cybersecurity can be addressed most effectively. Rather, it is to point out that reform efforts exist that could help ease some of the risk because the function of the ACO infrastructure will allow for sharing and collaboration of data without running afoul of existing regulatory and statutory limitations.Google Scholar
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