76% of patients are interested in telemedicine but only 46% of them use telemedicine. On one hand, there is a lack of awareness of telehealth offerings and understanding of reimbursement policies. On the other hand, there are various reservations from both and doctors and patients such as its effectiveness compared to in-person visits and of course, security issues. It is no surprise then, that there is a significant portion of patients that are still skeptical about virtual consultations. However, telemedicine software can successfully be implemented safely and effectively by understanding are security challenges the industry is currently facing and how to tackle them.

Security challenges with telehealth

The communication of sensitive information between physician and patient takes place over a digital network. Though the technology to ensure this communication is smooth, the security issues that arise with them are plenty. Telemedicine software implemented on laptops can easily be secured via the use of encryption.

However, the delivery of telehealth through the use of medical devices such as movement sensors, smartwatches, and glucose detectors are generally not secured. For example, movement sensors in a patient’s home may be used to detect information on falls but it may also transmit information on who is present in the house and on the interactions taking place.

Many of these medical devices store information and transmit it to mobile a mobile health application. Mobile applications manage to control malware threats by preventing the installation of software not examined or approved by the application. Though, the issue with these applications is that they are often financed by third-party advertisers. These collect information on users to tailor advertisements to them according to their use. Patients are usually unaware of this information because they do not often understand privacy policies very well. They either skim through the privacy policies or blindly agree with policies which may leave them at a disadvantage.

Medical health devices and wearables such as insulin pumps have fitness trackers have been heavily adopted by more than 50% of consumers to track their health and share that information with physicians. Unlike telemedicine software, these devices are sensitive to hacking. Most of them are usually highly sensitive to attack by malware. Furthermore, these generate information that can be classified as highly sensitive. Often, they do not have safeguards to protect the information when it becomes part of their record. This will become a more pressing issue as health devices of consumers become increasingly connected.

Laws that govern the security of telemedicine software

Health Insurance Portability and Accountability Act of 1996

Better known as HIPAA it was an act that required regulations to protect the privacy of certain health information. It established national standards used to deal with health information that is transferred or held in electronic form. The Office of Civil Rights (OCR) in the Department of Human Health and Services (HHS) is tasked with the enforcement of privacy and security rules of protected health information (PHI).

HIPAA was not developed for telehealth platforms. Rather, with the rapid digitization of information in the healthcare industry such as electronic health records, pharmaceutical prescriptions, computerized physician order entry systems, it was important to have a set of rules that could deal with the implementation of new technology in the industry such as the rise of electronic health records and telemedicine software.

Hence, to be able to offer telehealth services to customers it is important to meet certain security requirements that are governed by laws such as HIPAA. Telemedicine software is not the only aspect of telehealth that is affected by these devices to deliver telehealth are also included in it. The HHS states that entities

“Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit. Identify and protect against reasonably anticipated threats to the security or integrity of the information. Protect against reasonably anticipated, impermissible uses or disclosures; and Ensure compliance by their workforce.”

In addition to complying with the rules, the telemedicine software and other telehealth related software and devices must also follow three types of safeguards: Physical, technical, and administrative.

Physical safeguards refer to limiting physical access to its facilities to only authorized personnel. There must be specific policies and procedures regarding the transfer, removal, disposal, and re-use of electronic media so that protected health information is safeguarded.

Technical Safeguards on the other hand include

Access control: it is the technical policies and procedures that allow only authorized individuals to access electronically protected health information.

Audit control: Involves the used hardware, software, and/or procedural mechanisms to keep track of and analyze activity in information systems that contain electronically protected health information.

Integrity controls Are the set of policies an entity must implement to ensure that electronically protected health information is not improperly altered or destroyed.

Transmission security: It is the use of technical security measures to prevent unauthorize access to electronic protected health information when it is being transferred over an electronic network.

Administrative Safeguards include

Security management: This involves the use of security measures to reduce risks and vulnerabilities to electronically protected health information to a reasonable and appropriate level. 

Security personnel: It is the process of entrusting an individual with the task of implementing and developing security policies and procedures.

Information access management: It limits the use and disclosure of protected health information the “minimum necessary”

Workforce training and management: all workforce members must be trained regarding relevant security policies and procedures.

Evaluation: a periodic assessment of security policies and procedures must be carried out to ensure that the entity meets the requirements of the security rule.

What is encryption?

Information transmitted across the telehealth network must be encrypted to follow HIPAA regulations. By using complex mathematics and encryption keys information is “locked”. Hence, even if a hacker manages to break into the system and access the information the raw data will be meaningless.

 Encryption depends on the manipulation of data. Usually, when data is stored or being transmitted, encryption depends on the operating software and browsers. However, end to end encryption is more commonly used in telemedicine software since the information remains safe between the two users

With encryption, only the person with the correct key can retrieve meaningful data. When data is encrypted end to end only information is available at the two endpoints and never in between. Access to any underlying information is controlled by using authentication and control access control mechanisms which restrict access to unauthorized individuals. Encryption is a surefire way to keep data across transferred across telemedicine software safe.

Types of attacks

There are different categories of threats to telemedicine software and other telehealth devices. Generally speaking, they can be grouped into four categories depending on the hindrance to the flow of information.

  1. Interruption: in this type of attack information is either destroyed or becomes unavailable.
  2. Interception: it is when confidential information is accessed by unapproved third parties
  3. Modification: in addition to accessing confidential information the unapproved third party also tampers with the information
  4. Fabrication: when the unapproved third party  

Attacks on Networks can also be classified into two broad categories Active attacks and Passive attacks. An active attack usually involves attempts to control or alter information it includes:

  1. Masquerade: it is when a unit misrepresents its identity and pretends to be part of the system. This type of attack can compromise both the confidentiality and integrity of information.
  2. Modification of messages: when an entity modifies a fragment or holds back a legitimate message to produce an unauthorized effect
  3. Denial of Service: an entity modifies a computing or memory resource to hurt the computing or memory resource so that memory resources are too busy to handle legitimate requests and management of communication facilities.

Passive Attacks are aimed not to alter the data but rather to capture it for a variety of purposes. it includes:

  1. Release of message content: information such as patient data, private messages, or emails are intercepted
  2. Traffic analysis: it is when a third party analyzes the traffic in the network to obtain information of what is communicated throughout the network.

How to prevent security risks in your telehealth platform

There are various ways for healthcare providers and telemedicine software developers to ensure that optimum security practices are being followed.

Identity authentication

One of the most common ways to do this to include a two-step verification process. By submitting account sign-in information and verifying the device from which the user is logged in, most cyberattacks can be blocked. The use of strong passwords can also help mitigate the risk of cybersecurity attacks. Though, this can often be annoying for users who often forget their passwords. Though the development of Blockchain and AI is bringing the potential to develop telemedicine software that does not require a username and a password whilst providing the same level of protection if not, even more without requiring complicated passwords or the need to set up an account.

Continuous verification

Since telehealth can be delivered from any location physicians may choose to work remotely. However, this raises security issues since the devices they use to log in are not protected by their organization’s network perimeter security. As such, telehealth systems and telemedicine software should implement continuous endpoint posture checking which is a tool used to authenticate the user and the device being used. Another way to implement optimum security protocols is to use applications that ensure that firewalls, anti-phishing software, and healthcare-related applications that are running on the device are being monitored. If any third party attempts to tamper with the data it can be dealt with swiftly. 

Ensuring telemedicine software security

The cybersecurity of the devices and the telemedicine software used by the healthcare practitioner is possible by complying with HIPAA laws and regulations. However, it is a complicated process to ensure the safety of the devices used by patients as

Educating patients

Though the adoption of telehealth has increased and it is becoming more and more mainstream, it is important to educate patients on cybersecurity adoption. The first party that must be well aware of optimum cybersecurity practices for telemedicine software is physicians. Only then they will be able to implement optimum security protocols during their virtual consultations. Patients need to understand what is the role of the government and organizations in the protection of their data. At the same time, well-informed and highly aware patients can also make smart decisions regarding the use of telemedicine software and the information available to them.

Changing the way security is developed

Usually, security controls and processes are developed at the end of the software development process. It is treated as a separate layer of the telemedicine software which can become a hindrance in the future. Instead, developing security controls and processes from the beginning is a much better way to improve the confidentiality of data. This approach is also known as DevSecOps or Development, security, and operations. Though it is more expensive to develop telemedicine software in this way, in the long run, it prevents potential security breaches that can arise and prevent the loss of patient trust.

Implementing VPN

The biggest advantage of VPNs is that they ensure that information is encrypted. Even if they use is making use of encrypted telemedicine software, they ensure that any information sent through internet hosted applications are not prey to third party attacks. Newer versions of VPN’s allow users to set a configuration lockdown. It prevents users from changing the configurations set y the administrator by accident. Patients, in particular, must be instructed to use VPNs during the use of telehealth services and for the safety of their devices.    

Though telehealth rises various security challenges, it is possible to tackle them. By complying with HIPAA and encrypting all the data incoming and outgoing from the virtual clinic. Moreover, taking preventive measures such as educating patients and physicians and implementing VPN’s can prevent potential security issues. Besides, changing the way security is developed, ensuring telemedicine software is HIPAA compliant, following multistep verification, and using continuous verification for the employees within the practice can help mitigate security issues.

Managing your clinic can be a hassle-free process with the right software. Provide safe and effective telehealth services with Outsquaremd’s telemedicine software. We are a fully integrated telehealth solution provider, we hospitals and practices of all sizes with a 360 solution for all of their virtual health care needs. Contact us at (516) 6304 025 or schedule an appointment with us.

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