Key Document Management System Features

R&G LCMS

The paperless office is here to stay, with many businesses, large and small, making the move to online storage. Document management systems come in various forms. Some are simple online filing systems, others are complex with features such as access control, audit trails, encryption, and data backup. The type of information a business maintains is a driver for the type of security needed as a safeguard. For example, law firms often need a system associated with case files that safeguard client personal health care information. A small business many need a billing document management system.  

A robust document management system should offer multiple layers of protection. For example, access controls allow individuals permission to access data. Two examples are personal identification numbers and passwords. Some passwords are specialized and require special characters. The more complex the password, the less likely a hack will occur. Audit trails are another means of protection which provide a history of who viewed certain data and when. It allows for the tracking of a source of a breach. Lastly, encryption provides a way to share files securely as well as limits the viewing of certain documents.  

A good document management system also has a data backup feature. This occurs when data is replicated to an additional system such as the cloud. Theft, data loss, or a natural disaster are just a few reasons to incorporate redundancy into the system as data redundancy is essential for speedy and seamless recovery. If there is no built-in redundancy, the opportunity for recovery of files may be forever lost. The key to redundancy is to balance the redundancy so that data remains as clean and up to date as possible.  

Document collaboration is a more sophisticated feature of an online system. This feature allows for mark up, versioning, searchability, e-signature and customized security. While overkill for some businesses, the features are essential for others.  

Customer support is essential for any document management system. A standard method for contacting the developer should be known and responses should come quickly when there are questions. A client portal with a help button is a common feature for many systems.  

R&G offers clients a Legal Case Tracking System as a secure means of online case storage information. The Legal Case Management System (LCMS) is an integral part of workflow management at R&G. LCMS is a state-of-the-art database providing anytime-anywhere access to case details, retrieved medical records, and completed work products. 

There are no additional fees associated with access. All of R&G’s medical legal consulting or document management clients can: 

  • Track case deadlines and status of records in real time 
  • Access medical records and completed work products 
  • Data is safe and private! LCMS uses BOTH redundant storage (to protect your data in real-time) AND frequent backups (to protect data in case of disaster) 

If you need assistance with a case, please call R&G Medical Legal Solutions at 1-888-486-2245. 

Hit by Ransomware? Check out these tools to see if any of them can help you.

Ransomware stock image

If you’ve been hit by ransomware, check out the tools found here to see if any will unlock your files. There are over 121 ransomware decryption tools and it’s growing every day.

Another couple website that we like to check for virus/ransomware removal tools is bleepingcomputer.com and majorgeeks.com

Here’s a recent article covering The No More Ransom website listed above.

“The project, founded by Europol, the National High Tech Crime Unit of the Netherlands’ police, Europol’s European Cybercrime Centre, Kaspersky, and McAfee, launched five years ago and has grown to involve 170 partners across law enforcement, cybersecurity companies, academia, and others. 

The No More Ransom portal now offers 121 free ransomware decryption tools which can decrypt 151 ransomware families. They’ve helped more than six million ransomware victims recover their encrypted files for free – all without the need to give into the demands of cyber extortionists. 

Available in 37 languages, ransomware victims around the world have used the portal to help against ransomware attacks. The website’s ‘Crypto Sheriff‘ allows users to upload encrypted files to help identify which form of ransomware they’ve fallen victim to, then directs them to a free decryption tool if one is available.”  

Ransomware is getting worse

ransomware stock image

There has been another high-profile ransomware attack and this one could possibly be more significant that the ones before.  

We covered ransomware awhile back, on what it was and how it is a growing threat. You can read that blog here. 

Just last week, Colonial Pipeline, which accounts for 45% of the US East Coast’s fuel, was attacked by ransomware. It took down its systems and forced them to shut down operations.  

https://www.zdnet.com/article/colonial-pipeline-cyberattack-shuts-down-pipeline-that-supplies-45-of-east-coasts-fuel/

Also last week, Scripps Health, a very large hospital network with over 10,000 employees and 7,000 patients, got taken down by a cyberattack.

https://www.10news.com/news/local-news/scripps-health-ceo-addresses-cyberattack-in-an-internal-memo

and

https://healthitsecurity.com/news/scripps-health-ehr-patient-portal-still-down-after-ransomware-attack

both cover that news and the implications they are still dealing with.

In the past year there has been well over $215 million in damages from ransomware attacks around the world.  

With most of the workforce still working from home in 2021, due to the Covid-19 pandemic, its making cyberattacks and ransomware much easier to pull off. Where employees and their PCs were once safely behind the office firewall, are now at makeshift workstations in their home office, bedrooms, or kitchen, using all manner of cobbled-together technologies to get the job done. 

Companies now have a MUCH bigger attack surface. This is due to employees now on all different networks and at various locations. They are no longer working within their organization’s network and covered under its normally secure protection and firewall settings. Some are smart and using a secure VPN connection to stay within their office’s network protection, but most are not. ZDNet has a great article by Danny Palmer on this topic as well.  

If you suspect you or your company has been affected by Ransomware, I am sure your first thought is to shut down or reboot all the computers and server(s) in your office. This is something that you DO NOT want to do. Shutting down or rebooting may lead to restarting a crashed file-encryption process and potential loss of encryption keys stored in the memory.  

Experts instead recommend that victims just hibernate their computer(s) and disconnect it from their network. (Easiest way is to pull out the network cable from the back of it, if it is hardwired to the internet). If you suspect more than one machine is affected, disconnect the office network switch(s), and cut its connection to the internet to keep the infection from spreading further if possible. Once done, it is advised to reach out to a professional IT support firm for further steps. 

Victims should take note that there are two stages of ransomware recovery process they must go through. 

The first is finding the ransomware’s artifacts — such as processes and boot persistence mechanisms — and removing them from an infected host. 

Second is restoring the data if a backup mechanism is available. 

When companies miss or skip the first step, rebooting the computer often restarts the ransomware’s process and ends up encrypting the recently restored files, meaning victims will have to restart the data recovery process from scratch. 

In the case of enterprises, this increases downtime and costs the company operating profits. 

To learn more about dealing with ransomware attacks, you can check out the Emsisoft guide on how to remove ransomware and Coveware’s first response guide on dealing with a ransomware attack. 

Above all please keep up with regular training and remind your employees and co-workers, not to click on any questionable links or download anything that they are not sure of. Stress that if they should ever question something, it is always best to just ask their IT department about it first. While it might create more work to make sure something is legit or safe for you to use, it will tremendously save the company in the long run from massive expenses incurred from getting infected by ransomware. 

Stay safe out there everyone. 

What is a DICOM?

DICOM Images

What is DICOM? 

In a clinical environment dealing with any medical imaging, DICOM, short for Digital Imaging and Communications in Medicine, has become essential. The broad application of DICOM is not difficult to understand, given the need and usefulness of medical imaging in healthcare. It allows the storage, viewing, and sharing of medical images and related data on devices within and across medical facilities.  
  

The standard communications protocol used to capture, store, and transmit medical images and related information is DICOM. In medical imaging, DICOM acts as a blueprint for the information structures and procedures in medical imaging systems that control the input and output of data. Both the protocol itself and its corresponding file format are referred to by the term. All data acquired in the medical imaging process is stored in this format. Without it, it would be considerably more difficult to exchange information between various imaging devices.  

Differences between DICOM and PACS, RIS, and CIS 

In addition to DICOM, words such as PACS, RIS, and CIS are often discussed , especially when talking about the benefits that have been brought to healthcare by modern software technologies, standards, and protocols. With regard to what differentiates them, this may lead to some confusion, particularly when it comes to the difference between PACS and DICOM.  

Medical IT systems focused on networks of different devices are the former. DICOM is the common protocol and file format that defines the communication between these devices and allows many different systems to communicate equally.  

Now that that’s clear, here’s an overview of the most popular medical IT systems:  

  • PACS (Picture Archiving and Communication Systems) are medical imaging systems that provide multi-modality storage and access to images. Its key application is as a superior storage option that removes the need to store and retrieve data manually. 
  • RIS (Radiology Information System) – Another type of information system for storing and handling medical imaging data widely used in radiological practices is RIS (Radiology Information System). Radiologists typically use it for, among other purposes, scheduling patients, monitoring and interpreting exams, and billing. 
  • As they are applied to the same area and sometimes used in combination, the distinction between RIS and PACS can be a little vague. These are both systems for enabling the handling of patient information, but while PACS provides storage and a long-term patient data management solution, RIS streamlines procedures and enhances workflow by allowing real-time patient monitoring and providing medical records for patients from one central source.  
  • EHR (Electronic Health Record) – EHRs are digital versions of patients’ paper charts. They are digital archives of the entire medical care history of patients. It encompasses medical pictures. EHRs can work in combination with other medical information systems, much like the previously described patient data systems. They can come with a DICOM production, send, or customer, and can be integrated with PACS or RIS as well. 
  • CIS (Clinical Information System) is an information system that documents, stores and manipulates the clinical information of patients. How does this vary, you might ask, from EHRs? EHRs include a patient’s entire medical history and are therefore much more generalized. CIS manages very precise data, obtained directly from inputs from equipment and medical staff. 

In addition to offering countless advantages, such as enhancing workflow and performance, reducing costs and space requirements, these medical information systems allow practices to concentrate more on patient care efforts. In modern medical services, this has made them indispensable.  

To respond to the diverse demands of medical imaging systems, medical technology is continually evolving and diversifying. New kinds of DICOM-compliant applications are constantly being developed, and cloud-based DICOM image viewers have been one of the most important innovations to emerge from this.  

R&G Medical Legal Solutions, is excited to announce that we have developed our very own proprietary online DICOM viewer that is a part of our database management system and will make this service available in the very near future. This will allow our clients to view any records including radiology, 24-7. Please give us a call at 1-623-566-3333 or email us at marketing@rngmedical.com today for a demonstration.  

R&G Medical Legal Solutions, LLC is a highly regarded litigation support services firm.  R&G is a second-generation company headed by Brian Oldham, a retired, service disabled veteran of The United States Air Force.  

Why hackers are going after healthcare records…

 

When data is stolen from a bank, it quickly becomes useless once the breach is discovered and passwords are changed. However, data from the healthcare industry, which includes both personal identities and medical histories, can live and affect people for a lifetime.

Cyberattacks will cost society more than $305 Billion over the next five years.   According to industry consultancy, Accenture, 1 in 13 patients will have their data compromised as a result.

chart

The healthcare sector is uniquely vulnerable to privacy breaches.  Recent government regulations have required healthcare providers to adopt electronic health records (EHR) under the Patient Protection and Affordable Care Act.  This has the potential to expose patient data to potential compromise unless providers make equal investments in the security of the systems used to house and manage that data.   To comply with legal requirements, healthcare organizations often store detailed medical information for many years. The probability of a breach and the potential severity of the consequences increases according to the amount of data store and the length of time it is stored.

To a hacker, healthcare records contain valuable information, including Social Security numbers, home addresses, and patient histories. Criminals can sell this data for a premium on the black market, providing incentive to focus attacks on the healthcare industry.

With the push toward integrated care, medical data is being shared with many different entities whose employees may have access to patient records. This extended access to medical records also increases the potential for privacy breaches.

In summary, as companies move to digital record-keeping, the industry is so focused on regulatory compliance, that cybersecurity has largely been a secondary thought. Companies with legacy systems are trying to connect to and integrate EHRs. Security is not always considered an integral part of that, and patching systems are always filled with issues.

Source:

https://www.accenture.com/t20150723T115443__w__/us-en/_acnmedia/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Dualpub_19/Accenture-Provider-Cyber-Security-The-$300-Billion-Attack.pdf

‘Ransomware’ a growing threat

It is 6 a.m. and you’re drinking your favorite cup of coffee as you sit down at your computer to check your daily emails. You get a message from UPS with an attachment that says “track your shipment”.  “Hmm…” you wonder to yourself, “I don’t remember ordering anything. Maybe someone sent me gift or something?” You then proceed to click on the attachment to track your package. Suddenly your computer screen blinks and starts acting weird, a window pops up with a warning…

ransomware example

 

ransonware 2

You sit there in shock as you slowly come to realize you have just gotten infected with some kind of a virus.  You start to panic as you start checking your various files on your computer and are finding out that you cannot open them up as they are encrypted. “Oh no…” you whisper to yourself, “How could this have happened? All the photos of my kids growing up over the years, all my scanned banking statements, PDF copies of my Tax returns, my resume, my entire music library that I have spent the last 6 months ripping my music CD collection to…. All encrypted! I don’t have any backup copies anywhere!” you scream to yourself in horror.

That scenario could have very well happened to you. More and more people and businesses these days are falling victim to “ransomware”. Ransomware is a malicious code that locks up computer files and cybercriminals demand a ransom to free them.  “Ransomware” may have many various names and variants, but they all have one goal in mind. To hold every digital file you own on your computer as well as across your network, hostage until you pay their ransom fee, typically by paying an online currency, such as Bitcoin. Once paid, you might get a “key” and be able to unlock your files. However there have been several cases of this not happening at all, after a ransom is paid and files have been permanently lost.

Some of the more recent and known ransomware code names are “Petya”, “ Jigsaw”, “Crypto-locker”,  “CryptoWall”, “Rokku”, “KimcilWare”, “Coverton”, etc…  Usually ransomware will have you go buy a green dot money card from your local Walgreens or Walmart, and load up the specific dollar amount they are asking for. They will have you follow instructions to convert that amount into Bitcoin (which is currently untraceable) and send it to them over the “Dark-web” using a Tor browser or something similar.

Most ransomware is delivered via email. The typical overall themes are usually shipping notices from delivery companies or purchase orders. In the past year, we have seen the content of these emails being both near-perfect in local languages and also looking much more legitimate than previously. While the majority of ransomware attacks still happen opportunistically, you will often see them being ‘localized’ so they fit their targeted countries. Also, many attacks are being delivered by mass random emails. The intention is to infect as many as possible to maximize the chances of getting a result. Ransomware is also delivered via drive-by-download attacks on compromised websites. Although the problem is well known, avoiding infection is a bigger problem, as well as what to do when you are infected.

Because ransomware is able to encrypt files on mapped network drives, disconnect the mapping where possible if you are not using the drive. Organizations must make sure backups are not accessible from endpoints through disk mounts; otherwise those will be encrypted as well. Once the backups are done and stored securely, we recommend checking that the backups are working and that you can recover from them.

The best way to recover from an attack by ransomware relies largely on if a good backup policy is employed for your data and its entire system backups. Regular backups are the most reliable method for recovering infected systems, which makes it all the more important to prevent the initial infection. Rather than a simple backup, in order to be effective, a backup must be “dated”, with older versions of files available in case newer versions have been corrupted or encrypted. Also get into the habit of storing backups in an offline environment, because many ransomware variants will try to encrypt data on all connected network shared and removable drives. It’s imperative to always have known good and up-to-date backups that are as close to real time as possible. One thing to consider is making sure you don’t overwrite your backups with the compromised data, so that when you go to restore, you are able to. If backups are not an option, you may be able to use Windows’ own shadow copies to restore files, if the ransomware has not disabled its use.

Having a layered approach to security is one of the clichés of modern infrastructure, but for repelling ransomware, it should be taken very seriously.  The best way to protect against a virus is to have defenses set up to ensure you never receive any viruses in the first place. Deploying a layered approach, utilizing technologies such as anti-virus, web filtering and firewalls will help prevent this from happening to you. More modern consumer security software now contains personal firewalls and web filtering alongside the more traditional anti-malware.

Current ransomware will typically run an executable from the App Data or Local App Data folders, so it is best to restrict this ability either through user policy, Windows or by third-party prevention kits that are designed for this purpose. As well as adopting a layered approach, getting software patches installed and being up-to-date remain the best form of security.

The final piece of advice to protect against malware is to ensure your user privileges are locked down. Most organizations or people sharing a home computer are not watching or analyzing all their users’ activities. Cyber criminals will return to someone who paid, so payment to recover your files simply confirms that you will be a good target for future attacks and scams. Most malware will execute with the same privileges as the victim executing the payload. If the person getting compromised has local or global administrative privileges, the malicious code will have access to the same resources. In the instance of ransomware, this also means ransomware will have the capacity to encrypt data across network drives, shares and removable media.

Infection by ransomware does happen. There are free tools that exist from companies such as Kaspersky and Cisco that may work in removing them. There are websites such as www.bleepingcomputer.com  and www.thehackernews.com that have great tutorials on how to remove some of the more popular ones. The worst thing about a restore is the time it takes, but this is obviously less expensive than paying a ransom.

Of course, the biggest problem with paying ransoms is that you are dealing with criminals, and there is no guarantee that the victim will get their data back, or that the attacker will not leave other forms of malware running on the system. Like other scammers, cyber criminals will return to someone who paid, so payment to recover your files simply confirms that you will be a good target for future attacks and scams.

If you are a victim, then consider the sensitivity of your data, your profile and the sophistication of the attacker before you pay, because low sophistication in communication could mean low quality of encryption.

This is a modern problem in malware, combining both sophisticated and basic tactics, and people are still getting caught, despite the fact that there are fairly straightforward methods to avoid becoming a victim.

As ransomware gets more and more advanced, you will start hearing about it on the news more often.  You can almost guarantee that a lot of companies have been affected by it as well, but have elected to keep it under wraps. If word got out that their confidential data was affected, it could potentially ruin a business.

Here are a few recent news articles of events of ransomware that had happened…

http://www.wsj.com/articles/ransomware-a-growing-threat-to-small-businesses-1429127403

http://thehackernews.com/2016/02/ransomware-medical-record.html

http://thehackernews.com/2015/10/fbi-ransomware-malware.html

http://www.reuters.com/article/us-apple-ransomware-idUSKCN0W80VX

http://arstechnica.com/security/2016/04/ok-panic-newly-evolved-ransomware-is-bad-news-for-everyone/

http://www.scmagazine.com/ransomware-and-pos-attackers-to-zero-in-on-small-businesses-retailers/article/466318/

http://www.cio.com/article/3055323/security/ransomware-world-war-business-and-the-post-modern-cio.html

How Copy-and-Paste Makes EMR & EHR Fraud Easy

Healthcare Data Privacy

Federal officials say the copy-and-paste features common to computers which are used to enter Electronic Medical Records (EMR) and Electronic Health Records (EHR) invite fraud.  Merely copying and pasting another patient’s clinical notes can be considered fraud. The Federal Government believes there is a need to reduce the healthcare provider’s ability to duplicate notes.

In a report dated December 2013, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) says: “Not All Recommended Safeguards Have Been Implemented in Hospital EHR Technology.”  The study was done by the OIG who sent out a questionnaire to 864 hospitals that received Medicare payments as of March 2012. The OIG also visited eight hospitals to see how the EHR & EMR systems were being used.  In addition to obtaining information from health care providers, the OIG surveyed four EHR vendors about the implementation of fraud safe guards in their software products.

According to the report: “Copy-pasting, also known as cloning, allows users to select information from one source and replicate it in another location. When doctors, nurses, or other clinicians copy-paste information but fail to update it or ensure accuracy, inaccurate information may enter the patient’s medical record and inappropriate charges may be billed to partients [sic] and third-party health care payers. Furthermore, inappropriate copy-pasting could facilitate attempts to inflate claims and duplicate or create fraudulent claims.”

When the experts at Evidence Solutions, Inc. examine Electronic Medical Records, they may look for evidence of note cloning. The process is made difficult, however, by the fact that they rarely see more than one patient’s records.

HHS agencies have confirmed they are developing comprehensive rules and regulations to deter fraud and abuse involving EMRs / EHRs, including guidelines for cut-and-paste features. According to the OIG report, “Certain EHR documentation features, if poorly designed or used inappropriately, can result in poor data quality or fraud.”

“When a healthcare provider inappropriately clones sections of a medical record, he or she may be entering the crosshairs of CMS (Centers for Medicare and Medicaid Services),” so says Dr. Burton Bentley II*, an emergency physician with 21 years of clinical practice.  “When an EHR does not accurately reflect the clinical encounter, then the clinician’s documentation may be subject to federal scrutiny.”

While it may seem that copying and pasting information from similar patient records is benign, failure on the part of providers to review what has been copied can lead to significant discrepancies between what really was collected from the patient encounter and the notes recorded in the record.

A missed edit from “positive result” to “negative result” can have devastating effects on not only the patient’s record but on their treatment.

Regarding fraudulent claims, it is easy to understand how copy-and-paste make it too easy to bill for work which wasn’t actually performed. Especially when the copied text comes from a different patient’s record with a couple of keystrokes.

The study found that only about one quarter of the hospitals surveyed had policies in place that governed the use of Copy and Paste in EHR and EMR systems.

* Dr. Bentley is a practicing Emergency Medicine physician and Fellow of the American Academy of Emergency Medicine (EM).  He frequently consults nationally on medicolegal issues while enjoying a busy EM practice in southern Arizona.


About the Author:

For 30 years, Scott Greene has been helping owners, CEO’s, managers and IT departments understand data. Scott Collects, Analyzes and Explains Complex Electronic Evidence in Plain English.

In 2008 he created Evidence Solutions, Inc., a full service Computer, Technology & Digital Forensics firm, from the Technology Forensics department of Great Scott Enterprises.

Scott’s extensive knowledge draws clients to him from all over the United States as well as Internationally for consulting and expert witness services in the field of Computer, Technology & Digital Forensics. His extensive and diverse experience allows him to be an expert in many facets of computer & digital technology. He is a sought after speaker and educator and travels throughout the country presenting to local, regional, national and International organizations.