A recent ransomware presentation… while the Petya attack was underway

I was recently invited to present two talks on ransomware at EMR-related seminars attended by physicians, clinical staff and service providers, held last week in British Columbia.

Interestingly, the last seminar took place just as news was emerging that morning of Petya, described as a new, massive ransomware attack, was spreading across the Ukraine, Europe, and the US. We are now learning that, because it encrypts entire hard disks but does not appear to have the capability to decrypt them, Petya may not have been ransomware at all. Instead, some analysts believe it may have been designed to be a weapon to cripple systems, possibly targeting infrastructure in the Ukraine. This gives little comfort to organizations around the world that have been hit with it, including shipping companies, a multinational law firm, and the giant pharmaceutical firm, Merck.

What was immediately apparent during the morning of the attack, however, is that it won’t be the last.  The need to protect information systems in health care clinics is more important than ever.

My presentation summarizes some of the information that is described in more detail here:


Update 20170630: More information is emerging concerning the Petya attack. For further information, here is the latest update from US National Health Information Sharing and Analysis Center (NH-ISAC)

Ransomware revisited


A few months ago, we wrote an article on Ransomware: ten ways you can help protect your clinic .  Since then, the Doctors Technology Office (DTO), at Doctors of BC, has published a brief indicating there has been an increase in reports from doctors about attacks by ransomware.

We agree with the DTO’s statement in their accompanying technical bulletin called “Ransomware – What should I do?“, “It’s spreading like the plague. Healthcare organizations must know that they ARE a target and will be attacked”.

Furthermore, the DTO indicated, quite rightly, that antivirus software does not provide sufficient protection from ransomware. The best practices we’ve published above, and the DTO’s technical bulletin, provide some helpful measures to assist in preventing some of the most common ways clinics may be hit with ransomware.

What we have been observing since our first report is that ransomware and malware tools are rapidly evolving to trick users into installing it onto their computers.  And attacks are becoming increasingly sophisticated. For example,

  • If you are scanning your email for possible “phishing” attempts to get you to download malware, be aware that no matter how carefully you examine the embedded link, it can be almost impossible identify malware websites based on the URL.
  • It used to be thought that PDF documents were safe. No longer. A new ransomware variant has emerged that will embed itself inside a PDF document.
  • Some variants that are emerging will also leak your data if you don’t pay the ransom.  Will keeping your patient files on a server outside the clinic help prevent this? Perhaps, but remember that for network efficiency reasons temporary files are frequently generated on local computers every time files are downloaded and reports are printed, all of which may contain confidential data.

Since our last “best practices” post was published, we have noticed it seems a number of clinicians and even some IT technical support staff have mistaken ideas about the threat of ransomware in medical and dental clinics.  Here are some examples.

“I don’t keep my electronic medical records (EMR) data on my Windows laptop. It is stored on a Linux server, so if ransomware hits my computer, it won’t be affected”.  Simple answer, no, that’s not correct.

  • Linux systems are not immune to ransomware. And more and more cross-platform threats are appearing, due to multi-platform frameworks that are available nowadays under Linux. Frameworks such as Adobe Flash and Reader, Java, JavaScript, Perl, PHP, Python, Ruby, etc.
  • In addition to mapped network drives which are always at risk, Microsoft Active Directory is now being used by some ransomware for reconnaissance and to spread across an entire network, encrypting files on every server and computer.
  • There is nothing to prevent other malware to be installed along with ransomware that could exploit vulnerabilities on any system.

“If ransomware hits my computer, I have other computers that I can use until I get my laptop back”.  Don’t depend on this. Some types of ransomware can propagate across a network. And besides, if your clinic is unfortunate enough to experience it, you will be immediately affected, without warning. Do you really want to have to deal with this problem when you have a waiting room full of patients?

If I am hit with ransomware, I’ll simply recover my data from backups”  We agree, backups are essential to recover from an attack. But only if backups are done right.

  • Any information you have entered that has been encrypted by ransomware since the last backup may not be recoverable.
  • We have seen cases where perfectly good backups have been overwritten with later scheduled backups where dormant malware will simply reinfect the computer when it is restored.
  • If the backup is located on a shared drive that a user can access with a network-connected computer, ransomware can encrypt those backups, too.

“If ransomware strikes, I’ll pay the ransom to get my files back.”  That, of course, is your decision, and with respect to some forms of ransomware, the FBI has actually recommended this. But just know that:

  • There are known variants of ransomware that will encrypt your data, but the ‘unlock’ key you receive after paying the ransom may not actually unlock it.  In the case cited, involving a hospital, the extortionist tried asking for more money.
  • Attendees at an RSA cybersecurity conference in February learned that 31% of victims have been hit multiple times, and 25% did not get their data back, even after they paid the ransom.
  • Even if you pay the ransom, this doesn’t necessarily resolve the risk of personal health information having been disclosed.  It should be treated as a potentially serious privacy breach.

The impact:  Ransomware may do more than just lock you out from using your laptop or desktop computer. Once it gets a foothold in your clinic, it can be difficult and costly to eradicate. The threat to clinic business continuity and protecting patient personal health information is considerable. Understanding the specific risks your clinic may have at this time is a vital first step towards taking proactive measures to mitigate them and ensuring you have well-tested procedures to quickly recover if needed.

The bottom line:  Please take the threat of ransomware in your clinic seriously.  Make sure you have tested, proactive measures in place to mitigate risks before ransomware hits.

If you need help, contact us.


Welcome to our official new blog!

stan-shawCTS has been providing professional IT project and change management services to British Columbians for over ten years.  We are excited, however, to launch our new website today, in the midst of announcing a comprehensive new range of privacy and data security services specifically designed to support the health care community in western Canada. Together with our website, we will be sharing timely and helpful information through this journal.

Why is this important?

Because many clinicians, dentists and health care professionals have massively changed the manner in which they are handling patient information.  Paper health care charts in physician offices are in many cases completely replaced by electronic medical records.  Dental images are now digitized.  Lab reports are flowing into sophisticated EMR systems. Billing is linked directly to patient records.  Scheduling is increasingly on-line through patient portals. Teams of clinical practitioners are beginning to share electronic medical records in order to efficiently refer patients and provide coverage.  Electronic medical records can transform clinical practice in even the smallest clinics.

All of this has the potential to dramatically improve the quality of health care delivery. But how can a physician or dentist in their clinics keep pace with the technology impact on privacy? Or, when faced with increasingly sophisticated cyber security attacks, maintain business continuity?  And if patient or client confidential records are ever compromised, would you know what to do?

Here are some topics that we are writing with this in mind:

We hope the practical information and tips we will be sharing through these posts will assist you in safeguarding personal information and protecting your clinic.

Stan Shaw, CTS Founder and CEO


Click here to see how we can assist your clinic.