How Kelsey-Seybold Clinic recovered from a ransomware attack

This past year, ransomware attacks cost healthcare organizations more than $20 billion, according to a study from Comparitech. Even more critical, however, is the risk to patient care continuity.

Data backup remains essential. Today, however, rapid restore is equally important to defend recover from ransomware other malicious attacks.

Martin Littmann, senior director, chief technology officer chief information security officer at Houston-based Kelsey-Seybold Clinic, has more than 30 years of experience in healthcare IT. He knows firsthwhat’s needed to successfully defend recover. 

After it experienced a ransomware incident, the clinic shifted its security strategy, creating an environment of immutable data snapshots backups. Healthcare IT News interviewed Littman, who shared his expertise on the matter.

Q. Please talk about the ransomware incident you experienced. When did it happen? How did the hackers take control? What was affected? And how did you resolve it?

A. It may surprise folks to know that ransomware has been around a long time – with the first documented incident occurring in 1989. Based on one article I read, there were quite a few variants in existence by 2015, which was the same year we experienced our incident.

Two employees working in the same department visited a day care site to look at their services during lunchtime. That site was built on WordPress was not kept current. The malware they received as a drive-by download was a zero-day variant of Crypto Locker. Our FireEye appliance notified us of the malware at the same time as users calling to report they were unable to access certain files on a network share.

We were able to quickly identify the two infected machines. One was a physical PC, one was a virtual desktop. The virtual desktop was rebooted to a clean image the physical machine was taken off the network re-imaged. The systems storage team was able to quickly identify the extent of the impact: hundreds of thousands of encrypted files across two department shares.

After several discussions with the executives over the area impacted, we decided to work through the day perform remediation that evening. We first restored affected files from snap backups so users could continue their business processes. At the end of the day, we restored the entire file shares followed by backups of the files revised throughout the business day.

Q. What are a couple lessons you learned from that ransomware incident?

A. The event highlighted the need for the information security team to be vigilant in reviewing responding to alerts from our security solutions. It also illuminated the value of the information security, network systems teams working in harmony, underscored the reality that security is everyone’s business. 

In subsequent years, this event was used to highlight the need for richer more frequent user education, as well as bolstering continually improving our security systems tools.

Too often, security teams are flooded with alerts from various tools systems. Without an effective tool or process or increased “eyes on glass,” there is a risk of missing critical alerts. We ultimately upgraded our SIEM approach by employing a data lake-based tool with significantly improved AI analytic capabilities.

We also were able to increase the number of infrastructure, network security systems feeding the SIEM. With this tool, we were able to fine-tune alerts to ensure critical alerts were not missed, lower false positives. We then further improved our process by the addition of a SOAR (security orchestration, automation response) to ensure the security team could triage respond to alerts we had a record of that accountability. 

Additionally, we invested time evaluating open shares over-provisioned user access to limit exposure in any actual malware event.

We have stepped up our user education program. On the one hand, this includes periodic phishing testing. We also leverage current security privacy news items about breaches healthcare fines to remind executives leaders of the need for the organization to be educated vigilant. 

Monthly, we also send out an information security tips newsletter discussing current types of attacks remediations precautions we can take as a business as individuals.

Q. You implemented immutable snapshots backups across Kelsey-Seybold. What is this technology, how does it work to protect your systems data?

A. We have a blended mix of storage technologies a solid data protection solution we have leveraged upgraded since 2007. This strategy was developed based on this solution set before most storage vendors had delivered or matured immutable backup approaches. Our backup strategy was developed before immutable snapshots were available in any storage products we used.

We developed a layered approach that relies on primary, backup archive backups on separate fault domains, as well as local snapshot copies. Each of these relies on separate administrator-level accounts on separate storage systems. The result of this strategy actually creates five copies of our critical EHR database across three different vendor platforms.

The production ODB (open database connectivity) volumes are housed on a purpose-built Pure Storage FlashArray //x50. This is the initial live dataset. The primary volumes are mapped to active/passive frames that are kept in configuration lockstep via Pure Storage HostGroups. This ensures consistent volume mappings during a compute host frame failover.

The database is array snapped four times a day using a snapshot process that leverages a freeze/snap/thaw script workflow that was developed in collaboration with Pure Storage engineers in-house teams. A second copy is replicated to a secondary FlashArray.

The arrays are linked via FlashArray Async-Replication over redundant 10G links with replication schedules controlled through protection groups. Copies three four are sent to another backup proxy to tape. The fifth copy of the database is application-mirrored to a disaster recovery instance. The DR instance lives on separate compute hardware a separate tertiary FlashArray.

In our future implementations evolution, we will look at adding in native storage data protection solutions, such as the immutable capabilities now in the market.

Q. What are the data center business continuity security considerations you have, what are you doing about them?

A. For many years, our executive leadership was content with the level of performance, availability reliability of our systems infrastructure delivered through our top tier network high availability data center.

But as our business continued to grow with significant future growth projections, we all came to the realization that a single data center represents a business risk that should be mitigated regardless of how redundant resilient any implementation may be. This realization led to approval of establishing a second backup/recovery data center.

In today’s environment, this decision also required an evaluation of a cloud-based approach to backup recovery. We studied the technical aspects of cloud-based infrastructure application solutions on the market how these fit with our current premise-based solutions hybrid cloud application solutions.

A significant consideration was conversion from premise-hosted virtual desktops, as well as key clinical applications. In the final analysis, we determined the technical limitations opportunities are not quite there for our needs to move to a full cloud implementation. 

Rather, we decided to continue with our current hybrid model: premise-based compute storage for critical applications department/user file shares, combined with cloud-based email collaboration in Office 365.

We will continue to develop Power Apps, leverage Azure migrate some data backup/archive to S3 instances. Our cloud utilization will continue to grow as more applications mature to include cloud components or shift entirely to cloud architectures. 

Eventually this shift will include moving to desktop-as-a-service, that shift will drastically affect the premise footprint of storage compute.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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