Journal:Health care and cybersecurity: Bibliometric analysis of the literature

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Full article title Health care and cybersecurity: Bibliometric analysis of the literature
Journal Journal of Medical Internet Research
Author(s) Jalali, Mohammad S.; Razak, Sabina; Gordon, William; Perakslis, Eric; Madnick, Stuart
Author affiliation(s) Harvard Medical School, Massachusetts Institute of Technology, Brigham & Women’s Hospital, Partners Healthcare,
Primary contact Email: msjalali at mgh dot harvard dot edu
Year published 2019
Volume and issue 21(2)
Article # e12644
DOI 10.2196/12644
ISSN 1438-8871
Distribution license Creative Commons Attribution 4.0 International
Website https://www.jmir.org/2019/2/e12644/
Download https://www.jmir.org/2019/2/e12644/pdf (PDF)
Emblem-important-yellow.svg This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed.

Abstract

Background: Over the past decade, clinical care has become globally dependent on information technology. The cybersecurity of health care information systems is now an essential component of safe, reliable, and effective health care delivery.

Objective: The objective of this study was to provide an overview of the literature at the intersection of cybersecurity and health care delivery.

Methods: A comprehensive search was conducted using PubMed and Web of Science for English-language peer-reviewed articles. We carried out chronological analysis, domain clustering analysis, and text analysis of the included articles to generate a high-level concept map composed of specific words and the connections between them.

Results: Our final sample included 472 English-language journal articles. Our review results revealed that a majority of the articles were focused on technology. Technology–focused articles made up more than half of all the clusters, whereas managerial articles accounted for only 32 percent of all clusters. This finding suggests that nontechnological variables (human–based and organizational aspects, strategy, and management) may be understudied. In addition, software development security, business continuity, and disaster recovery planning each accounted for three percent of the studied articles. Our results also showed that publications on physical security account for only one percent of the literature, and research in this area is lacking. Cyber vulnerabilities are not all digital; many physical threats contribute to breaches and potentially affect the physical safety of patients.

Conclusions: Our results revealed an overall increase in research on cybersecurity and identified major gaps and opportunities for future work.

Keywords: bibliometric review, cybersecurity, health care, literature analysis, text mining

Introduction

Cybersecurity is an increasingly critical aspect of health care information technology infrastructure. The rapid digitization of health care delivery, from electronic health records (EHR) and telehealth to mobile health (mHealth) and network-enabled medical devices, introduces risks related to cybersecurity vulnerabilities.[1] These vulnerabilities are particularly worrisome because cyberattacks in a health care setting can result in the exposure of highly sensitive personal information or cause disruptions in clinical care.[2][3][4][5] Cyberattacks may also affect the safety of patients, for example, by compromising the integrity of data or impairing medical device functionality. The WannaCry and NotPetya ransomware attacks and vulnerabilities in Medtronic Implantable Cardiac Device Programmers are recent examples that have resulted in impaired health care delivery capabilities.[6]

Health care organizations are particularly vulnerable to cyber threats. Verizon’s 2018 Data Breach Investigations Report found that the health care field, in general, was most affected by data breaches, which accounted for 24 percent of all investigated breaches across all industries.[7] Additionally, a report by the Ponemon Institute found that almost 90 percent of respondents (involved in health plans and health care clearinghouses, as well as health care providers with EHRs) experienced a data breach in the past two years.[8] Another survey of health care information security professionals revealed that over 75 percent of health care organizations experienced a recent security incident.[9] The causes are multifactorial, involving both technology and people, and human error and cultural factors play increasingly critical roles.[10][11] Despite efforts to teach best-practice security behavior through training programs, recent surveys have revealed that one in five health care employees still write down their usernames and passwords on paper.[12]



References

  1. ↑ Jalali, M.S.; Kaiser, J.P. (2018). "Cybersecurity in Hospitals: A Systematic, Organizational Perspective". Journal of Medical Internet Research 20 (5): e10059. doi:10.2196/10059. PMC PMC5996174. PMID 29807882. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996174. 
  2. ↑ Gordon, W.J.; Fairhall, A.; Landman, A. (2017). "Threats to Information Security - Public Health Implications". New England Journal of Medicine 377 (8): 707–9. doi:10.1056/NEJMp1707212. PMID 28700269. 
  3. ↑ Perakslis, E.D. (2014). "Cybersecurity in health care". New England Journal of Medicine 371 (5): 395–7. doi:10.1056/NEJMp1404358. PMID 25075831. 
  4. ↑ Jarrett, M.P. (2017). "Cybersecurity-A Serious Patient Care Concern". JAMA 318 (14): 1319–20. doi:10.1001/jama.2017.11986. PMID 28973258. 
  5. ↑ Kramer, D.B.; Fu, K. (2017). "Cybersecurity Concerns and Medical Devices: Lessons From a Pacemaker Advisory". JAMA 318 (21): 2077–78. doi:10.1001/jama.2017.15692. PMID 29049709. 
  6. ↑ Furnell, S.; Emm, D. (2017). "The ABC of ransomware protection". Computer Fraud & Security 2017 (10): 5–11. doi:10.1016/S1361-3723(17)30089-1. 
  7. ↑ Verizon (2018). "2018 Data Breach Investigations Report" (PDF). Verizon. https://enterprise.verizon.com/resources/reports/DBIR_2018_Report.pdf. Retrieved 01 September 2018. 
  8. ↑ Ponemon Institute, LLC (May 2016). "Sixth Annual Benchmark Study on Privacy & Security of Healthcare Data" (PDF). Ponemon Institute, LLC. https://www.ponemon.org/local/upload/file/Sixth%20Annual%20Patient%20Privacy%20%26%20Data%20Security%20Report%20FINAL%206.pdf. Retrieved 09 April 2018. 
  9. ↑ Healthcare Information and Management Systems Society (2018). "2018 HIMSS Cybersecurity Survey" (PDF). Healthcare Information and Management Systems Society. https://www.himss.org/sites/hde/files/d7/u132196/2018_HIMSS_Cybersecurity_Survey_Final_Report.pdf. Retrieved 30 July 2020. 
  10. ↑ Madnick, S.; Jalali, M.S.; Siegel, M. et al. (2017). "Measuring Stakeholders’ Perceptions of Cybersecurity for Renewable Energy Systems". Proceedings from DARE 2016: Data Analytics for Renewable Energy Integration. Lecture Notes in Computer Science 10097: 67–77. doi:10.1007/978-3-319-50947-1_7. 
  11. ↑ Jalali, M.S.; Siegel, M.; Madnick, S. (2019). "Decision-making and biases in cybersecurity capability development: Evidence from a simulation game experiment". The Journal of Strategic Information Systems 28 (1): 66–82. doi:10.1016/j.jsis.2018.09.003. 
  12. ↑ "One in Five Health Employees Willing to Sell Confidential Data to Unauthorized Parties, Accenture Survey Finds". Accenture. 1 March 2018. https://newsroom.accenture.com/news/one-in-five-health-employees-willing-to-sell-confidential-data-to-unauthorized-parties-accenture-survey-finds.htm. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation, grammar, and punctuation. In some cases important information was missing from the references, and that information was added. The original cited an Accenture YouTube video for the claim regarding users writing their credentials down; for this version a more informative press release, which links to the video, was used.

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