Cybersecurity in health – disentangling value tensions

Vulnerability to Cyberattacks and Sociotechnical Solutions for Health Care Systems: Systematic Review

BACKGROUND

Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy.

OBJECTIVE

From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR).

METHODS

An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal (Management Information Systems Quarterly) for articles published between 2012 and 2022 and indexed using the following keywords: "(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare)." Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review.

RESULTS

In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent.

CONCLUSIONS

This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner.

Digital Transformation and Cybersecurity Challenges for Businesses Resilience: Issues and Recommendations

This systematic literature review explores the digital transformation (DT) and cybersecurity implications for achieving business resilience. DT involves transitioning organizational processes to IT solutions, which can result in significant changes across various aspects of an organization. However, emerging technologies such as artificial intelligence, big data and analytics, blockchain, and cloud computing drive digital transformation worldwide while increasing cybersecurity risks for businesses undergoing this process. This literature survey article highlights the importance of comprehensive knowledge of cybersecurity threats during DT implementation to prevent interruptions due to malicious activities or unauthorized access by attackers aiming at sensitive information alteration, destruction, or extortion from users. Cybersecurity is essential to DT as it protects digital assets from cyber threats. We conducted a systematic literature review using the PRISMA methodology in this research. Our literature review found that DT has increased efficiency and productivity but poses new challenges related to cybersecurity risks, such as data breaches and cyber-attacks. We conclude by discussing future vulnerabilities associated with DT implementation and provide recommendations on how organizations can mitigate these risks through effective cybersecurity measures. The paper recommends a staged cybersecurity readiness framework for business organizations to be prepared to pursue digital transformation.

People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design

The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.

Cyberattacks as “state of exception” reconceptualizing cybersecurity from prevention to surviving and accommodating

Purpose

This paper aims to outline how destructive communication exemplified by ransomware cyberattacks destroys the process of organization, causes a “state of exception,” and thus constitutes organization. The authors build on Agamben's state of exception and translate it into communicative constitution of organization (CCO) theory.

Design/methodology/approach

A significant increase of cyberattacks have impacted organizations in recent times and laid organizations under siege. This conceptual research builds on illustrative cases chosen by positive deviance case selection (PDCS) of ransomware attacks.

Findings

CCO theory focuses mainly on ordering characteristics of communication. The authors aim to complement this view with a perspective on destructive communication that destroys the process of organization. Based on illustrative cases, the authors conceptualize a process model of destructive CCO.

Practical implications

The authors expand thoughts about a digital “corporate immune system” to question current offensive cybersecurity strategies of deterrence and promote resilience approaches instead.

Originality/value

Informed by destructive communication of cyberattacks, this theory advancement supports arguments to include notions of disorder into CCO theory. Furthermore, the paper explains where disruptions like cyberattacks may trigger sensemaking and change to preserve stability. Finally, a novel definition of ‘destructive CCO’ is provided: Destructive Communication Constitutes Organization by disrupting and destroying its site and surface while triggering sensemaking and becoming part of sensemaking itself.

Leveraging human factors in cybersecurity: an integrated methodological approach

Computer and Information Security (CIS) is usually approached adopting a technology-centric viewpoint, where the human components of sociotechnical systems are generally considered as their weakest part, with little consideration for the end users' cognitive characteristics, needs and motivations. This paper presents a holistic/Human Factors (HF) approach, where the individual, organisational and technological factors are investigated in pilot healthcare organisations to show how HF vulnerabilities may impact on cybersecurity risks. An overview of current challenges in relation to cybersecurity is first provided, followed by the presentation of an integrated top-down and bottom-up methodology using qualitative and quantitative research methods to assess the level of maturity of the pilot organisations with respect to their capability to face and tackle cyber threats and attacks. This approach adopts a user-centred perspective, involving both the organisations' management and employees, The results show that a better cyber-security culture does not always correspond with more rule compliant behaviour. In addition, conflicts among cybersecurity rules and procedures may trigger human vulnerabilities. In conclusion, the integration of traditional technical solutions with guidelines to enhance CIS systems by leveraging HF in cybersecurity may lead to the adoption of non-technical countermeasures (such as user awareness) for a comprehensive and holistic way to manage cyber security in organisations.

Ethical Value-Centric Cybersecurity: A Methodology Based on a Value Graph

Our society is being shaped in a non-negligible way by the technological advances of recent years, especially in information and communications technologies (ICTs). The pervasiveness and democratization of ICTs have allowed people from all backgrounds to access and use them, which has resulted in new information-based assets. At the same time, this phenomenon has brought a new class of problems, in the form of activists, criminals and state actors that target the new assets to achieve their goals, legitimate or not. Cybersecurity includes the research, tools and techniques to protect information assets. However, some cybersecurity measures may clash with the ethical values of citizens. We analyze the synergies and tensions between some of these values, namely security, privacy, fairness and autonomy. From this analysis, we derive a value graph, and then we set out to identify those paths in the graph that lead to satisfying all four aforementioned values in the cybersecurity setting, by taking advantage of their synergies and avoiding their tensions. We illustrate our conceptual discussion with examples of enabling technologies. We also sketch how our methodology can be generalized to any setting where several potentially conflicting values have to be satisfied.