Secure Network Proposal for San Antonio MD

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Secure Network ProposalforSan Antonio MD

• By
• DT Consulting

Created by Antonio Gonzales (Tony) Duangkamol
Phuengpanyalert (Dee)
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• Organizational Overview

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Organizational Overview

• Locally owned medical group
• Specializes in healthcare billing and information
  storage
• SAMD currently employs over 30 individuals
• (3 IT workers)

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Organizational Overview
Business Process

• Patient visits doctor, fills out appropriate
  insurance and Legal documentation.
• Paperwork is sent via runner to SAMDs office
• Documentation is inputted into the system using
  SAMDs Medical Manager and stored in file room.
• Insurance data is sent in batches to the
  appropriate insurance carrier throughout the
  business day

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Organizational Overview
Stakeholders

• Patients
• - Integrity and confidentiality of data
• - Availability of information
• Doctors
• - Reputation
• - Legal liability
• - Livelihood
• Insurance Companies
• - Accurate data reporting

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• Current Network Design

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Current Network Design
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Threats and Vulnerabilities
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Current Physical Design
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Physical -Threats and Vulnerabilities

• Fire
• - No sufficient fire suppression system
• - Potential for loss from fire.
• Theft
• - Loss or theft of patient medical information

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Network -Threats and Vulnerabilities

• Single point of failure
• - Multiple SPF points
• Espionage
• - No methods in place to help protect the
  medical data or business data from corporate
  spies
• Man in the Middle Attacks
• - No methods in place for protecting patient
  information from being intercepted by
  outsiders.
• Viruses, Worms, Trojans
• Lack of sufficient Policies
• - No internal methods of control

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Disaster Recovery

• Need to mediate effects of loss of service
• - Business needs
• - Multiple lines of communication
• - Back-up hardware

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Legal Considerations
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Legal Considerations

• HIPAA
• (Health Insurance Portability and Accountability
  Act)

• Electronic Transactions and Code Sets
• Unique Identifiers
• Privacy
• Security

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HIPAA Electronic Transactions and Code Sets and
Unique Identifier Standards

• Electronic Transactions and Code Sets
• Standard for transactions and data elements
• Help processing claims and other transactions
  electronically easier.

Unique Identifier Standards Standard for a
unique ID for health care providers to identify
themselves in all standard transactions
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HIPAA Privacy Standards

• Providing patients with access to
• their medical records
• giving patients the right to obtain a copy
• of their own health records
• enabling patients to find out how their
• information may be used and
• what disclosures of their information
• have been made

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HIPAA Security Standards

• Specifying safeguards to ensure the
• Confidentiality, Integrity, and Availability
• of health information collected, maintained,
• and transmitted.
• Three Categories
• 1. Administrative procedures 2. Physical
  safeguards
• 3. Technical safeguards

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HIPAA Security Standards

• Administrative Procedures
• Security management processes
• Contingency plan
• Physical Safeguards
• Facility access control standards
• Workstation security standards
• Technical Safeguards
• Access control standards
• Integrity standards

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Legal Considerations

• Confused Yet?

• Essentially, in order to be in compliance with
  HIPAA SAMD must
• Train the employees on the transaction code sets
  and unique identifier
• Set-up policy and procedures which handle the
  transmission and handling of patient data
• Put in place mechanisms to protect the integrity,
  confidentiality, and availability of patient data

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• Proposed Design

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Proposed Physical Design
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Proposed Physical Design

• Relocate the recent files into the secured file
  room
• Add a token controlled lock on the file room and
  server room
• Assign designated employees to control access to
  the sensitive data
• Use Argonite in the server room, file room, and
  conference room

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Current Network Design
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Proposed Network Design

• Basic ACLs
• Harden stateful
• firewall
• Internal router
• with integrated
• NIDS
• Mail servers
• Anti-virus server
• Mirrored back-up database (MD5)
• PGP
• VPN solution

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Design Considerations

• Basic ACL
• Ingress/egress filtering to narrow the field of
  attack for the firewall
• RFC1918 addressing
• RFC 2827 filtering
• Blocking non-VPN traffic to the IPsec VPN gateway

• Harden Stateful Firewall
• Change the default setting
• Log unauthorized access attempts
• Built-in TCP SYN flood protection
• Audit point at L3-L7

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Design Considerations

• Internal router w/integrated NIDS
• Determine the datas path
• Detect abnormal and suspect traffic
• Stop attacks like TCP SYN flood, virus, worm, and
  Trojan horse

• VPN Solution
• Remote User VPN
• 3DES, Pre-shared key, and OTP
• IPsec gateway with integrated stateful firewall
• Split tunneling
• Host anti-virus, patches, and personal firewall

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Design Considerations

• Mail Servers
• Separate external from Internal Mail Servers
• Both are placed in the trusted network
• Internal Mail Server with anti-virus protection

• Anti-virus Server
• Automatically monitor, manage, and update the
  up-to-date library to all hosts on a regular
  basis

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Design Considerations

• Database Servers
• Replication of the mirrored back-up database
• File system integrity checking
• Both are placed in the trusted network with
  strong user-id and passwords
• Load bearing device if needed

• PGP
• Encrypt and digitally sign email messages between
  SAMDs customers and employees

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Attack Mitigation Considerations

• Single Point of Failure Mediation
• The Mirror back-up database with MD5
• The un-plugged network router
• Virus, Worm, and Trojan horse
• Anti-virus server
• The firewall (defense in depth)
• The personal firewall at the remote users PC
• Man In The Middle
• VPN
• Secure email by PGP

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Politische Richtlinien

• Politiques

POLICIES
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Politiche
Políticas
Beleid
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Policies

• Acceptable Use Policy
• - Outlines the acceptable use of computer
  equipment at SAMD..
• Confidentiality Policy
• - Intended to first help employees determine
  what information can be disclosed to
  non-employees, as well as the relative
  sensitivity of information that should not be
  disclosed outside of SAMD without proper
  authorization.
• - Establishes SAMDs Conflict of Interest
  policy.
• Medical Data Acquisition Request Form
• - New (Low-tech) method of data tracking.

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Policies

• User Account Policy
• - Provide an outline for the technology techs to
  follow when adding a new user to the system,
  maintaining exiting users, and the proper
  procedure for dealing with expired accounts.
• VPN Policy
• - Provide guidelines for Remote Access SAMD-TG
  or L2TP Virtual Private Network (VPN) connections
  to the SAMD corporate network.
• Password Policy
• - Establishes a standard for creation of strong
  passwords, the protection of those passwords, and
  the frequency of change.

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Migration Strategies

• Step1. Start with the data center
• Adding the mirror back-up database
• Hardening the OS
• Setting up the regular tasks, converting the data
  file to a hash version, and testing the back-up
  file
• Installing the anti-virus software

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Migration Strategies

• Step2. Protect the edge network
• Adding the basic ACL
• Hardening the stateful firewall
• Moving the Web Server and installing the
  anti-virus software
• Adding the External Mail Server

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Migration Strategies

• Step3. Internal Network
• Setting up the Internal Mail Server
• Implementing the PGP software
• Setting up the Anti-virus Server
• Changing and hardening the internal router
• Educating users

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Migration Strategies

• Step4. Setting up VPN tunnel
• Setting up the IPsec gateway
• Setting up clients PC
• Testing the connection

• Step5.
• Transfer knowledge to SAMDs IT staff to maintain
  their network

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Questions

• In SAMDs proposed network design, a router with
  basic ACL's was placed before a stateful
  filtering firewall. Why was this done?

Hardware Placement - The strategic placement of
hardware within a network design in an effort to
maximize effectiveness, efficiency, and security.
2. What are the primary HIPAA requirements in
regards to network security?
Ensure the CIA of the medical data through
Technical safeguards.