Software that is intended to damage or disable the computer is then downloaded to the user’s computer, and it quickly encrypts all of the data on that machine and possibly reaches out over the network to encrypt data on other machines as well, thus rendering all data inaccessible. While specific details of how ransomware attacks begin are not well known, they often start when a user is tricked into clicking a link or opening an attachment of a malicious email message. In the absence of a centralized learning system for these events, it is not possible to decipher specific details of what happened, how it was initiated, who was responsible, and how it was resolved. Reports of these events are generally leaked to the news media only after hospital operations are compromised for an extended period of time. Most of these organizations either a) fended off the attacks through intelligent use of network and user activity surveillance systems, b) were able to restore their critical systems from backups, or c) quietly paid the ransom. Furthermore, a recent survey of 61 chief information officers, chief information security officers, and other IT director-level respondents conducted by HIMSS Analytics (Chicago, IL) found that more than half of them had been targets of ransomware attacks in the previous 12 months. Recently there have been several high-profile ransomware attacks involving hospitals. Rapid adoption of electronic health records (EHRs) has fundamentally changed the way health care organizations and clinicians care for patients, manage the hospital, account for health care quality, and bill for their services. Similar to approaches to address other complex socio-technical health IT challenges, the responsibility of preventing, mitigating, and recovering from these attacks is shared between health IT professionals and end-users. We also elaborate on recommendations from other authoritative sources, including the National Institute of Standards and Technology (NIST). Finally, organizations need to respond adequately to and recover quickly from ransomware attacks and take actions to prevent them in future. Concomitantly, the organization needs to monitor computer and application use continuously in an effort to detect suspicious activities and identify and address security problems before they cause harm. Next, the health care organizations need to ensure more reliable system defense by implementing user-focused strategies, including simulation and training on correct and complete use of computers and network applications. First, health IT professionals need to ensure adequate system protection by correctly installing and configuring computers and networks that connect them. In this manuscript, we discuss a socio-technical approach to address ransomware and outline four overarching steps that organizations can undertake to secure an electronic health record (EHR) system and the underlying computing infrastructure. Once the attack has been launched, users have three options: 1) try to restore their data from backup 2) pay the ransom or 3) lose their data. Ransomware is intended to damage or disable a user’s computer unless the user makes a payment. Recently there have been several high-profile ransomware attacks involving hospitals around the world.
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