Thursday , January 28 2021

SingHealth IOC: separation of Internet browsing is an "additional burden" for healthcare professionals, says the MOH counselor

SINGAPORE: Challenges in providing patient care are among the problems that arose due to the temporary Internet Surfing Separation (ISS) applied to the public healthcare clusters following the cyber attack in SingHealth, the chief information adviser of the Ministry of Health ( MOH), James Yip, in a research commission (IOC) on Monday (November 12).

The interim security measure also reduced operating efficiency by introducing other possible cyber security risks, he said.

Introducing a report to the IOC with information from SingHealth, the National Health System of the University (NUHS) and the National Health Group (NHG), Dr. Yip added that health professionals "accepted the burden and the additional challenges" that access The Internet is delinquished, but stressed that the ISS "may not be sustainable in the long run."

"In the immediate sequence of cyber attacks in SingHealth, public health personnel accepted the additional burden and challenges that the temporary ISS imposes. Patients also accepted delivery standards for poorer services, delays and inconveniences, in some cases at the moment," said the Dr. Yip.

"The operational challenges … will inevitably translate labor and tangible financial costs, and will reduce the satisfaction of the employees and the patient. In short, the health costs for the general public of Singapore will rise."

He added that the task of finding enough health workers for the future will become "even more challenging," given the limitations of Singapore's workforce.

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Cyber ​​attacks in the SingHealth database in July is the most serious violation of public data in Singapore to date. In total, personal non-medical data of 1.5 million patients were stolen, while 160,000 had prescribed medication records.

Among those affected, it was Prime Minister Lee Hsien Loong, with the attackers directed to their personal information and information about their medications.

Database administrators of the Integrated Health Information Systems (IHiS) discovered the infraction on July 4. Since the month of September, a IOC has held public hearings to investigate what happened during data breach.

The temporary ISS was implemented on SingHealth on July 19, before it was extended to NUHS and NHG three days later.

This was to "strengthen (its) IT system against the evolution of cybernetic security threats, and most importantly, to protect the confidentiality of the data of our patients," said the MOH in a press release.


However, this has caused "difficulties on the ground," said Dr. Yip, who is also the head of the NUHS medical informatics group.

"The implementation of the temporary ISS has had a significant impact on the public healthcare sector," he said, adding that it affects access to key information sources and prevents communication between doctors and other health personnel.

Citing the example of the TigerConnect2 desktop, a safe application that allows healthcare professionals to communicate with their colleagues when they need to seek advice or guidance for treatment, Dr. Yip said that some had to resort to their personal cell phones.

"In some polyclinics, the use of TigerConnect has been incorporated into its workflow," he added. "As a result of the temporary ISS, TigerConnect can not be used on corporate work devices."

I see that doctors constantly use their own devices could also go to patients and "hate to see" a doctor "making music" with phones, Dr. Yip added.


Dr. Yip also said that the implementation of the temporary ISS resulted in "significant operational inefficiencies."

On the one hand, the administrative tasks were affected by the ISS, Dr Yip said, since front line staff now have to use a separate device for the Internet to verify and retrieve patient information.

This led initially to prolong waiting times for patients, since these devices are shared, he said. The staff also had to work overtime to complete tasks in some public health institutions, since the management of multiple devices and the sharing of these devices between the staff also increase the time needed to perform tasks.

Although these problems were "largely resolved", public health institutions spent a "significant amount of resources" to acquire more advanced devices and tools with Internet, such as Internet dongles to facilitate these administrative processes and reduce the time needed to complete these Tasks, said Dr. Yip.

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Some hospitals also had to suspend their policies of not allowing staff to use their personal cell phones while in service, so staff can use their personal cell phones to perform their work, he added.

As such, the use of separate internet devices could lead to new risks and vulnerabilities to cyber security, Dr. Yip added.

"As the devices enabled for the Internet are not in the corporate network, they need to be patched manually," he explained. "However, the manual patch will probably lead to delays in the updates and may pose the risk that these devices with Internet are compromised with malware and other viruses, which could be transmitted to corporate devices when the information is transferred between them."


Earlier in the day, the IOC also heard of the former director of the National Security Agency of the U.S. UU. Keith Alexander, who emphasized the importance of a "collective" effort in the battle against cyber attacks.

"I think the critical infrastructure and government agencies should work together, and the government must be involved in security, especially against persistent advanced threats," said Alexander, who is now the executive director of IronNet Cybersecurity.

Mr. Alexander emphasized the importance of having a system with an "analytical ability of behavior", which would mark suspicious activities.

This system would be able to detect unauthorized activities, such as an individual who accesses an unusually large number of data volumes such as patient records, explained Mr. Alexander.

"Behavioral analysis makes collective defense possible," said Mr. Alexander. "An effective and proven behavioral analytical capacity produces a large number of events that can be shared in a collective defense strategy at the speed of the network."

The hearings will continue on Tuesday.

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