Uniting New Mexico: Health Information Interoperability in the Service of all New Mexicans

New Mexico Health Information Collaborative (NMHIC)
Presents its Third Annual HIE Users’ Conference

Uniting New Mexico

Health Information Interoperability in the Service of all New Mexicans

Why You Should Attend

NMHIC presents its third annual conference to advance the cause of healthcare information exchange in New Mexico by helping participants create a shared vision, examine the current state of interoperability and factors hindering it, build consensus on standards, and formulate strategies for overcoming barriers to information exchange.

The New Mexico Health Information Collaborative (NMHIC), your statewide health information exchange, invites you to attend our third annual HIE Users’ Conference to participate in meaningful presentations and thoughtful discussions about the benefits, challenges, and solutions for interoperability and exchange of health information in New Mexico and surrounding communities.

Keynote Presenter – Laura Adams, President and Chief Executive Officer
Rhode Island Quality Institute

Ms. Adams will present a National Update on Health Information Exchange to set the stage for a highly-interactive day of thoughtful presentations, discussion, and problem-solving around interoperability in New Mexico.

David S. Nilasena, MD, MSPH, MS, Chief Medical Officer for U.S. Centers for Medicare & Medicaid Services (CMS), Dallas Regional Office, will present on CMS’s proposed plan to Promote Interoperability (P.I.).

“Even though we may work for different organizations with different internal priorities and hold different perspectives, I believe we all share the common goal of and responsibility for improving the health of our patients and communities – and, frankly, working together to achieve that goal has never been more important for all of us than it is today.”
– Timothy Washburn RN, BSN, MBAHM, Memorial Medical Center, 2018 Conference Chair

Who Should Attend

Join your colleagues from the healthcare community, including:

  • Physicians and mid-level providers in any size of type of practice
  • Staff, e.g., nurses, medical assistants, case managers, and others
  • Inpatient, outpatient, and emergency personnel
  • Payers, insurers, and self-insured employers
  • Quality assurance administrators
  • Office and practice managers
  • Health IT professionals
  • Public health professionals

Continuing Medical Education

This activity has been planned and implemented in accordance with the Essential Areas and polices of the New Mexico Medical Society (NMMS) through the joint sponsorship of HealthInsight New Mexico and LCF Research/NMHIC. HealthInsight New Mexico is accredited by the NMMS to provide Continuing Medical Education for physicians.

Register now

For more details, click here.

Aligned Risk Management will be there! You should, too.

Los Alamos Public Schools superintendent Dr. Kurt Steinhaus phished

Dr. Kurt Steinhaus, Superintendent of Los Alamos Public Schools

Phishing attacks occur when an attacker pretends to be a trusted entity, fooling you into opening a malicious email or message

Back in September, Facebook revealed that as many as 50 million accounts may have been hacked, due to a “security issue.”

Dr. Kurt Steinhaus’s Facebook was compromised, likely caused by the bigger data breach that Facebook reported in late September, 2018

Attackers exploited a vulnerability in Facebook’s code that impacted the “View As” feature that lets people see what their own profile looks like to someone else.

According to Guy Rosen, Facebook’s VP of Product Management: “This allowed them to steal Facebook access tokens which they could then use to take over people’s accounts.

“Access tokens are the equivalent of digital keys that keep people logged in to Facebook so they don’t need to re-enter their password every time they use the app.”

While the issue has now been resolved, the problems may not end there, according to one expert; we may now also see a string of phishing attacks.

Phishing attacks occur when an attacker pretends to be a trusted entity, fooling you into opening a malicious email or message.

Oz Alashe, CEO of cyber security platform CybSafe, said: “Facebook is going by the book notifying authorities as soon as it detected this vulnerability, and it should be applauded for its quick action.

“However, with a security issue as high profile as this one, it’s likely that phishing attacks will swiftly follow urging recipients to change their Facebook passwords via an email and then directing them to a malicious phishing site.

“It’s important to be extra vigilant, to follow Facebook’s instructions on the site or app, but do not act on unsolicited emails unless you are able to verify the sender.”

This latest breach of personally identifiable information (PII) hit home recently when Dr. Kurt Steinhaus, Superintendent of Los Alamos Public Schools, was revealed to have been targeted in a phishing scam, likely made possible as a result of the larger breach.

Dr. Steinhaus’s compromised social media account is just one example that goes to show that no-one is totally invulnerable. Medical records and protected health information (PHI) are exceptionally high value targets.

Aligned Risk Management suggests an immediate change of your Facebook password, as well as enabling two-factor authentication on Facebook and any other social media platforms where 2FA is available.

Additionally, check out this neat tool to find out if accounts associated with any given email were compromised in any other major breaches in recent memory: Have I Been Pwned.

KRQE: Hundreds of private medical documents scattered on Albuquerque street

By Brittany Bade.

ALBUQUERQUE, N.M. (KRQE) – At first glance, it just looked like a lot of litter lining the street, but when concerned citizens stopped to look, they realized these discarded papers hold information no one would want out in the open.

“I’m floored. I don’t even know yet how I feel,” said a patient named Renee.

Renee is one of dozens of patients who had their personal medical information scattered along Avenida Cesar Chavez at I-25.

“It’s personal information. I had to sign a HIPAA form to protect my privacy,” said Renee.

On these documents, are patients private medical histories, social security numbers and billing information.

“That’s a HIPPA violation right there,” said a woman who stopped to help pick up the papers.

The records are all from the Turquoise Lodge Hospital, a state-run rehabilitation center specializing in treating pregnant women and parents trying to get clean.

The New Mexico Department of Health refused an interview with KRQE News 13, agreeing only to send this statement:

“We take the security and privacy of patient health information very seriously. Turquoise Lodge was in the process of transporting patient records yesterday from the hospital to a secure facility. As soon as we were made aware of the misplaced records, we sent a team out to recover as many documents as possible. We have immediately launched an investigation and will follow all requirements under patient privacy laws to further protect the privacy of all patients and their health information.”

When asked if the department will contact patients to let them know if their personal information has been compromised, they said they would.

Concerned people who say they saw the papers fly out of a truck stopped to pick up the mess. The Department of Health says they also sent a crew out Friday to pick up the remainder of the papers.

Still, patients, like Renee, are concerned someone with bad intentions was also out there picking up the pieces filled with their personal information. The documents were out on the streets for at least 12 hours.

“Hundreds of private medical documents scattered on Albuquerque street”. KRQE, United States. Retrieved October 16, 2018.

Apple denies server compromise through Chinese hardware hack

Apple has come out swinging at last week’s Bloomberg spy chip report today with a new letter to some of the biggest tech watchdogs in Congress, flatly denying that any of the company’s servers were compromised through the use of microchips implanted by Chinese spies. The entirety of the letter from Apple:

Dear Chairmen and Ranking Members:

In light of your important leadership roles in Congress, we want to assure you that a recent report in Bloomberg Businessweek alleging the compromise of our servers is not true. You should know that Bloomberg provided us with no evidence to substantiate their claims and our internal investigations concluded their claims were simply wrong.

We are eager to share the facts in this matter because, were this story true, it would rightly raise grave concerns. A compromise of this magnitude, and the effective deployment of malicious chips like the one described by Bloomberg, would represent a serious threat to the security of systems at Apple and elsewhere. That’s why, ever since we were first contacted by Bloomberg’s reporters in October 2017, we have worked diligently to get to the bottom of their allegations.

While the story was being reported, we spoke with Bloomberg’s reporters and editors and answered any and all of their questions. We methodically dispelled the often-shifting nature of their claims. While we repeatedly asked them to share specific details about the alleged malicious chips that they seemed certain existed, they were unwilling or unable to provide anything more than vague secondhand accounts.

We were struck by the fact that the gravity and magnitude of the claims seemed to be undermined by their uncertainty around key details. Nevertheless, we worked tirelessly to ascertain whether these claims were true or, failing that, if anything even like them were true.

In the end, our internal investigations directly contradict every consequential assertion made in the article—some of which, we note, were based on a single anonymous source.

Apple has never found malicious chips, “hardware manipulations” or vulnerabilities purposely planted in any server. We never alerted the FBI to any security concerns like those described in the article, nor has the FBI ever contacted us about such an investigation.

On Saturday night, the U.S. Department of Homeland Security joined the U.K.’s National Cyber Security Centre in saying they have no reason to doubt the statements we’ve made

Our frustration is animated by the fact that we share your rightful focus on cybersecurity and the integrity of the global supply chain. We understand that, though this story only relates to our enterprise hardware, Americans are justly concerned about how supply chain security affects the consumer products they use every day. Concern for supply chain security is absolutely central to the way we run our business.

If any of the reported details cited above were true, we would have every interest—economic, regulatory, and ethical—to be forthcoming about it. We hold ourselves to the highest standard in the products we create and the data we safeguard, and to help address any concerns you may have, I would like to offer a brief summary of the supply chain protocols we follow to protect ourselves and our customers.

With respect to the information systems we use, we purposely work with multiple vendors, and our infrastructure is very diverse, protected by multiple layers of security. We deploy both commercially available and Apple proprietary security tools, led by an experienced security team that is familiar with diverse threats, simple and sophisticated.

We apply rigorous and ongoing diligence to vendors. Before we begin a relationship, vendors are submitted to a review process which can incorporate, depending on the criticality of the services offered, a layers-deep study of the security infrastructure of the vendor in question. The hardware incorporated into our environment is also placed in the scope of Apple’s Vulnerability Management Program which makes these products subject to ongoing vulnerability scans, patching, and security reviews.

In the situation Bloomberg describes, the so-called compromised servers were allegedly making outbound connections. Apple’s proprietary security tools are continuously scanning for precisely this kind of outbound traffic, as it indicates the existence of malware or other malicious activity. Nothing was ever found.

I understand that these topics are of particular interest to your committees. I will be available to brief your staff this week to further address the information we’ve offered here.

Today, individuals, communities, and nations depend on the security and integrity of our shared technological infrastructure. We at Apple hold this responsibility sacrosanct, and we will continue to dedicate intense focus on keeping ahead of the hackers, cybercriminals, and even nation states that hope to steal data and harm user faith in the potential of technology to build a better world.

Sincerely,

George Stathakopoulos
Vice President, Information Security

“Apple’s Letter”. Scribd, US. Retrieved October 11, 2018.

Despite HIPAA Law, Researchers Say Getting Medical Records Still is Burdensome

Although federal law has long promoted patients’ access to their protected health information, a recent study of 83 hospitals has revealed that there was noncompliance with federal regulations for formats of release and state regulations for request processing times.

The research, published recently in JAMA, also found that there was discordance between information provided on medical records release authorization forms and that obtained directly from medical records departments regarding the medical records request processes.

The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives patients the right of access to their protected health information. Per federal regulation, medical record requests must be fulfilled within 30 days of receipt (with the possibility of a single 30-day extension) in the format requested by the patient if the records are readily producible in that format.

Despite HIPAA and the fact that electronic health records (EHRs) are much more widespread now than in years past, patients may not be able to easily request, receive, and manage their medical records. Under guidance from the U.S. Department of Health and Human Services, hospitals are permitted to impose a reasonable cost-based fee for the release of medical records, but costs still remain high. What’s more, many hospitals add procedural obstacles that can limit patient access, the researchers noted.

To this point, a GAO (Government Accountability Office) report earlier this year also found some troubling trends regarding patient access to medical records. The GAO analyzed four states, finding one instance in which patients paid more than $500 for a single medical record request, and another in which one patient was charged $148 for a PDF version of her medical record.

For this latest study, researchers collected both medical records release authorization forms from each hospital, and subsequently telephoned each hospital’s medical records department to collect data.

Among the 83 hospitals, 44 (53 percent) provided patients the option on the forms to acquire their entire medical record. For individual categories of “requestable” information on the forms, as few as nine hospitals (11 percent) provided the option of selecting release of physician orders and as many as 73 hospitals (88 percent) provided the option of selecting release of laboratory results. Most hospitals (92 percent) provided the option of an “other” category for requesting information not explicitly listed on the form.

Among the telephone calls made, all the hospitals said they were able to release entire medical records to patients. When asked if any information would be withheld with a request of an entire medical record, two hospitals disclosed that nursing notes would not be released unless they were specifically requested. However, just 25 percent of the hospitals who were called said they were able to release information onto patient portals. All hospitals stated in telephone calls and on the forms that they could release information via mail.

Regarding cost, on the authorization forms, 35 percent of hospitals disclosed exact costs for releasing medical records, 22 percent said they would charge patients without specifying a cost, and 36 percent did not specify anything about fees. For a 200-page record, the cost of release ranged from $0.00 to $281.54, based on the 29 hospitals that disclosed costs.

Among the telephone calls, 82 out of 83 hospitals disclosed costs for paper formats of release. For a 200-page record, the cost of release as communicated in telephone calls ranged from $0.00 to $541.50. And of the 82 hospitals that disclosed costs, 48 hospitals (59 percent) stated costs of release above the federal recommendation of a $6.50 flat fee for electronically maintained records.

Finally, for processing times for medical records release, of the 71 hospitals that provided mean times of release when called, 21 percent reported mean times of less than 7 days; 25 percent in seven to 10 days; 31 percent in 11 to 20 days; 5 percent in 21 to 30 days; and 3 4 percent in more than 30 days. In general, most hospitals were able to release records in electronic format in a shorter time frame than records in paper format.

Of the hospitals that responded with times of release, seven had ranges extending beyond their state’s requirement before applying the single 30-day extension granted by HIPAA.

The researchers concluded, “Requesting medical records remains a complicated and burdensome process for patients despite policy efforts and regulation to make medical records more readily available to patients. Our results revealed inconsistencies in information provided by medical records authorization forms and by medical records departments in select U.S. hospitals, as well as potentially unaffordable costs and processing times that were not compliant with federal regulations. As legislation, including the recent 21st Century Cures Act, and government-wide initiatives like MyHealthEData continue to stipulate improvements in patient access to medical records, attention to the most obvious barriers should be paramount.”

“Despite HIPAA Law, Researchers Say Getting Medical Records Still is Burdensome”. Healthcare Informatics, US. Retrieved October 8, 2018.

Bloomberg The Big Hack: How China Used a Tiny Chip to Infiltrate U.S. Companies

The attack by Chinese spies reached almost 30 U.S. companies, including Amazon and Apple, by compromising America’s technology supply chain, according to extensive interviews with government and corporate sources.

Jordan Robertson and Michael Riley.

In 2015, Amazon.com Inc. began quietly evaluating a startup called Elemental Technologies, a potential acquisition to help with a major expansion of its streaming video service, known today as Amazon Prime Video. Based in Portland, Ore., Elemental made software for compressing massive video files and formatting them for different devices. Its technology had helped stream the Olympic Games online, communicate with the International Space Station, and funnel drone footage to the Central Intelligence Agency. Elemental’s national security contracts weren’t the main reason for the proposed acquisition, but they fit nicely with Amazon’s government businesses, such as the highly secure cloud that Amazon Web Services (AWS) was building for the CIA.

To help with due diligence, AWS, which was overseeing the prospective acquisition, hired a third-party company to scrutinize Elemental’s security, according to one person familiar with the process. The first pass uncovered troubling issues, prompting AWS to take a closer look at Elemental’s main product: the expensive servers that customers installed in their networks to handle the video compression. These servers were assembled for Elemental by Super Micro Computer Inc., a San Jose-based company (commonly known as Supermicro) that’s also one of the world’s biggest suppliers of server motherboards, the fiberglass-mounted clusters of chips and capacitors that act as the neurons of data centers large and small. In late spring of 2015, Elemental’s staff boxed up several servers and sent them to Ontario, Canada, for the third-party security company to test, the person says.

Nested on the servers’ motherboards, the testers found a tiny microchip, not much bigger than a grain of rice, that wasn’t part of the boards’ original design. Amazon reported the discovery to U.S. authorities, sending a shudder through the intelligence community. Elemental’s servers could be found in Department of Defense data centers, the CIA’s drone operations, and the onboard networks of Navy warships. And Elemental was just one of hundreds of Supermicro customers.

During the ensuing top-secret probe, which remains open more than three years later, investigators determined that the chips allowed the attackers to create a stealth doorway into any network that included the altered machines. Multiple people familiar with the matter say investigators found that the chips had been inserted at factories run by manufacturing subcontractors in China.

This attack was something graver than the software-based incidents the world has grown accustomed to seeing. Hardware hacks are more difficult to pull off and potentially more devastating, promising the kind of long-term, stealth access that spy agencies are willing to invest millions of dollars and many years to get.

“Having a well-done, nation-state-level hardware implant surface would be like witnessing a unicorn jumping over a rainbow”

There are two ways for spies to alter the guts of computer equipment. One, known as interdiction, consists of manipulating devices as they’re in transit from manufacturer to customer. This approach is favored by U.S. spy agencies, according to documents leaked by former National Security Agency contractor Edward Snowden. The other method involves seeding changes from the very beginning.

One country in particular has an advantage executing this kind of attack: China, which by some estimates makes 75 percent of the world’s mobile phones and 90 percent of its PCs. Still, to actually accomplish a seeding attack would mean developing a deep understanding of a product’s design, manipulating components at the factory, and ensuring that the doctored devices made it through the global logistics chain to the desired location—a feat akin to throwing a stick in the Yangtze River upstream from Shanghai and ensuring that it washes ashore in Seattle. “Having a well-done, nation-state-level hardware implant surface would be like witnessing a unicorn jumping over a rainbow,” says Joe Grand, a hardware hacker and the founder of Grand Idea Studio Inc. “Hardware is just so far off the radar, it’s almost treated like black magic.”

But that’s just what U.S. investigators found: The chips had been inserted during the manufacturing process, two officials say, by operatives from a unit of the People’s Liberation Army. In Supermicro, China’s spies appear to have found a perfect conduit for what U.S. officials now describe as the most significant supply chain attack known to have been carried out against American companies.

One official says investigators found that it eventually affected almost 30 companies, including a major bank, government contractors, and the world’s most valuable company, Apple Inc. Apple was an important Supermicro customer and had planned to order more than 30,000 of its servers in two years for a new global network of data centers. Three senior insiders at Apple say that in the summer of 2015, it, too, found malicious chips on Supermicro motherboards. Apple severed ties with Supermicro the following year, for what it described as unrelated reasons.

In emailed statements, Amazon (which announced its acquisition of Elemental in September 2015), Apple, and Supermicro disputed summaries of Bloomberg Businessweek’s reporting. “It’s untrue that AWS knew about a supply chain compromise, an issue with malicious chips, or hardware modifications when acquiring Elemental,” Amazon wrote. “On this we can be very clear: Apple has never found malicious chips, ‘hardware manipulations’ or vulnerabilities purposely planted in any server,” Apple wrote. “We remain unaware of any such investigation,” wrote a spokesman for Supermicro, Perry Hayes. The Chinese government didn’t directly address questions about manipulation of Supermicro servers, issuing a statement that read, in part, “Supply chain safety in cyberspace is an issue of common concern, and China is also a victim.” The FBI and the Office of the Director of National Intelligence, representing the CIA and NSA, declined to comment.

The companies’ denials are countered by six current and former senior national security officials, who—in conversations that began during the Obama administration and continued under the Trump administration—detailed the discovery of the chips and the government’s investigation. One of those officials and two people inside AWS provided extensive information on how the attack played out at Elemental and Amazon; the official and one of the insiders also described Amazon’s cooperation with the government investigation. In addition to the three Apple insiders, four of the six U.S. officials confirmed that Apple was a victim. In all, 17 people confirmed the manipulation of Supermicro’s hardware and other elements of the attacks. The sources were granted anonymity because of the sensitive, and in some cases classified, nature of the information.

One government official says China’s goal was long-term access to high-value corporate secrets and sensitive government networks. No consumer data is known to have been stolen.

The ramifications of the attack continue to play out. The Trump administration has made computer and networking hardware, including motherboards, a focus of its latest round of trade sanctions against China, and White House officials have made it clear they think companies will begin shifting their supply chains to other countries as a result. Such a shift might assuage officials who have been warning for years about the security of the supply chain—even though they’ve never disclosed a major reason for their concerns.

Back in 2006, three engineers in Oregon had a clever idea. Demand for mobile video was about to explode, and they predicted that broadcasters would be desperate to transform programs designed to fit TV screens into the various formats needed for viewing on smartphones, laptops, and other devices. To meet the anticipated demand, the engineers started Elemental Technologies, assembling what one former adviser to the company calls a genius team to write code that would adapt the superfast graphics chips being produced for high-end video-gaming machines. The resulting software dramatically reduced the time it took to process large video files. Elemental then loaded the software onto custom-built servers emblazoned with its leprechaun-green logos.

Elemental servers sold for as much as $100,000 each, at profit margins of as high as 70 percent, according to a former adviser to the company. Two of Elemental’s biggest early clients were the Mormon church, which used the technology to beam sermons to congregations around the world, and the adult film industry, which did not.

Elemental also started working with American spy agencies. In 2009 the company announced a development partnership with In-Q-Tel Inc., the CIA’s investment arm, a deal that paved the way for Elemental servers to be used in national security missions across the U.S. government. Public documents, including the company’s own promotional materials, show that the servers have been used inside Department of Defense data centers to process drone and surveillance-camera footage, on Navy warships to transmit feeds of airborne missions, and inside government buildings to enable secure videoconferencing. NASA, both houses of Congress, and the Department of Homeland Security have also been customers. This portfolio made Elemental a target for foreign adversaries.

Supermicro had been an obvious choice to build Elemental’s servers. Headquartered north of San Jose’s airport, up a smoggy stretch of Interstate 880, the company was founded by Charles Liang, a Taiwanese engineer who attended graduate school in Texas and then moved west to start Supermicro with his wife in 1993. Silicon Valley was then embracing outsourcing, forging a pathway from Taiwanese, and later Chinese, factories to American consumers, and Liang added a comforting advantage: Supermicro’s motherboards would be engineered mostly in San Jose, close to the company’s biggest clients, even if the products were manufactured overseas.

Today, Supermicro sells more server motherboards than almost anyone else. It also dominates the $1 billion market for boards used in special-purpose computers, from MRI machines to weapons systems. Its motherboards can be found in made-to-order server setups at banks, hedge funds, cloud computing providers, and web-hosting services, among other places. Supermicro has assembly facilities in California, the Netherlands, and Taiwan, but its motherboards—its core product—are nearly all manufactured by contractors in China.

The company’s pitch to customers hinges on unmatched customization, made possible by hundreds of full-time engineers and a catalog encompassing more than 600 designs. The majority of its workforce in San Jose is Taiwanese or Chinese, and Mandarin is the preferred language, with hanzi filling the whiteboards, according to six former employees. Chinese pastries are delivered every week, and many routine calls are done twice, once for English-only workers and again in Mandarin. The latter are more productive, according to people who’ve been on both. These overseas ties, especially the widespread use of Mandarin, would have made it easier for China to gain an understanding of Supermicro’s operations and potentially to infiltrate the company. (A U.S. official says the government’s probe is still examining whether spies were planted inside Supermicro or other American companies to aid the attack.)

With more than 900 customers in 100 countries by 2015, Supermicro offered inroads to a bountiful collection of sensitive targets. “Think of Supermicro as the Microsoft of the hardware world,” says a former U.S. intelligence official who’s studied Supermicro and its business model. “Attacking Supermicro motherboards is like attacking Windows. It’s like attacking the whole world.”

Well before evidence of the attack surfaced inside the networks of U.S. companies, American intelligence sources were reporting that China’s spies had plans to introduce malicious microchips into the supply chain. The sources weren’t specific, according to a person familiar with the information they provided, and millions of motherboards are shipped into the U.S. annually. But in the first half of 2014, a different person briefed on high-level discussions says, intelligence officials went to the White House with something more concrete: China’s military was preparing to insert the chips into Supermicro motherboards bound for U.S. companies.

The specificity of the information was remarkable, but so were the challenges it posed. Issuing a broad warning to Supermicro’s customers could have crippled the company, a major American hardware maker, and it wasn’t clear from the intelligence whom the operation was targeting or what its ultimate aims were. Plus, without confirmation that anyone had been attacked, the FBI was limited in how it could respond. The White House requested periodic updates as information came in, the person familiar with the discussions says.

Apple made its discovery of suspicious chips inside Supermicro servers around May 2015, after detecting odd network activity and firmware problems, according to a person familiar with the timeline. Two of the senior Apple insiders say the company reported the incident to the FBI but kept details about what it had detected tightly held, even internally. Government investigators were still chasing clues on their own when Amazon made its discovery and gave them access to sabotaged hardware, according to one U.S. official. This created an invaluable opportunity for intelligence agencies and the FBI—by then running a full investigation led by its cyber- and counterintelligence teams—to see what the chips looked like and how they worked.

The chips on Elemental servers were designed to be as inconspicuous as possible, according to one person who saw a detailed report prepared for Amazon by its third-party security contractor, as well as a second person who saw digital photos and X-ray images of the chips incorporated into a later report prepared by Amazon’s security team. Gray or off-white in color, they looked more like signal conditioning couplers, another common motherboard component, than microchips, and so they were unlikely to be detectable without specialized equipment. Depending on the board model, the chips varied slightly in size, suggesting that the attackers had supplied different factories with different batches.

Officials familiar with the investigation say the primary role of implants such as these is to open doors that other attackers can go through. “Hardware attacks are about access,” as one former senior official puts it. In simplified terms, the implants on Supermicro hardware manipulated the core operating instructions that tell the server what to do as data move across a motherboard, two people familiar with the chips’ operation say. This happened at a crucial moment, as small bits of the operating system were being stored in the board’s temporary memory en route to the server’s central processor, the CPU. The implant was placed on the board in a way that allowed it to effectively edit this information queue, injecting its own code or altering the order of the instructions the CPU was meant to follow. Deviously small changes could create disastrous effects.

Since the implants were small, the amount of code they contained was small as well. But they were capable of doing two very important things: telling the device to communicate with one of several anonymous computers elsewhere on the internet that were loaded with more complex code; and preparing the device’s operating system to accept this new code. The illicit chips could do all this because they were connected to the baseboard management controller, a kind of superchip that administrators use to remotely log in to problematic servers, giving them access to the most sensitive code even on machines that have crashed or are turned off.

This system could let the attackers alter how the device functioned, line by line, however they wanted, leaving no one the wiser. To understand the power that would give them, take this hypothetical example: Somewhere in the Linux operating system, which runs in many servers, is code that authorizes a user by verifying a typed password against a stored encrypted one. An implanted chip can alter part of that code so the server won’t check for a password—and presto! A secure machine is open to any and all users. A chip can also steal encryption keys for secure communications, block security updates that would neutralize the attack, and open up new pathways to the internet. Should some anomaly be noticed, it would likely be cast as an unexplained oddity. “The hardware opens whatever door it wants,” says Joe FitzPatrick, founder of Hardware Security Resources LLC, a company that trains cybersecurity professionals in hardware hacking techniques.

U.S. officials had caught China experimenting with hardware tampering before, but they’d never seen anything of this scale and ambition. The security of the global technology supply chain had been compromised, even if consumers and most companies didn’t know it yet. What remained for investigators to learn was how the attackers had so thoroughly infiltrated Supermicro’s production process—and how many doors they’d opened into American targets.

Unlike software-based hacks, hardware manipulation creates a real-world trail. Components leave a wake of shipping manifests and invoices. Boards have serial numbers that trace to specific factories. To track the corrupted chips to their source, U.S. intelligence agencies began following Supermicro’s serpentine supply chain in reverse, a person briefed on evidence gathered during the probe says.

As recently as 2016, according to DigiTimes, a news site specializing in supply chain research, Supermicro had three primary manufacturers constructing its motherboards, two headquartered in Taiwan and one in Shanghai. When such suppliers are choked with big orders, they sometimes parcel out work to subcontractors. In order to get further down the trail, U.S. spy agencies drew on the prodigious tools at their disposal. They sifted through communications intercepts, tapped informants in Taiwan and China, even tracked key individuals through their phones, according to the person briefed on evidence gathered during the probe. Eventually, that person says, they traced the malicious chips to four subcontracting factories that had been building Supermicro motherboards for at least two years.

As the agents monitored interactions among Chinese officials, motherboard manufacturers, and middlemen, they glimpsed how the seeding process worked. In some cases, plant managers were approached by people who claimed to represent Supermicro or who held positions suggesting a connection to the government. The middlemen would request changes to the motherboards’ original designs, initially offering bribes in conjunction with their unusual requests. If that didn’t work, they threatened factory managers with inspections that could shut down their plants. Once arrangements were in place, the middlemen would organize delivery of the chips to the factories.

The investigators concluded that this intricate scheme was the work of a People’s Liberation Army unit specializing in hardware attacks, according to two people briefed on its activities. The existence of this group has never been revealed before, but one official says, “We’ve been tracking these guys for longer than we’d like to admit.” The unit is believed to focus on high-priority targets, including advanced commercial technology and the computers of rival militaries. In past attacks, it targeted the designs for high-performance computer chips and computing systems of large U.S. internet providers.

Provided details of Businessweek’s reporting, China’s Ministry of Foreign Affairs sent a statement that said “China is a resolute defender of cybersecurity.” The ministry added that in 2011, China proposed international guarantees on hardware security along with other members of the Shanghai Cooperation Organization, a regional security body. The statement concluded, “We hope parties make less gratuitous accusations and suspicions but conduct more constructive talk and collaboration so that we can work together in building a peaceful, safe, open, cooperative and orderly cyberspace.”

The Supermicro attack was on another order entirely from earlier episodes attributed to the PLA. It threatened to have reached a dizzying array of end users, with some vital ones in the mix. Apple, for its part, has used Supermicro hardware in its data centers sporadically for years, but the relationship intensified after 2013, when Apple acquired a startup called Topsy Labs, which created superfast technology for indexing and searching vast troves of internet content. By 2014, the startup was put to work building small data centers in or near major global cities. This project, known internally as Ledbelly, was designed to make the search function for Apple’s voice assistant, Siri, faster, according to the three senior Apple insiders.

Documents seen by Businessweek show that in 2014, Apple planned to order more than 6,000 Supermicro servers for installation in 17 locations, including Amsterdam, Chicago, Hong Kong, Los Angeles, New York, San Jose, Singapore, and Tokyo, plus 4,000 servers for its existing North Carolina and Oregon data centers. Those orders were supposed to double, to 20,000, by 2015. Ledbelly made Apple an important Supermicro customer at the exact same time the PLA was found to be manipulating the vendor’s hardware.

Project delays and early performance problems meant that around 7,000 Supermicro servers were humming in Apple’s network by the time the company’s security team found the added chips. Because Apple didn’t, according to a U.S. official, provide government investigators with access to its facilities or the tampered hardware, the extent of the attack there remained outside their view.

American investigators eventually figured out who else had been hit. Since the implanted chips were designed to ping anonymous computers on the internet for further instructions, operatives could hack those computers to identify others who’d been affected. Although the investigators couldn’t be sure they’d found every victim, a person familiar with the U.S. probe says they ultimately concluded that the number was almost 30 companies.

That left the question of whom to notify and how. U.S. officials had been warning for years that hardware made by two Chinese telecommunications giants, Huawei Corp. and ZTE Corp., was subject to Chinese government manipulation. (Both Huawei and ZTE have said no such tampering has occurred.) But a similar public alert regarding a U.S. company was out of the question. Instead, officials reached out to a small number of important Supermicro customers. One executive of a large web-hosting company says the message he took away from the exchange was clear: Supermicro’s hardware couldn’t be trusted. “That’s been the nudge to everyone—get that crap out,” the person says.

Amazon, for its part, began acquisition talks with an Elemental competitor, but according to one person familiar with Amazon’s deliberations, it reversed course in the summer of 2015 after learning that Elemental’s board was nearing a deal with another buyer. Amazon announced its acquisition of Elemental in September 2015, in a transaction whose value one person familiar with the deal places at $350 million. Multiple sources say that Amazon intended to move Elemental’s software to AWS’s cloud, whose chips, motherboards, and servers are typically designed in-house and built by factories that Amazon contracts from directly.

A notable exception was AWS’s data centers inside China, which were filled with Supermicro-built servers, according to two people with knowledge of AWS’s operations there. Mindful of the Elemental findings, Amazon’s security team conducted its own investigation into AWS’s Beijing facilities and found altered motherboards there as well, including more sophisticated designs than they’d previously encountered. In one case, the malicious chips were thin enough that they’d been embedded between the layers of fiberglass onto which the other components were attached, according to one person who saw pictures of the chips. That generation of chips was smaller than a sharpened pencil tip, the person says. (Amazon denies that AWS knew of servers found in China containing malicious chips.)

China has long been known to monitor banks, manufacturers, and ordinary citizens on its own soil, and the main customers of AWS’s China cloud were domestic companies or foreign entities with operations there. Still, the fact that the country appeared to be conducting those operations inside Amazon’s cloud presented the company with a Gordian knot. Its security team determined that it would be difficult to quietly remove the equipment and that, even if they could devise a way, doing so would alert the attackers that the chips had been found, according to a person familiar with the company’s probe. Instead, the team developed a method of monitoring the chips. In the ensuing months, they detected brief check-in communications between the attackers and the sabotaged servers but didn’t see any attempts to remove data. That likely meant either that the attackers were saving the chips for a later operation or that they’d infiltrated other parts of the network before the monitoring began. Neither possibility was reassuring.

When in 2016 the Chinese government was about to pass a new cybersecurity law—seen by many outside the country as a pretext to give authorities wider access to sensitive data—Amazon decided to act, the person familiar with the company’s probe says. In August it transferred operational control of its Beijing data center to its local partner, Beijing Sinnet, a move the companies said was needed to comply with the incoming law. The following November, Amazon sold the entire infrastructure to Beijing Sinnet for about $300 million. The person familiar with Amazon’s probe casts the sale as a choice to “hack off the diseased limb.”

As for Apple, one of the three senior insiders says that in the summer of 2015, a few weeks after it identified the malicious chips, the company started removing all Supermicro servers from its data centers, a process Apple referred to internally as “going to zero.” Every Supermicro server, all 7,000 or so, was replaced in a matter of weeks, the senior insider says. (Apple denies that any servers were removed.) In 2016, Apple informed Supermicro that it was severing their relationship entirely—a decision a spokesman for Apple ascribed in response to Businessweek’s questions to an unrelated and relatively minor security incident.

That August, Supermicro’s CEO, Liang, revealed that the company had lost two major customers. Although he didn’t name them, one was later identified in news reports as Apple. He blamed competition, but his explanation was vague. “When customers asked for lower price, our people did not respond quickly enough,” he said on a conference call with analysts. Hayes, the Supermicro spokesman, says the company has never been notified of the existence of malicious chips on its motherboards by either customers or U.S. law enforcement.

Concurrent with the illicit chips’ discovery in 2015 and the unfolding investigation, Supermicro has been plagued by an accounting problem, which the company characterizes as an issue related to the timing of certain revenue recognition. After missing two deadlines to file quarterly and annual reports required by regulators, Supermicro was delisted from the Nasdaq on Aug. 23 of this year. It marked an extraordinary stumble for a company whose annual revenue had risen sharply in the previous four years, from a reported $1.5 billion in 2014 to a projected $3.2 billion this year.

One Friday in late September 2015, President Barack Obama and Chinese President Xi Jinping appeared together at the White House for an hourlong press conference headlined by a landmark deal on cybersecurity. After months of negotiations, the U.S. had extracted from China a grand promise: It would no longer support the theft by hackers of U.S. intellectual property to benefit Chinese companies. Left out of those pronouncements, according to a person familiar with discussions among senior officials across the U.S. government, was the White House’s deep concern that China was willing to offer this concession because it was already developing far more advanced and surreptitious forms of hacking founded on its near monopoly of the technology supply chain.

In the weeks after the agreement was announced, the U.S. government quietly raised the alarm with several dozen tech executives and investors at a small, invite-only meeting in McLean, Va., organized by the Pentagon. According to someone who was present, Defense Department officials briefed the technologists on a recent attack and asked them to think about creating commercial products that could detect hardware implants. Attendees weren’t told the name of the hardware maker involved, but it was clear to at least some in the room that it was Supermicro, the person says.

The problem under discussion wasn’t just technological. It spoke to decisions made decades ago to send advanced production work to Southeast Asia. In the intervening years, low-cost Chinese manufacturing had come to underpin the business models of many of America’s largest technology companies. Early on, Apple, for instance, made many of its most sophisticated electronics domestically. Then in 1992, it closed a state-of-the-art plant for motherboard and computer assembly in Fremont, Calif., and sent much of that work overseas.

Over the decades, the security of the supply chain became an article of faith despite repeated warnings by Western officials. A belief formed that China was unlikely to jeopardize its position as workshop to the world by letting its spies meddle in its factories. That left the decision about where to build commercial systems resting largely on where capacity was greatest and cheapest. “You end up with a classic Satan’s bargain,” one former U.S. official says. “You can have less supply than you want and guarantee it’s secure, or you can have the supply you need, but there will be risk. Every organization has accepted the second proposition.”

In the three years since the briefing in McLean, no commercially viable way to detect attacks like the one on Supermicro’s motherboards has emerged—or has looked likely to emerge. Few companies have the resources of Apple and Amazon, and it took some luck even for them to spot the problem. “This stuff is at the cutting edge of the cutting edge, and there is no easy technological solution,” one of the people present in McLean says. “You have to invest in things that the world wants. You cannot invest in things that the world is not ready to accept yet.”

“The Big Hack: How China Used a Tiny Chip to Infiltrate U.S. Companies”. Bloomberg Businessweek, US. Retrieved October 5, 2018.

Use the RFP Process to Find Best HIPAA Security Risk Assessment Vendor

A Request for Proposal (RFP) is one of the best ways to find out what each HIPAA security risk assessment vendor has to offer your organization, provided you structure it properly

From the August 2004 Issue of HIPAA Security Compliance Insider.

The annually required HIPAA Security Risk Assessment isn't a joke....Like many organizations, your organization may not have the resources to conduct a HIPAA security risk assessment that compares your technical and nontechnical security measures to HIPAA’s requirements. That’s where an outside security assessment vendor can help. It can identify and explain your security weaknesses and the potential threats and vulnerabilities to your electronic protected health information (EPHI). Plus, a security assessment vendor can give you advice on what security measures you should implement to comply with HIPAA’s security regulations and stay in business.

But how do you know which security assessment vendor is the best one for your organization? One good way is to put together a request for proposal (RFP) that you send to prospective HIPAA security risk assessment vendors. Creating an RFP for prospective vendors will help you focus your security assessment project. And it will give you a chance to review and compare prospective vendors’ written responses to questions tailored to your organization. “Done well, an RFP is an indispensable tool for visualizing a project; and it provides a concrete roadmap for your relationship with the vendor you select,” says information technology attorney Jay Hollander.

We’ll tell you the steps you should take to start the process of choosing the right HIPAA security risk assessment vendor, including how to set up an RFP. And to help you set up your own, we’ll give you a Model Form of an RFP that you can adapt and distribute to potential vendors.

Follow Three Steps to Start Your HIPAA Security Risk Assessment Vendor Selection Process

According to Hollander, choosing a vendor to perform a HIPAA security risk assessment should start with three steps.

  1. Assess needs/scope of project. First you must identify what areas your HIPAA security risk assessment should include. Do you need an assessment of your physical access controls and security policies? Should the vendor conduct a penetration test of your internal and external networks to see how easily they can be breached? “Each organization’s needs will be different,” says information security consultant Earl Crane. For example, smaller organizations that don’t transfer EPHI over extranet connections probably won’t need a security assessment of their extranet, he explains. 

    Insider Says: For a list of the various areas an organization’s security assessment might need to cover, click here. You can use this list to help you identify your own needs so you can communicate them to prospective vendors.

  2. Narrow list of vendors. Next, you will need to get a list of prospective vendors. To do this, you can search for security assessment vendors on the Internet or ask colleagues for recommendations. Narrow your list by considering the vendors’ experience, general pricing approach, and the services they provide, says Hollander. 

    Focus on vendors that have the ability to assess both your technical and nontechnical security, recommends Crane. To get a complete picture of your security practices, you will need a technical assessment and a policy assessment, preferably by the same vendor, he explains. “Look for a vendor with a good understanding of HIPAA’s security regulations, and a good technical reputation,” he adds.

  3. Prepare RFP. Once you’ve narrowed your list of prospective vendors down to four or five, it’s time to create an RFP. Your RFP, like ours, should include the following provisions:
  • Purpose and goals. Begin your RFP with a brief explanation of the reason you’re seeking a HIPAA security risk assessment vendor and your goals for the assessment—that is, to identify and repair security gaps and comply with the HIPAA security regulations.
  • Proposal contact and method of evaluation. Give prospective vendors the name and contact information of a knowledgeable person in your organization to whom they can go for more information. And tell them who should receive the proposals and any additional information your organization might need [Form, sec. 2(a)]. Also tell them the factors that will affect your decision to accept a proposal. Explain that your consideration of the proposals will be based on more than cost, says Crane. This way, they’ll understand that they may be rejected even if they have the lowest bid.
  • Schedule. Vendors will also need a schedule that outlines the RFP process from beginning to end, including the date when:
    • Responses to the RFP are due;
    • Vendor interviews will be held;
    • Supplemental information must be received;
    • A decision will be made; and
    • The project should start and finish.
  • Organization information. To understand the scope of the project and price it appropriately, prospective vendors will need a basic description of your organization and the information systems it currently uses. Be sure to describe all hardware and software, and let prospective vendors know how many active IP addresses your organization uses.
  • Scope of project. Based on the needs assessment you conducted before you narrowed down your vendor list, define the scope of the project in your RFP. Be precise, says Crane. Otherwise, your vendors might not bid on the same project, resulting in service and pricing differences that could be hard to identify and compare. And ask your vendors to break down their costs and the amount of time they require for each type of assessment you list in your RFP, Crane adds.

Confused? That’s okay! Call Aligned Risk Management for help:

505-908-9040

“Use RFP to Find Best HIPAA Security Assessment Vendor”. HIPAA Security Compliance Insider, US. Retrieved July 3, 2018.