Recent discoveries, along with the recent drama over the Heartbleed bug, make me believe that in next few months we could see the largest leak of private patient information ever reported. Attacks against health IT systems are particularly concerning because so much personal data lives in an electronic health record. If hackers compromised such a system, they’d get contact and financial information, as well as lots of even more personal health data. 

Heartbleed, the recently exposed vulnerability in a very common version of OpenSSL, put pressure on many IT security professionals to roll out quick fixes. Unfortunately, backwards thinking in health IT, arguably one of the most important-to-protect arenas, leaves many vendors unprepared to respond quickly to bugs like Heartbleed.

There is already evidence that companies that develop electronic health record software and other health IT products are not prepared to react to security vulnerabilities of any kind. For example, on April 4, Josh Mandel, a health IT expert with the SMART project, an effort to develop a common interface for health IT platforms, discovered a significant vulnerability in a common part of a health-care informatics software adopted by many electronic health record software vendors. Mandel and his team reported the bug, but very few vendors of electronic health record software responded appropriately. Mandel found that less than 10 percent of electronic health record vendors he contacted had the proper procedures in place to handle vulnerabilities.

Hackers generally move at breathtaking speed, and can take over millions of machines in minutes. The only advantage that security professionals have is that they can take certain steps to prepare for attacks. If those preparations are in place, the IT professionals can (barely) keep up. But in the case of health information, most security professional aren’t properly prepared to react.

Has Heartbleed affected any electronic health record systems? It is hard to say. Usually leaks of protected health information must be reported to the HHS Office of Civil Rights under the Health Insurance Portability and Accountability Act. But it is an open secret in health IT circles that health-care providers frequently fail to report “smaller” problems. Even if hospitals and other providers did report back to the Office of Civil Rights, it might be difficult for us to tell, as an industry, how well health IT vendors performed.

It will be interesting to see, over the course of the next few months, what kinds of hacking attempts are reported. Let’s hope I’m wrong about that leak.

Fred Trotter is chief operating officer at Open Source Health, founder of CareSet, and a technical blogger for O’Reilly Radar.