Radiology Clinic, Hospital Among Latest Rural Cyber Victims

A small North Carolina radiology practice and a 25-bed Pennsylvania hospital and are among the latest rural healthcare providers struggling to recover from recent cyberattacks that are disrupting their technology operations and affecting patient care services.

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Pinehurst Radiology, which serves the Sandhills region of North Carolina, has closed down while it recovers from a cyber incident in January. A recorded greeting on the practice’s voicemail system said on Thursday it will be closed for “the foreseeable future.”

The message instructs Pinehurst patients to contact their referring physicians to reschedule their appointments and that patients who need MRI or PET scans should schedule those appointments with the affiliated First Imaging, which is part of the nearby FirstHealth of the Carolinas healthcare system.

A FirstHealth spokeswoman told Information Security Media Group that Pinehurst Radiology’s IT systems and its practice are separate entities from FirstHealth of Carolinas, which operates several small hospitals in North Carolina. FirstHealth has offered to help Pinehurst Radiology patients needing certain imaging services, such as mammography and ultrasound tests, while Pinehurst Radiology is “temporarily closed,” she said.

Meanwhile, Endless Mountains Health System, located in Montrose, Penn., has been trying to recover from a cyberattack since at least March 5. A notice on its website said that after discovering the attack, the hospital immediately initiated measures to mitigate the impact and protect sensitive data.

“At this time, certain systems are unavailable, and we appreciate the patience and understanding of our patients, staff and the community as we work through this challenge,” non-profit EMHS said.

EMHS’ electronic health records are among IT systems affected by the incident, the organization said on its Facebook page.

The hospital is asking patients to bring to all physician, laboratory, radiology and surgical appointments a list of prescription and over-the-counter medications, as well as doses and frequencies; insurance cards; photo IDs; allergy lists; and imaging and lab orders.

EMHS on its Facebook page Tuesday said that its IdentoGO identity verification services “will be down another week as we are still unable to connect to their system. We hope to be able to service the public with fingerprinting again” on March 18.

Neither EMHS nor Pinehurst Radiology immediately responded to ISMG’s requests for comment and additional details about their cyber incidents and recovery status.

Big Problems for Small Entities

Ransomware and other cyberattacks on small and rural healthcare organizations often have devastating effects on providers, their patients and their communities (see: Are Efforts to Help Secure Rural Hospitals Doing Any Good?).

In some cases, the technological and financial blow of a cyberattack is too great, and organizations never recover and reopen the business. That was the case for a 44-bed hospital operated by St. Margaret’s Health in Spring Valley, Ill., which permanently closed its doors in 2023 in part due to a 2021 ransomware attack that worsened financial woes and other problems that it was already dealing with before the incident (see: Rural Healthcare Provider Closing Due in Part to Attack Woes).

Other healthcare groups that have also closed their doors for good after a cyber incident include Wood Ranch Medical, a small clinic in Simi Valley, Calif., that in 2019 announced it would close because it could not recover access to any of its records as a result of a ransomware attack (see: Latest US Healthcare Ransomware Attacks Have Harsh Impact).

Because most rural and small healthcare entities lack cybersecurity resources – including technology and staff – they can be “very attractive targets” for cybercriminals, said Mike Hamilton, field CISO at security firm Lumifi Cyber.

“Rural healthcare is very critical because they’re widely separated in rural areas – and so when a hospital is knocked down, all of a sudden someone has to drive 450 miles for treatment,” he said. And that’s bad. That is a threat to patient care – loss of life as a potential impact,” he said.

Because they’re not adequately resourced with cybersecurity, rural facilities may find it difficult to “up their game,” he said.

The reasons Pinehurst Radiology fell victim to its cyberattack “are likely the same reasons they have yet to recover – limited cybersecurity infrastructure, insufficient funding and lack of cybersecurity expertise,” said Tamra Durfree, virtual CISO or security firm Fortified Health Security.

“Recovery from a cyberattack is extremely labor intensive, requiring highly skilled resources, working long hours to determine the source of the attack, remediate – meaning purge the cyber attackers from the environment – and then recover,” she said.

“When an organization is down this long, it generally means they do not have backups to recover from, or their backups were also compromised, and they are having to rebuild from scratch,” she said.

Small and rural organizations can take certain measures to better prepare themselves to handle a potential cyberattack, minimizing risks and ensuring more efficient recovery when the unexpected happens, she said.

That includes implementing regular data backups and ensuring they are stored offline or in a secure, remote location; assessing the security posture of third-party vendors and service providers; and considering a cyber insurance policy. “That can help with the financial and operational recovery after an attack, covering costs such as legal fees, data recovery, and system restoration,” she said.

Hamilton also recommends that rural, small and other resource-stressed healthcare focus on several key areas to help improve their overall cybersecurity posture. “There are some solutions out there that are not going to break the bank overall,” he said.

“Train your users, manage your credentials, and get good with patching right,” he said. “Make sure that you have very good communication between you and the vendors that supply the technology that faces the Internet.”

Rural and small healthcare organizations can also consider tapping into programs by some technology vendors and industry groups that offer free or low-cost cybersecurity tools, services and educational resources (see: Microsoft, Google Offering Cyber Help to Rural Hospitals).