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Cited by 154Thoreau and American LiteratureInformation and Cyber SecurityAdvanced Malware Detection Techniques

The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index.

Trends in ransomware attacks on US hospitals, clinics, and other health care delivery organizations, 2016-2021.

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Neprash, Hannah T., McGlave, Claire C., Cross, Dori A., Virnig, Beth A., Puskarich, Michael A., Huling, Jared D., Rozenshtein, Alan Z., Nikpay, Sayeh S.·2022·JAMA Health Forum
DOI 10.1001/jamahealthforum.2022.4873PMC PMC9856685
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Abstract

Importance: Anecdotal evidence suggests that health care delivery organizations face a growing threat from ransomware attacks that are designed to disrupt care delivery and may consequently threaten patient outcomes. Objective: To quantify the frequency and characteristics of ransomware attacks on health care delivery organizations. Design, Setting, and Participants: This cohort study used data from the Tracking Healthcare Ransomware Events and Traits database to examine the number and characteristics of ransomware attacks on health care delivery organizations from 2016 to 2021. Logistic and negative binomial regression quantified changes over time in the characteristics of ransomware attacks that affected health care delivery organizations. Main Outcomes and Measures: Date of ransomware attack, public reporting of ransomware attacks, personal health information (PHI) exposure, status of encrypted/stolen data following the attack, type of health care delivery organization affected, and operational disruption during the ransomware attack. Results: From January 2016 to December 2021, 374 ransomware attacks on US health care delivery organizations exposed the PHI of nearly 42 million patients. From 2016 to 2021, the annual number of ransomware attacks more than doubled from 43 to 91. Almost half (166 [44.4%]) of ransomware attacks disrupted the delivery of health care, with common disruptions including electronic system downtime (156 [41.7%]), cancellations of scheduled care (38 [10.2%]), and ambulance diversion (16 [4.3%]). From 2016 to 2021, ransomware attacks on health care delivery organizations increasingly affected large organizations with multiple facilities (annual marginal effect [ME], 0.08; 95% CI, 0.05-0.10; P < .001), exposed the PHI of more patients (ME, 66 385.8; 95% CI, 3400.5-129 371.2; P = .04), were less likely to be restored from data backups (ME, -0.04; 95% CI, -0.06 to -0.01; P = .002), were more likely to exceed mandatory reporting timelines (ME, 0.06; 95% CI, 0.03-0.08; P < .001), and increasingly were associated with delays or cancellations of scheduled care (ME, 0.02; 95% CI, 0-0.05; P = .02). Conclusions and Relevance: This cohort study of ransomware attacks documented growth in their frequency and sophistication. Ransomware attacks disrupt care delivery and jeopardize information integrity. Current monitoring/reporting efforts provide limited information and could be expanded to potentially yield a more complete view of how this growing form of cybercrime affects the delivery of health care.

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Figure 1. Number of Ransomware Attacks on US Hospitals, Clinics, and Other Health Care Service Delivery Organizations, 2016-2021 PHI indicates personal health information.
Figure 1. Number of Ransomware Attacks on US Hospitals, Clinics, and Other Health Care Service Delivery Organizations, 2016-2021 PHI indicates personal health information.CC BY · PubMed Central
Figure 2. Operational Disruption Likelihood and Duration by Health Care Delivery Organization Type, 2016-2021 Ransomware attacks affecting multiple health care delivery organization types simultaneously appear in all relevant columns.
Figure 2. Operational Disruption Likelihood and Duration by Health Care Delivery Organization Type, 2016-2021 Ransomware attacks affecting multiple health care delivery organization types simultaneously appear in all relevant columns.CC BY · PubMed Central
Figure 3. Personal Health Information (PHI) Exposure and Reporting During Ransomware Attacks Each dot represents a ransomware attack on a health care delivery organization. The 84 health care delivery organizations that experienced a ransomware attack but did not submit information to the US Department of Health and Human Services were excluded.
Figure 3. Personal Health Information (PHI) Exposure and Reporting During Ransomware Attacks Each dot represents a ransomware attack on a health care delivery organization. The 84 health care delivery organizations that experienced a ransomware attack but did not submit information to the US Department of Health and Human Services were excluded.CC BY · PubMed Central

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Metadata

Authors
Neprash, H. T., McGlave, C. C., Cross, D. A., Virnig, B. A., Puskarich, M. A., Huling, J. D., Rozenshtein, A. Z., & Nikpay, S. S.
Affiliations
  • University of Minnesota (US)
  • University of Florida Health (US)
Corresponding author
Neprash, Hannah T.
ORCID
Venue
JAMA Health Forum
Publisher
American Medical Association (AMA)
Published
2022-12-29
Volume
3
Issue
12
Pages
e224873
ISSN
2689-0186 (ISSN-L)
DOI
10.1001/jamahealthforum.2022.4873
PMC
PMC9856685
OpenAlex
W4313325293
Cited by
154
References
8
Citations by year
2026: 49 · 2025: 43 · 2024: 43 · 2023: 19
FWCI
25.94
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Health Forum (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Thoreau and American Literature
  • Physical Sciences › Computer Science › Information Systems › Information and Cyber Security
  • Physical Sciences › Computer Science › Software › Advanced Malware Detection Techniques
Keywords
ransomware, health care delivery organization, hospitals, clinics, operational disruption, mandatory reporting, ransom negotiation, ransom payments, ambulance diversion, patient safety
MeSH terms
Delivery of Health Care, Health Facilities, Hospitals, Humans, Organizations, Cohort Studies

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