Cybersecurity Challenges in European Telehealth

Telehealth or telemedicine is one of the most common ways of providing healthcare services in the EU, with nearly 77% of countries adopting some type of telehealth service. Countries like Norway, Sweden, Denmark, and Italy are considered some of the world’s leaders in providing telehealth services. Following the COVID-19 pandemic, telehealth became widely adopted across Europe, with many countries participating in cross-border collaboration.

Naturally, with the amount of technology involved and personal data exchanged over digital methods in telehealth, it came with increased cybersecurity risks. Because the healthcare industry is one of the most breached in the world, it’s critical for European healthcare entities to take additional efforts to uphold robust data security protocols and meet certain cybersecurity requirements to better protect their patients’ data.

We’ll take a look at some of the biggest risks to telehealth in Europe, how healthcare service providers can better secure their information security, and how they can comply with leading industry standards and regulations.

Learn how UpGuard helps healthcare entities improve their data security practices >

What is telehealth?

Telehealth is the practice of offering health care services remotely through technology and other digital methods. These remote technologies can support long-distance health care, connect patients with healthcare professionals online, provide public health education, conduct remote patient monitoring (RPM), and communicate through live video calls.

The benefits of telehealth include increased accessibility to medical professionals, lower healthcare delivery costs, reduced travel costs, faster care delivery, and improved patient engagement and overall service. It’s largely considered the “new era” of medicine

What cybersecurity risks impact EU telehealth?

The European healthcare sector and telehealth industry face many cybersecurity threats that can severely impact its ability to operate if left unaddressed. These include:

1. Data breaches: Unauthorized access to sensitive electronic health records (EHR) or healthcare networks can lead to significant data theft, privacy violations, or data leaks.
2. Ransomware attacks: Ransomware attacks are one of the most commonly deployed attack methods to hold critical data hostage until a large sum of money is paid to the cybercriminals or hackers.
3. Phishing attacks: Attempting to acquire sensitive information such as patient health data, health insurance information, and even payment information by pretending to act as a trustworthy party or through fake emails.
4. Insider threats: Poorly trained employees may pose a security risk if they commit an error that leads to unintentionally compromising the data networks. In some cases, disgruntled employees may purposely leak information if they are able to gain access to sensitive data.

Learn more about the biggest threats in healthcare >

The vulnerabilities inherent in telehealth systems, such as reliance on public networks and the extensive use of mobile devices, exacerbate these threats.

What are the biggest cybersecurity challenges for European telehealth?

The rapid growth of telehealth in Europe has highlighted many new cybersecurity challenges. As patient safety, security, and privacy are the focus of healthcare cybersecurity, it’s essential that healthcare organizations protect themselves against their biggest risks and implement best practices going forward.

Here are some of the biggest cybersecurity challenges in European telehealth:

1. Cross-border data flows

Telehealth often involves the transfer of health data across borders, especially in a unified market like the European Union (EU). Managing the security and regulatory requirements of data that crosses international boundaries is complex, as countries have different levels of data protection standards, even within the EU framework.

2. Data privacy and compliance

The EU's strict data protection regulations, particularly those listed in the General Data Protection Regulation (GDPR), set high standards for the processing and handling of personal data. Telehealth platforms must ensure that they are compliant with these regulations, which involve securing protected health information (PHI), protecting patient rights, reporting any security incidents in a timely manner, and ensuring that data is processed and stored safely and securely.

3. Poor endpoint device and user security

Telehealth often relies on patients using their own devices to access services. These devices, such as smartphones and laptops, may not always be adequately secured or updated, making them vulnerable to cyber attacks. Additionally, healthcare providers might also use various medical devices and IoT technologies that are not secure.

4. Lack of standardization

Telehealth often requires the integration of various healthcare systems and technologies, such as the storage of electronic health records (EHRs), various diagnostic tools, and different billing systems. Currently, there is a lack of standardization can make interoperability difficult, as different systems may not effectively communicate or securely exchange data with each other. This complicates the user experience a great deal but can also introduce new zero-day vulnerabilities if data exchanges are not properly connected.

5. Use of legacy technology

The healthcare industry is known to be a heavy user of legacy technology, largely because the cost to upgrade can be fairly significant, causing many providers to push off getting new technology and equipment as long as possible. However, as a technology-first digital health service, telehealth organizations cannot afford to use legacy technology in case of a potential data breach or other cybersecurity issues, like a lack of security patches or updates provided.

6. Lack of telehealth legal frameworks

Although European telehealth must adhere to major data privacy standards such as GDPR, there are very few telehealth frameworks that provide guidance to build better cybersecurity practices for telehealth providers. As telehealth grows, if there are no legal frameworks to regulate the industry, it may lead to significant security concerns and other legal issues if any information systems become compromised.

What regulations currently govern the European telehealth industry?

Regulations for telehealth in Europe primarily revolve around data protection and privacy, given the sensitive nature of health-related information. It’s important to note that telehealth falls under other health sector guidelines but does not have regulations specifically directed at the telehealth industry.

Due to the sensitive digital nature of telehealth, it’s imperative that future EU legislations have more defined regulations regarding telehealth directly to better manage its usage. One of the major concerns with this rapidly growing industry is that there are very few legal frameworks regulating it, which can quickly lead to legal issues without the proper safeguards.

Currently, the key regulations on European healthcare include:

1. General Data Protection Regulation (GDPR): GDPR currently is the overarching legislation that enforces strict guidelines on data privacy and security for all entities operating in the EU.
2. ePrivacy Directive (2002/58/EC): Specifically relevant to electronic communications, the ePrivacy directive complements the GDPR and is currently under review to potentially include more specific provisions related to telehealth.
3. Medical Device Regulation (MDR): This regulation covers the approval, surveillance, and monitoring of medical devices, including software and telehealth technologies that are classified as medical devices.
4. ISO 13131: Titled “Health informatics — Telehealth services — Quality Planning Guidelines”, this is one of the newer standards of telehealth that is being adopted across European telehealth entities. ISO 13131 covers many aspects of quality management listed in ISO 9001, such as risk management, risk assessment, quality management, care planning, HR planning, facilities management, technology management, and information management.
5. Cross-Border Healthcare Directive (Directive 2011/24/EU): This directive provides rules for access to safe, cross-border healthcare within the EU. It includes provisions that affect telehealth, particularly regarding patient rights to seek healthcare services in another EU country and be reimbursed for them.

The future of EU telehealth

The future of EU telehealth comes with major potential for significant technological advancements and even more widespread adoption. However, in order for the industry to grow, so must its cybersecurity measures surrounding the safety and security of digital healthcare. As telehealth technologies evolve, regulations and standards governing them must be able to adapt as well.

However, with the continued collaboration between healthcare providers, information technology (IT) professionals, regulatory bodies, and policymakers, the future of the security of telehealth services in Europe looks to be extremely promising.