Organizations of major importance to the German state whose failure or disruption would result in sustained supply shortages, significant public safety disruptions, or other dramatic consequences are categorized as critical infrastructure (KRITIS).

Nine sectors and 29 industries currently fall under this umbrella, including healthcare, energy, transport and financial services. Hospitals as part of the health care system are also included if they meet defined criteria.

For hospitals, the implementation instructions of the German Hospital Association (DKG) have proven to be important. The number of fully inpatient hospital treatments in the reference period (i.e. the previous year) was defined as the measurement criterion. With 30,000 fully inpatient treatment cases, the threshold value for the identification of critical infrastructures has been reached, which concerns considerably more than 100 hospitals. These are obliged to fulfil clearly defined requirements, which are derived from the IT-SiG - "Gesetz zur Erhöhung der Sicherheit informationstechnischer Systeme (IT-Sicherheitsgesetz)" - for the security of IT systems and digital infrastructures, including critical infrastructures in Germany, and the BSI-KritisV - "BSI-Kritisverordnung". The above-mentioned implementation instructions of the DKG thus also define proposed measures for the assurance of adequate security, in particular about the IT used.

Companies had until June 30th this year to meet the requirements and to commission a suitable, trustworthy third party for testing and certification.

But according to a report in Tagesspiegel Background, this has been challenging: industry associations have been pointing out for some time that there are not enough suitable auditing firms. This is not least due to the fact that auditors must have a double qualification, which in addition to IT also includes knowledge of the industry, in this case the healthcare system in hospitals. Here, as in many other areas, the infamous skill gap strikes, i.e. the lack of suitable, qualified employees in companies or on the job market.

This led to the companies capable of performing the audits being overloaded and thus to a varying quality and availability of audits and resulting audit reports. According to the press report, these certificates suffer the same fate when they are submitted to the BSI, which evaluates these reports. Here, too, a shortage of skilled workers leads to a backlog of work. A comprehensive evaluation was not available at the time of publication. Even the implementation instructions of the German Hospital Association, on the basis of which many implementations were carried out in the affected hospitals, have not yet been confirmed by the BSI.

Does this place KRITIS in the list of toothless guidelines (such as PSD2 with its large number of national individual regulations) that have not been adequately implemented, at least in this area? Not necessarily.. The obligation to comply has not been suspended; the lack of personnel and skills on the labour market merely prevents consistent, comprehensive testing by suitable bodies such as TÜV, Dekra or specialised auditing firms. However, if such an audit does take place, the necessary guidelines are applied and any non-compliance is followed up in accordance with the audit reports. The hospitals concerned are therefore advised they should have  fulfilled the requirements by the deadline and to continue working on them in the name of continuous implementation and improvement.

Even hospitals that today slightly miss this threshold are now encouraged to prepare for adjustments to requirements or increasing patient numbers. And this means that even without the necessity of a formal attestation, the appropriate basic conditions, such as the establishment of an information security management system (ISMS) in accordance with ISO 27.001, can be created to serve as a foundation.

In addition, the availability of a general framework for the availability and security of IT in this and other industries gives other sector players (such as group practices or specialist institutes) a resilient basis for creating appropriate framework conditions that correspond to the current state of requirements and technology. This also applies if they are not or will not be KRITIS-relevant in the foreseeable future, but want to offer their patients a comparably good degree of security and resulting trustworthiness.

KuppingerCole offers comprehensive support in the form of research and advisory for companies in all KRITIS-relevant areas and beyond. Talk to us to address your cybersecurity, access control and compliance challenges.

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