Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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Exam Number : PANCE
Exam Name : Physician Assistant National Certifying
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PANCE exam Format | PANCE Course Contents | PANCE Course Outline | PANCE exam Syllabus | PANCE exam Objectives

The material on NCCPA's certification and recertification exams can be organized in two dimensions:
Organ systems and the diseases, disorders and medical exams physician assistants encounter within those systems; and
The knowledge and skills physician assistants should exhibit when confronted with those diseases, disorders and exams.

Please note that while the subject matter covered on the certification and recertification exams is the same, there is some difference in the nature of the questions on those exams. Generally, the questions on the initial certification exam are more specific, while questions on the recertification exam tend to address broader clinical issues. This difference is most apparent in the questions related to applying basic science concepts and reflects the different functions of the two exams.

Note: Because of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) publication, NCCPA will adapt its content blueprints, disease and disorder lists, and psychiatry-related terminology within test questions to conform to DSM-5 classifications and diagnostic criteria for all of their examinations.

In NCCPA examinations, psychiatry-related terminology within test questions will include the DSM-5 terminology followed by the DSM-IV-TR terminology in parentheses. Example: illness anxiety disorder (hypochondriasis)

Based on delays in implementation of DSM-5 guidelines within the field of psychiatry, NCCPA will continue to present psychiatry-related terminology within test questions in the manner outlined above until further notice.

Beginning in 2019, there was a new content blueprint released for the Physician Assistant National Certifying exam (PANCE). The content blueprint provides guidance on the information assessed on the Physician Assistant National Certifying exam (PANCE). The examination is categorized in two dimensions:

Knowledge of the diseases and disorders physician assistants encounter; and Knowledge and skills related to tasks physician assistants perform when treating patients.

The detailed listings provided under each of these two categories represent examples of the material that may be covered on PANCE. It is not possible to include all courses on a single exam, and it may be possible that some questions on the exam cover content that is not listed in the examples.

The content blueprint for PANCE is based on information provided from certified physician assistants who participate in profession-wide practice analysis studies. Certified PAs are involved throughout the exam development process, including: reviewing results of the practice analysis, writing questions that appear on PANCE, reviewing exams before they are administered, reviewing performance data for exam questions, and developing recommendations for the passing standard. Certified PAs work with NCCPA to continuously review the content included on PANCE to ensure it is relevant and current, as the practice of medicine changes and treatment guidelines are revised or new ones introduced.

Cardiovascular System 13%

Dermatologic System 5%

Endocrine System 7%

Eyes, Ears, Nose, and Throat 7%

Gastrointestinal System/Nutrition 9%

Genitourinary System (Male and Female) 5%

Hematologic System 5%

Infectious Diseases 6%

Musculoskeletal System 8%

Neurologic System 7%

Psychiatry/Behavioral Science 6%

Pulmonary System 10%

Renal System 5%

Reproductive System (Male and Female) 7%

History Taking and Performing Physical exam 17%

Using Diagnostic and Laboratory Studies 12%

Formulating Most Likely Diagnosis 18%

Managing Patients

Health Maintenance, Patient Education, and Preventive Measures 10%

Clinical Intervention 14%

Pharmaceutical Therapeutics 14%

Applying Basic Scientific Concepts 10%

Professional Practice 5%

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AI in Primary Care? Sure, Bring It On -- But Check With End Users First

  • Fred Pelzman of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what's going on in the world of primary care medicine from the perspective of his own practice.

  • Might artificial intelligence (AI) hold some helpful answers for improving outpatient primary care?

    Over the past couple of months, interest in AI and its applications in medicine have been surging. We've been seeing more and more examples of ways that people have been implementing this in their practice, from the grassroots level all the way up to the startup company level.

    Clearly, this technology has the potential to be a really powerful tool to help make the lives of doctors, patients, and all healthcare team members much better. Applications range from assisting radiologists by pre-screening images for abnormalities to speeding up the process of protein folding for basic science researchers seeking candidates for cutting-edge new medications.

    But where does primary care fit in? In talking to colleagues, and seeing chatter on social media, lots of folks have been trying to figure this out, and while there have been occasional cool use cases, I think they still have a long way to go before they start seeing really fruitful uses of this amazing and sometimes terrifying new technology.

    Right now, a lot of the examples that I've seen have to do with simple tasks -- automating responses to the stuff they get all day long through the patient portal or in messages from their staff in the electronic health record.

    I think this is a lot like the idea of building macros and templated visits for the kind of repetitive tasks they do over and over again, like a standardized normal lab letter that they can send to a patient with the click of a button or insertion of a smart phrase, or crafting intelligible patient education materials for a new medical condition. "Create for me a set of user-friendly instructions for a patient, written at the 6th-grade level, explaining how to do the Epley maneuver at home for benign positional vertigo."

    But I think if they put their minds to it -- if they let ourselves dream big -- they can probably find more and better ways to have this stuff really make everybody's lives better. I think there are opportunities for individual patients, for chronic disease management for populations, and for preventive medicine interventions that they can build to help address gaps in care and overcome healthcare inequities.

    Think about it. How many times a day do you get a message like this in your electronic health record? "Patient says they are scheduled for their mammogram this week and you need to enter an order."

    True, this is a fairly simple process in the electronic health record. I open the encounter that that message is in, click in the Orders section, type in "mammogram," select the appropriate test, link it to a diagnosis of "breast cancer screening," select the future date it is scheduled for, click "Sign," and the order is routed down to the radiologist's office who is responsible for getting prior authorization from the patient's insurance company and aligning that order with the patient's scheduled appointment.

    Whew! Lots of clicks, a few minutes of their precious time, not much clinical brainpower required, and not why they went into the field of medicine.

    For simple healthcare maintenance items that are regularly scheduled, rather than even this fairly simple process having to go to a provider, wouldn't it be great if they could teach the machines to think for us and recognize these gaps in care? They could respond to basic well-circumscribed requests, scrub the charts and find what's missing or what may in fact have actually been done but just not entered correctly in the chart, and help us get this work done behind the scenes, so they almost never need to see much of anything about it.

    I think of this as having a digital medical assistant working by my side, working much faster and more efficiently than any human could, seeing who's missing their colonoscopy, who never came in for their follow-up labs, who needs a video visit for follow-up for their smoking cessation or their diabetes, and who said they were going to go get their shingles vaccine done at their local pharmacy but apparently never did. This "assistant" could set all these up and line them up for me to sign and approve.

    In the future, as they get more sophisticated, perhaps these things will be humming along beside us -- listening in on their conversations with their patients; collecting data from their physical exam, laboratory findings, imaging results, and notes; helping us synthesize; acting as a peripheral brain; making suggestions; tweaking their differential diagnosis list; and prodding us and reminding us in ways they won't find annoying.

    Hopefully, smarter people than me are out there working on these things. I would just request that they do this with guidance from the people who are out here doing this work day to day. Talk to us and find out what bugs the heck out of us. Ask whether that system you're trying to build would really make their lives better, or would just add a lot more busywork to their already hectic, overwhelmed, and burned-out days.

    We've seen it with things like the electronic health record, the existing telephone answering system tweaks, Open Notes, or immediate and automatic release of labs for patients to view: far too often, when a group of people thinks something's a really great idea, they forget to check with the people it will impact most -- the providers on the front line as well as the patients -- to really make sure they're doing the best thing for everybody involved.

    If they move into this brave new world with the right level of guidance and feedback, not just forging ahead blindly because someone thinks it's a good idea, we're more likely to end up with a new suite of powerful tools that actually make everybody happy.

    And help us take better care of everyone.

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    Las Vegas opening health center for homeless, low-income patients

    The two-story clinic in the city of Las Vegas’ Courtyard Homeless Resource Center sat mostly empty Wednesday morning as workers added finishing touches in preparation for its upcoming opening.

    But come Monday, Las Vegas officials hope that the Health &Wellness Center will become a “medical home” for those experiencing homelessness, and for low-income earners who live in the surrounding neighborhoods.

    “Everything you would see in any other clinic, in any other part of the town is here,” said Jocelyn Bluitt-Fisher, the city’s community resources manager, during a tour of the facility.

    The wellness center, located on 8,532 square feet on Main Street and Foremaster Lane, will be operated by Nevada Health Centers, a federally-accredited contractor. It will include exam rooms, a pharmacy and a lab to examine bloodwork.

    A company spokesperson said that the center will be staffed by 17 employees, including a full-time advanced practice registered nurse and a per-diem physician assistant. Nevada Health Centers also is working to hire a full-time doctor.

    The city has so far invested about $6.4 million in the facility, Bluitt-Fisher said.

    It’s one of 10 health and wellness centers the city aims to develop across town, and the second that’s been built, Bluitt-Fisher said. Two more — one that will be located in the Historic Westside and another in east Las Vegas — are in the planning stages, she said.

    The city conceptualized the system years ago when it began purchasing land with the intention of helping underserved residents “get back on their feet,” Bluitt-Fisher said.

    The wellness center — which resembles an oversized “quick care” facility — will compliment a smaller clinic already operating in the courtyard, which serves as a triage for the shelter’s unhoused population.

    The new clinic will also serve as an educational hub to prevent the patients from getting progressively ill.

    “We’re focusing on wellness, not just medical treatment,” Bluitt-Fisher said. “We want them to have a relationship with a medical home before they get sick.”

    She said that anyone who walks in the door will be served, regardless of economic situation or immigration status.

    “If they can provide all those educational opportunities, remove some of the barriers that make health care a little scary,” Bluitt-Fisher said, “then they are on target to improving the health and wellness of their entire city.”

    Contact Ricardo Torres-Cortez at rtorres@reviewjournal.com. Follow him on Twitter @rickytwrites.


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    Warum sind Cyberrisiken so schwer greifbar?

    Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

    Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

    Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

    Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

    Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

    Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

    Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

    Nicht kriminelle Ursachen

    Höhere Gewalt

    Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

    Menschliches Versagen/Fehlverhalten

    Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

    Technisches Versagen

    Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

    Kriminelle Ursachen


    Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

    Physischer Angriff

    Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.


    Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

    Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:


    • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
    • Krisenkommunikation / PR-Maßnahmen
    • Systemverbesserungen nach einer Cyber-Attacke
    • Aufwendungen vor Eintritt des Versicherungsfalls

    Cyber-Drittschäden (Haftpflicht):

    • Befriedigung oder Abwehr von Ansprüchen Dritter
    • Rechtswidrige elektronische Kommunikation
    • Ansprüche der E-Payment-Serviceprovider
    • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
    • Vertragliche Schadenersatzansprüche
    • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
    • Rechtsverteidigungskosten


    • Betriebsunterbrechung
    • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
    • Mehrkosten
    • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
    • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
    • Cyber-Erpressung
    • Entschädigung mit Strafcharakter/Bußgeld
    • Ersatz-IT-Hardware
    • Cyber-Betrug