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The IS auditor’s most important course of action after finding that several similar incidents were logged during the audit period is to determine if a root cause analysis was conducted. A root cause analysis is a systematic process that identifies the underlying causes of system failures or incidents. A root cause analysis can help to prevent recurrence of similar incidents, improve system performance and reliability, and enhance incident management processes. The IS auditor should evaluate whether a root cause analysis was performed for each incident, whether it was timely and thorough, and whether it resulted in effective corrective actions.

 Data integrity is the property that ensures that data is accurate, complete, consistent, and reliable throughout its lifecycle. The best data integrity check is tracing data back to the point of origin, which is the source where the data was originally created or captured. This check can verify that data has not been altered or corrupted during transmission, processing, or storage. It can also identify any errors or discrepancies in data entry or conversion. Counting the transactions processed per day is a performance measure that does not directly assess data integrity. Performing a sequence check is a validity check that ensures that data follows a predefined order or pattern. It can detect missing or out-of-order data elements, but it cannot verify their accuracy or completeness. Preparing and running test data is a testing technique that simulates real data to evaluate how a system handles different scenarios. It can help identify errors or bugs in the system logic or functionality, but it cannot ensure data integrity in production environments. References: Information Systems Operations and Business Resilience, CISA Review Manual (Digital Version)

The most effective control for protecting the confidentiality and integrity of data stored unencrypted on virtual machines is to monitor access to stored images and snapshots of virtual machines. Images and snapshots are copies of virtual machines that can be used for backup, restoration, or cloning purposes. If data stored on virtual machines are unencrypted, they may be exposed or compromised if unauthorized or malicious users access or copy the images or snapshots. Therefore, monitoring access to stored images and snapshots can help detect and prevent any unauthorized or suspicious activities, and provide audit trails for accountability and investigation.

Restricting access to images and snapshots of virtual machines, limiting creation of virtual machine images and snapshots, and reviewing logical access controls on virtual machines regularly are not the most effective controls for protecting the confidentiality and integrity of data stored unencrypted on virtual machines. These controls may help reduce the risk or impact of data exposure or compromise, but they do not provide sufficient visibility or assurance of data protection. Restricting access to images and snapshots may not prevent authorized users from abusing their privileges or credentials. Limiting creation of virtual machine images and snapshots may not address the existing copies that may contain sensitive data. Reviewing logical access controls on virtual machines regularly may not reflect the actual access activities on images and snapshots.

The best test to provide assurance that a health care organization is handling patient data appropriately is compliance with local laws and regulations, as these are the primary sources of authority and obligation for data protection and privacy. Compliance with action plans, industry standards, or organizational policies and procedures are also important, but they may not cover all the legal requirements or reflect the current best practices for handling patient data. References: CISA Review Manual (Digital Version), Chapter 2, Section 2.3