The most effective way to avoid paying the ransom in a ransomware attack is to have a properly tested offline backup system. A ransomware attack is a type of cyberattack that encrypts the victim's data or systems and demands a payment for the decryption key. A properly tested offline backup system is a method of storing copies of the data or systems in a separate location that is not connected to the network or the internet. By having a properly tested offline backup system, the hospital can restore its critical server from the backup without paying the ransom or losing any data. The other options are not the most effective way to avoid paying the ransom in a ransomware attack, although they may be some preventive or detective measures. Employee training on ransomware is a preventive measure that can help raise awareness and reduce the likelihood of falling victim to phishing or other social engineering techniques that may deliver ransomware. However, it does not guarantee that employees will always follow best practices or that ransomware will not enter the network through other means. A continual server replication process is a method of creating copies of the server data or systems in real time or near real time. However, it may not be effective against ransomware, as the replication process may also copy the encrypted data or systems, making them unusable. A properly configured firewall is a preventive measure that can help block malicious network traffic and prevent unauthorized access to the server. However, it does not guarantee that ransomware will not bypass the firewall through other channels, such as email attachments or removable media.

The greatest concern for an information security manager in this situation would be the security of the data that is being processed by the third-party service provider working from a remote site. This could be a concern because the data may not be adequately protected from unauthorized access, manipulation, or theft. A secure communications protocol should be used to ensure the confidentiality and integrity of the data in transit. Additionally, the information security manager should ensure that the third-party service provider has appropriate security controls in place to protect the data, such as access controls, error checking, and malware protection. This information can be found in the ISACA's Certified Information Security Manager (CISM) Study Manual, Section 5.2.

The organizational risk register is the most useful for an information security manager when determining the need to escalate an incident to senior management because it contains a list of identified risks to the organization, their likelihood and impact, and their predefined risk thresholds or targets, which can help the information security manager assess the severity and urgency of the incident and decide whether it requires senior management's attention or action. Incident management procedures are not very useful for this purpose because they do not provide any specific criteria or guidance on when to escalate an incident to senior management. Incident management policy is not very useful for this purpose because it does not provide any specific criteria or guidance on when to escalate an incident to senior management. System risk assessment is not very useful for this purpose because it does not reflect the current risk exposure or status of the organization as a whole. Reference: https://www.isaca.org/resources/isaca-journal/issues/2016/volume-6/how-to-measure-the-effectiveness-of-information-security-using-iso-27004 https://www.isaca.org/resources/isaca-journal/issues/2017/volume-5/incident-response-lessons-learned