Data theft-It’s not just for medical facilities

 There’s been volumes written about data theft in medical facilities, methods, and effects. This is no

wonder given the mountain of data created daily from the patient care and operations. Another viable

target would be auto dealerships. This hold much the same data hospital would generally. When a

person purchases their vehicle, as a course of the process, they provide their name, address, data of

birth, SSN, financial information, and other data. The hospital or medical care facility collects much the

same, with additional data for the patient care.

In this case an automotive dealership was compromised. On or about May 27, 2023, the Jeff Wyler

Automotive Family an unauthorized party compromised their perimeter security and was able to access

the consumer information (e.g., name, date of birth, SSN, driver’s license or state ID #, medical

information, health insurance information, and financial information). This was detected on January 29,

2024.

The method of attack unfortunately was not detailed. Anytime this event occurs, there’s something to

learn and use to build up your defenses. This experience does highlight the need for regular

cybersecurity assessments. This, depending on the environment and budget, may consist of vulnerability

scans, per tests, and threat feeds for your equipment. This also includes working on the vulnerabilities to

remove these and secure your system.

Autonomous Vehicles (AVs) have a Substantial Attack Surface

 This is a fantastic age to live in. We have vehicles that notify us when another vehicle is near us, when we’re too close to the vehicle in front of us or the side of the road, when we are sliding inadvertently into the next lane, and log our activities. This is a massive step from the vehicles of 10-15 years ago. The sensors installed within the vehicle offer cutting edge technology for the driver. These also have improved safety for the occupants along with others on the roadmap. Have pentested an AV, I can attest this is a delight.

While I sing the praise of the AVs, there are issues. This has potential threats to the AVs due to the platform, sensors, and OS. These are all new attack surfaces and vulnerabilities. If exploited, these provide an opportunity for disaster. The new threats come from various sources. These new machines, as they are heavily dependent on software, are open to remote attacks. If successful, modules could be compromised. Depending on which one is targeted and breached, there are varying levels of criticality. For instance, steering or brake ECUs are relatively serious.

Data is the new gold and oil. This is especially the case with vehicles. Each collects a mass amount of data from general operations and the sensors. The data may be used in multiple scenarios.

While sensors have improved vehicle operations and safety, there are potential issues here also. The sensors could be spoofed, providing false data to the vehicle and data processing. The fake data could provide a false set of data for the surroundings. This could lead the vehicle on the wrong path.

While this could provide for issues, there are preventive measures to the taken. The software may be hardened, making these more robust. Patching is also pertinent. This occurring regularly limits the attack surface. Encryption should be used with vehicles data and communication. This limits the weak points which are targets.

  

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Medical Device Connectivity

 

With our new technology advancing so rapidly on different fronts, the nuances in applications are growing. One of these is connectivity. Most of the public is aware of connectivity in vehicles. We see this as we’re driving with the infotainment system, making calls, or following a map. This is not by far the only industry embracing connectivity.

Another is the medical device field. Globally, this is estimated to triple its value by 2028. This may take the form of home health monitors, or cardiac monitors reporting data to the backend or receiving updates.

There are several factors driving this massive increase. One of these includes telehealth. Our population has endured much through the pandemic and post-pandemic. This has shaped how we shop, gather information, and utilize healthcare. The need and want for home healthcare has assisted in the growth. If the patients didn’t want it, there wouldn’t be the need or market for this. Related to this is remote patient monitoring. This may involve cardiac or other monitoring. This advance allows the patient to stay in their home while the device collects the data and uploads it to the doctor or other device.

While this works great for the patient and doctor, this also adds to the attack surface and provides another point to test. This is another area to secure, test, and maintain through the SDLC. 

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New International Medical Device Standard

 With standards, regulations, statutes, etc., many feel this is a speedbump for their product. In the interest of the field, industry patient safety, and security these are a great idea. Without these in place, medical device cybersecurity could become like the Weld West with every entity doing their own thing, not following any guidance.

The FDA has recognized three new standards focused on medical device software security. These cover the total product lifecycle of medical device cybersecurity, data logging, software use, and reasonable software testing.

The first noted standard was ANSI/AAMI 2700-2-1. This standard is focused on medical device software’s safe usage in the integrated clinical environment (ICE). The specific usage is for data loggers to appropriately collect data in these systems. This includes the recording, data, storage, and playback for the data. The data usage would be for safety, quality assurance, and forensic analysis.

The second standard was ANSI/AAMI SW96:2023, which provides guidance on methods to manage security risks. Medical devices present a unique security risk. The standard addresses several security areas to identify threats and vulnerabilities and the controls to put in place to mitigate these.

Lastly ISO IEC IEEE 29119-1 provides guidance on germane topics in the field including software.

These standards provide additional guidance and a framework to further the safety and security for the products. By adding these into our security tools, the attack surface is decreasing, and potential attacks are mitigated.

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IoT Devices Need Cybersecurity Attention

 IoT devices have evolved and expanded into commercial, and consumer uses. These appear throughout people’s homes with refrigerators, ovens, thermostat, light bulbs, and many other pieces of equipment.

Smart thermostats have become more prevalent in residences in the last few years. These are a nice addition in that these are trained to learn your optimal temperature, when you on average are in the house, and other useful assists.

While these have beneficial aspects with this, let’s not forget about detriments. When smart thermostats have not included cybersecurity through their dev cycle and SDLC, you can be answering many questions from clients, federal agencies, and other interested persons and stakeholders when something goes wrong (i.e., a significant compromise).

Recently two models for smart thermostats have been noted to have multiple security vulnerabilities. When successfully exploited, the bad actors would be executing the code they wanted on the device. The device could be weaponized with modified or rogue firmware.

The vulnerability allows an unauthenticated connection from a local network. The attack point is the WIFI microcontroller. This acts as a network gateway. This has been corrected, but only after the vulnerability had been known and open. This emphasizes the need for cybersecurity to be applied through the dev cycle, with security being at each gate. This also requires staff being comfortable in working with embedded systems, and all the nuances associated with these. Embedded systems require a different set of skills, different than the traditional IT.

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Standards Assist with Medical Device Cybersecurity

 The technology expansion is pushing the options for medical device connectivity. The options and configurations used to be relatively limited. Connectivity continues to grow in its different forms. While this is great for the industry, doctors, and patients, applied cybersecurity also needs to be addressed in every step of the way.

These connected devices connect to the network using Bluetooth, BLE, or WIFI for communications. If configured correctly and cybersecurity being incorporated throughout the process, generally this should work well. To assist with this and provide guidance there are standards for medical devices (e.g., IEC 62304, ISO 14971, and FDA guidance). These provide directed guidance. The key though is documentation. The documents need to show not only you have secured these standards but have implemented them. Part of the plan and implementation includes the product’s risk analysis. I mention this specifically is the risk analysis or TARA is the bedrock for risk analysis. When thorough this will show the vulnerabilities, which need to be addressed. This system’s review will build a solid cybersecurity plan and product for your customers.

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Chicago Children's Hospital Targeted

 

There’s been a lot written about medical facilities being targeted and compromised over the last five years. The compromises have varied with their penetration into the network and data. The greater the attack’s expanse, the more potential for patient suffering. In late January/early February, Lurie Children’s Hospital system was compromised. This was rather significant with their phones, email, internet service, and medical equipment affected. These systems are in different operational areas in their network, which indicates this was a bit more than the usual attack. The department for penetration in the different systems is notable.

The timeframe for the affected systems was relatively short, at two days. This was still devastating for the staff and patients. The situation was further complicated by the data from the operations that did continue having to be merged into existing data sets.

With hospitals holding so much valuable data, this trend will continue if not grow. There is ample to do with all the patient PII, insurance information, medical history, and other data the hospitals have accumulate every day.

To rebound from this is much more than getting the systems up. The security staff needs to also understand the attack vector and how it was implemented, what systems were breached (not only the ones that were overly noticed), and what data was accessed.

The hospital has much work to do with the incident response. This unfortunately is a prime example of what can happen. Systems need not only be secured but monitored and the tooling reviewed at a regular cadence. Just like the industry is dynamic, so is the tolling. There may be better options or configurations available in the next review cycle.

 

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Repository=Malware Depository

 Not too long ago, repositories were not targeted. If you used a library or repository, there was a reasonable assumption it could be trusted and used without an issue. There started to be a trend around 2017 with malicious packages being placed in the Python Package Index (PyPI). There was also the case of the University of Minnesota sending buggy packages to Linux as a research experiment. Somehow this was approved by their research ethics board. The University was banned for their behavior from the repository.

In January 2024, more malicious packages were detected in the PyPI. One piece of malware noted this time around was the White Snake Stealer. These were uploaded by a bad actor named “WS”. The malware is designed to harvest data from web browsers, cryptocurrency wallets, and apps.

This is one reason not to blindly trust the repositories. You never know. Generally, you will be fine. As President Reagan is often quoted, “Trust, but verify.” There are several tools openly available to scan these for vulnerabilities. The last thing you want is to poison your elegant code with malicious code from a “trusted” repository. 

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Medical IoT Devices

 The technology with medical devices and the protocols continue to improve. For example, we started with WIFI, moved to BlueTooth, and improved to BLE (BlueTooth Low Energy). There are many other examples throughout the products. One of the latest pushes is for AI integration. This has vast potential to improve the entire device’s operations and security. The full integration of IoT into medical devices cannot be overlooked.

There are several factors driving this. There is an increasing demand for remote patient monitoring. Our population is aging. The demographics are clear. The aging population has more chronic diseases, which tends to need more of this remote patient monitoring. These can provide real-time monitoring for the patient’s vital signs, for example. This allows for ease of collecting data and proactive management for chronic diseases.

The connectivity has also been beneficial. The updated protocols allow for the ease of data transmission. These also have greater security, which likewise is a bonus.

With the vast amount of data collected, the patient’s doctors can provide a much more specialized level of patient care. The diagnosis and treatment have the potential to be specifically tailored for them.

With the ease of use, functionality, and improved security, these may be used in many more types of facilities. This includes hospitals, rehabilitation centers, homes, and other facilities.

 

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Capital Health Breached

 

No CISO wants to receive the urgent call from the SOC informing them of an issue. This may take the form of a request to make a missed vendor payment by month end or there’s a user that keeps on clicking on the internal phishing campaign emails. The conversation you don’t really want revolves around the defenses being breached. That is clear and immediate project.

Capital Health (NJ) had such an occurrence. LockBit 3.0 claims to have compromised the defenses and liberated over 10M files or over 7TB of confidential medical data. The estimated value of this was $250k. The group did have a bit of their conscious during the attack. They didn’t encrypt the data which quickly would have interfered with the patient care. It’s notable though LockBit 3.0 did not post evidence to document this. While this is the case, there were network outages near the end of December due to a cybersecurity incident. This is not a new event, as too many medical facilities have experienced this on some level.

There have been minimal details as to this which is the standard model. This does highlight the need for this industry to be hyper vigilant and maintain your info cybersecurity toolsets. Periodically when your contract is nearing renewal for the tools, scan the other vendors for their offerings and pricing. Running a PoC and going through the vendor vetting can take time, but it may be well worth it. 

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Security by Obscurity

 

During the budgeting cycle, departments may ask for increases in their respective budget, padding it or to accommodate capital purchases. When the senior management does not recognize the importance of security, the thought may float through their mind of what if we do nothing? After all, nothing has happened.

Well, nothing has happened…yet. The healthcare industry is targeted for many reasons and there are many options as to the individual targets, methods of attack, and other facets. A breach in this environment is horrific operationally with systems shut down for days or weeks, ERs shut down, patient data exfiltrated, etc. There is also the potential for patient mortality being directly attributable to the breach. Financially this can be a nightmare as the healthcare provider has to quickly address the issues and contract with a forensic firm to review the breach, what was accessed, and everything else with the issue. This is not cheap.

By ignoring cybersecurity and thinking you can get through the next cycle without adequately addressing this, the healthcare provider is doing everything they can to set themselves up for failure on the business, functional, and patient care side.

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