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The Security Risks of Medical Devices

The Security Risks of Medical Devices | Healthcare and Technology news | Scoop.it
There are a large number of potential attack vectors on any network. Medical devices on a healthcare network is certainly one of them. While medical devices represent a potential threat, it is important to keep in mind that the threat level posed by any given medical device should be determined by a Security Risk Assessment (SRA) and dealt with appropriately.

So let’s assume the worst case and discuss the issues associated with medical devices. First off, it must be recognized that any device connected to a network represents a potential incursion point. Medical devices are regulated by the FDA, and that agency realized the security implications of medical devices as far back as November 2009, when it issued this advisory. In it, the FDA emphasized the following points:

Medical device manufacturers and user facilities should work together to ensure that cybersecurity threats are addressed in a timely manner.
The agency typically does not need to review or approve medical device software changes made for cybersecurity reasons.
All software changes that address cybersecurity threats should be validated before installation to ensure they do not affect the safety and effectiveness of the medical devices.


Software patches and updates are essential to the continued safe and effective performance of medical devices.


Many device manufacturers are way behind on cybersecurity issues. As an example, many devices are still running on Windows XP today, even though we are one year past the XP support deadline. They are often loathe to update their software for a new operating system. In other situations device manufacturers use the XP support issue as a way to force a client to purchase a new device at a very high price. All healthcare facilities would be well advised to review any purchase and support contracts for medical devices and make sure that things such as Windows upgrades do not force unwanted or unnecessary changes down the road. While there are options to remediate risks around obsolete operating systems, they are unnecessary and costly. Manufacturers should be supporting their products in a commercially reasonable manner.

Why would anyone be interested in hacking into a medical device? Of course there are those that would argue that anything that can be hacked will be hacked, “just because”. While it is possible that hacking could also occur to disrupt the operations of the device, the more likely reason is that getting onto a medical device represents a backdoor into a network with a treasure trove of PHI that can be sold for high prices on the black market. Medical devices are often accessible outside of normal network logon requirements. That is because manufacturers maintain separate, backdoor access for maintenance reasons.


Hackers armed with knowledge of default passwords and other default logon information can have great success targeting a medical device. For example, this article details examples of a blood gas analyzer, a PACS system and an X-Ray system that were hacked. Many times healthcare IT departments are unaware or unable to remediate backdoor access to these systems. These are perhaps more “valuable” as a hack because they are hard to detect and can go unnoticed for a long period of time. As a reminder, the Target data breach last year was initiated because the access that a third party had to the retailer’s network was compromised. A complete SRA should inventory all network connected medical devices and analyze the access/credentials that a device has, and any associated security threat. The best defense is a good offense – make sure that networked devices have proper security built in and implemented. Then your devices will no longer be “the weak link in the chain”.

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The radical potential of open source programming in healthcare

The radical potential of open source programming in healthcare | Healthcare and Technology news | Scoop.it

Everyone wants personalized healthcare. From the moment they enter their primary care clinic they have certain expectations that they want met in regards to their personalized medical care.


Most physicians are adopting a form of electronic healthcare, and patient records are being converted to a digital format. But electronic health records pose interesting problems related to sorting through vast amounts of patient data.


This is where open source programming languages come in, and they have the ability to radically change the medical landscape.

So why aren’t EHRs receiving the same care that patients expect from their doctor? There are a variety of answers, but primarily it comes down to how the software interprets certain types of data within each record. There are a variety of software languages designed to calculate and sort through large amounts of data that have been out for years, and one of the most prominent language is referred to as “R”.

What is R?

According to r-project.org “R is an integrated suite of software facilities for data manipulation, calculation, and graphical display.” Essentially this programming language has been built from the ground up to handle large statistical types of data.


Not only can R handle these large data sets, but it has the ability to be tailored to an individual patient or physician if needed. There are a variety of other languages focused on interpreting this type of data, but other languages don’t have the ability to handle it as well as R does.

How can a language like R change the way in which EHRs function?

Take, for instance, the recent debate regarding immunization registry. EHRs contain valuable patient data, including information associated with certain types of vaccine.


If you were able to cross reference every patient that had received a vaccine, and the side effects associated with said vaccine, then you could potentially sort out what caused the side effect and create prevention strategies to deter that certain scenario from happening again.


According to Victoria Wangia of the University of Cincinnati, “understanding factors that influence the use of an implemented public health information system such as an immunization registry is of great importance to those implementing the system and those interested in the positive impact of using the technology for positive public health outcomes.”


This type of system could radically change the way we categorize certain patient health information.


Programming languages like R have the ability to map areas that have been vaccinated versus those that haven’t. This would be ideal for parents who wish to send their children to a school where they know that “x” number of students have received a shot versus those that haven’t. Of course, these statistics would be anonymous, but this information might be critical for new parents who are looking for a school that fits their needs.


This technology could have much bigger implications pertaining to personalized data, specifically healthcare records. Ideally, an individual could tailor this programming language to focus on inconsistencies within patient records and find future illnesses that people are unaware of.


This has the potential to stop diseases from spreading, even before the patient is aware that they might have a life threatening illness. Although such an intervention wouldn’t necessarily stop a disease, it could be a great prevention tool that would categorize certain types of illness.

Benefits of open source

One of the more essential functions that R offers is the ability to be tailored to patient or doctor’s needs. Most information regarding patient health depends on how a physician documents the patient encounter, but R has the ability to sort through a wide variety of documentation pertaining to important statistical information that is relevant to physician needs. This is what makes open source programming languages ideal for the medical field.


One of the great components associated with open source programming languages in the medical field is the cost. R is a completely free language to start working in, and there is a large amount of great documentation available to start learning the language. The only associated cost would be paying a developer to set up, or create a program that quickly sorted through personalized information.


Essentially, if you were well rounded in this language, the only cost associated with adopting it would be the paper you would need to print information on.


Lastly, because of HIPAA, the importance of information security has been an issue, and should be a primary concern when looking at any sensitive electronic document. Cyber security is always going to be an uphill battle, and in the end if someone wants to get their hands on certain material, they probably will.


Data breaches have the ability to cost companies large amounts of money, and not even statistical data languages are safe from malicious intent. A recent issue has been the massive amount of resources that are being built in R that have been shared online. Although this is a step in the right direction for the language, people are uploading malicious code. But if you are on an encrypted machine, ideally the information stored on that machine is also encrypted. Cloud based systems like MySQL, a very secure open source server designed to evaluate data, offer great solutions to these types of problems.


These are some of the reasons why more physicians should adopt these types of languages, especially when dealing with EHRs. The benefits of implementing these types of systems will radically alter the way traditional medicine operates within the digital realm.


More statistical information about vaccinations and disease registries would greatly benefit those that are in need. The faster these types of systems are implemented, the more people we are able to help before their diseases becomes life threatening.


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Healthcare cybersecurity info sharing still a work in progress

Healthcare cybersecurity info sharing still a work in progress | Healthcare and Technology news | Scoop.it

While President Barack Obama issued an executive order to use information sharing and analysis organizations (ISAOs) to boost cybersecurity awareness and coordination between private entities and the government, those efforts need more development before they provide useful information, according to an article at The Wall Street Journal.


About a dozen longstanding nonprofit Information Sharing and Analysis Centers (ISACs) serve specific sectors such as finance, healthcare and energy, and work with government on infomation sharing.


Though more narrowly focused, many ISAOs already exist, Deborah Kobza, executive director of the National Health Information Sharing and Analysis Center, told HealthcareInfoSecurity.


Executives who spoke with WSJ say large entities don't get much useful information from ISACs.


"Most of us are willing to put information into it largely because it provides good initial facilitation and informal networking opportunities," Darren Dworkin, CIO of Cedars-Sinai Medical Center and a member of the healthcare ISAC, tells the newspaper. As sharing standards are developed, he adds, "expectations will mount in terms of the kinds of specific data needed as everybody figures it out."


What's more, networking within the industry, Dworkin says, tends to provide more information about what's going on. ISACs generally are more useful to smaller organizations that lack security expertise in-house, the article adds.


The Health Information Trust Alliance (HITRUST), which quickly endorsed Obama's plan, said it is one of the ISAOs. HITRUST is working with providers to test and improve their preparedness for attacks through its CyberRX 2.0 attack simulations. The need for organizations to be more open about attacks was one of the early lessons from that program.


Participants in the recent White House Summit on Cybersecurity and Consumer Protection stressed that threat data-sharing doesn't pose the danger of exposing patients' insurance and healthcare information.


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11 Paths's curator insight, 8 April 2015, 09:30

This is a great news story

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Anthem Arrogantly Refuses Audit Processes. Twice.

Anthem Arrogantly Refuses Audit Processes. Twice. | Healthcare and Technology news | Scoop.it
Recently, I took a bunch of heat for writing that Anthem was right not to encrypt. My point was that the application encryption is just one of several security measures that add up to a security posture, and that we needed to wait until we got more information before condemning Anthem for a poor security posture.

A security posture is the combination of an organization’s overall security philosophy as well as the specific security steps that the organization takes as a result of that philosophy. Basically the type of posture taken shows whether an organization takes security and privacy seriously, or prefers a “window dressing” approach. I argued that simply knowing that the database in question did not have encryption was not enough detail to assess the Anthem security posture.

Well we have more evidence now, and its not looking good for Anthem.

Recently GovInfoSecurity reported that Anthem has again refused the OIG the ability to scan its network. OIG prefers to perform it’s own vulnerability assessments, so that it does not have to rely on the organizations internal assessments.

This is not the first time this has happened. When Anthem was called “WellPoint” it refused a request from OIG to scan, according to the OIG’s report at the time. OIG stands for Office of Inspector General and is essentially the “generic audit arm” of the US government. They are responsible for ensuring that government contractors are complying with regulations, and Anthem has an important contract to process medical claims for Federal Employees.

Here is what OIG had to say about this issue in September of 2013, the first time that Anthem refused its audit process:

This performance audit was conducted in accordance with generally accepted government auditing standards (GAS) issued by the Comptroller General of the United States, except for specific applicable requirements that were not followed. There was one element of our audit in which WellPoint applied external interference with the application of audit procedures, resulting in our inability to fully comply with the GAS requirement of independence.

We routinely use our own automated tools to evaluate the configuration of a sample of computer servers. When we requested to conduct this test at WellPoint, we were informed that a corporate policy prohibited external entities from connecting to the WellPoint network. In an effort to meet our audit objective, we attempted to obtain additional information from WellPoint, but the Plan was unable to provide satisfactory evidence that it has ever had a program in place to routinely monitor the configuration of its servers (see the “Configuration Compliance Auditing” section on page 9 for additional details.)

As a result of the scope limitation on our audit work and WellPoint’s inability to provide additional supporting documentation, we are unable to independently attest that WellPoint’s computer servers maintain a secure configuration.

Just months before, in July of 2013 Anthem (as WellPoint) had just payed 1.7 Million dollars for a HIPAA violation. That fine was the result of an investigation that found that Athem had not:

adequately implement policies and procedures for authorizing access to the on-line application database
perform an appropriate technical evaluation in response to a software upgrade to its information systems
have technical safeguards in place to verify the person or entity seeking access to electronic protected health information maintained in its application database.

Vulnerability scanning is intended, among other things, to detect exactly these kinds of problems.

Anthem felt, in 2013, that even though it just had a massive breach, that it was in a position to deny OIG the capacity to verify Anthem’s claims about its own network. Now, in 2015, Anthem has just had a second massive breach, and has again indicated to OIG that is has a “corporate policy” that again prevents OIG from conducting a vulnerability scan as part of its independent audit. Quoting the OIG spokesperson featured in the GovInfoSecurity piece:

“we attempted to schedule a new IT audit of Anthem for this summer. Anthem recently informed us that, once again, it will not permit our auditors to perform our standard vulnerability scans and configuration compliance tests. Again, the reason cited is ‘corporate policy.’”

I have just been defending the notion that Anthem might have been doing the right thing, and that perhaps it was just the victim of a really clever hacker team. As you can imagine, when you say things like this on the Interwebs, you get a flock of people saying “If you are defending Anthem you really don’t care about patient privacy…” etc etc. My only point at the time was “We really need more evidence before we publicly condemn an organization for deprioritizing patient privacy.”

Well the evidence is in.

The notion that Anthem thinks its corporate policies trump the public’s ability to make sure they are doing their job as a Federal contractor was arrogant in 2013, when it just had one massive breach. Now this organization believes that its “corporate policies” still exempt it from scrutiny? I am aghast. Really, I should be coding right now, but instead I am writing this. I am a fairly jaded healthcare/security professional, and I thought I had seen it all. This takes the cake. Seriously, WTF?

I can only think of a few examples of this kind of bold, unfiltered, unapologetic raw arrogance. But instead of causing scenes at music award shows, the arrogance of Anthem has damaged hundreds of thousands of people more than once.

Anthems should be given a brief opportunity to rethink its policy on this issue, and assuming it does not immediately see the error of its ways its government contract should be put up for new bids from other organizations. I think we might be able to location some other health insurance company that has a less inflated respect for their own “corporate policies”.
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Healthcare data security is like a box of chocolates

Healthcare data security is like a box of chocolates | Healthcare and Technology news | Scoop.it

The Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data by Ponemon Institute had more surprises than Forrest Gump’s box of chocolates – surprises that were far from palatable. One key finding was that criminal attacks are up 125 percent and are now the leading cause of healthcare data breaches. Other results of the study were just as unsettling:


Surprise 1: Sixty-five percent of healthcare organizations do not offer any protection services for patients whose information has been lost or stolen. With cyber threats on healthcare data mounting, this is unacceptable. Ironically, the Ponemon study also found that 65 percent of healthcare organizations—the same percentage that don’t offer protection services—believe patients whose records have been lost or stolen are more likely to become victims of medical identity theft.


According to the Ponemon Medical Identity Fraud Alliance study, 2014 Fifth Annual Study on Medical Identity Theft, medical identity theft nearly doubled in five years, from 1.4 million adult victims to over 2.3 million in 2014. Many medical identity theft victims report they have spent an average of almost $13,500 to restore their credit, reimburse their healthcare provider for fraudulent claims and correct inaccuracies in their health records. Healthcare organizations and business associates must make available medical identity monitoring and identity restoration services to patients whose healthcare records have been exposed.


On the other hand, the majority of people still don’t understand the serious risk of medical identity theft. They pay more attention to their credit score and financial information than they do their insurance EOBs or medical records. They don’t understand that while a credit card can be quickly and easily replaced, their medical identity can take years to be restored. When their records become polluted, patients can be misdiagnosed, mistreated, denied much needed medical services, or billed for services not rendered. Medical identity theft can literally kill you, as ID Experts CEO Bob Gregg has said.


Surprise 2: The average cost of a healthcare data breach has stayed fairly consistent over the past five years – $2.1 million. This is in contrast to the average total cost of data breach in general, which has risen 23 percent over the past two years to $3.79 million, according to another recent Ponemon report, 2015 Cost of Data Breach Study: Global Analysis. Cyber liability insurance to cover notification costs, better options for identity monitoring, and more privacy attorneys offering help should reduce the cost of healthcare data breaches over time.


Healthcare organizations can take proactive steps to reduce the likelihood and impact of a data breach. This means addressing the tactical issues of protecting patient data. According to Dr. Larry Ponemon, founder and chairman of Ponemon Institute, healthcare organizations face “the dual challenge of reducing both the insider risk and the malicious outsider. Both require different approaches that can tax even the most robust IT security budget.” 


According to the Ponemon report, 96 percent of healthcare organizations had a security incident involving lost or stolen devices, and employee negligence is the greatest concern among these organizations. Dr. Ponemon says healthcare providers should create “a more aggressive training and education awareness program, as well as invest in technologies that can safeguard patient data on mobile devices and prevent the exfiltration of sensitive information.”

These training and awareness programs should center around protecting PHI, especially education on how to avoid phishing emails and what to do to ensure data is not disclosed. Healthcare organizations must also collaborate with their business associates to also ensure they have similar programs in place. 


For external risks such as the growing number of criminal attacks, Dr. Ponemon says that healthcare providers must “assess what sensitive data needs to be monitored and protected, and the location of this data.” I would add that board and executive management must recognize that professional hackers are targeting health data and records and, as mentioned earlier, that such attacks are now the leading cause of data breaches in healthcare. This awareness should spur enterprise-wide alignment in addressing cyber threats.


Surprise 3: Too many healthcare organizations take an ad-hoc approach to incident risk assessment. Only 50 percent of healthcare organizations in the study performed the four-factor risk assessment following each security incident, as required by the HIPAA Final RuleOf that 50 percent, 34 percent used an ad hoc risk assessment process, and 27 percent used a manual process or tool that was developed internally.


This practice is not acceptable. Healthcare organizations now have software tools available to help automate and streamline processes such as risk assessment and data breach response. By supporting consistent and objective analysis of security incidents, providing a central repository for all incident information, and streamlining the documentation and reporting process, these tools can improve outcomes and free an organization’s privacy and security staff to spend more time on prevention.


So far, 2015 has been a bad year for protecting patients and their data. Increasing cyber attacks mean that even more patients and their data will be put in harm’s way. While nobody can escape the inevitable security incidents, it is my hope that we can all learn lessons from the Ponemon study and each other, and work more collectively so that next year will bring fewer unpleasant surprises and many more happy ones.

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Research surgical robot hacked by computer science experts

Research surgical robot hacked by computer science experts | Healthcare and Technology news | Scoop.it

Researchers at the University of Washington in Seattle have demonstrated the ability to remotely hack a research surgical robot, the RAVEN II platform.


Before continuing, I’ll stop to clarify one thing. The RAVEN II is not a clinically used surgical robot like, say, the Da Vinci surgical robot. It’s an “open-source” surgical robot developed at the University of Washington to test and demonstrate advanced concepts in robotic surgery. We contacted Applied Dexterity which is now in charge of the RAVEN platform and according to co-founder David Drajeske,

The RAVEN II platform is not approved for use on humans. The system has been placed at 18 robotics research labs worldwide…that are using it to make advances in surgical robotics technologies…The low level software is open-source and it is designed to be “hackable” or readily reprogrammed.

Clinically used surgical robots, like the Da Vinci platform, operate on secure local networks using proprietary (i.e. not publicly available) communications protocols between the console and the robot. By contrast, RAVEN II can work on unsecured public networks and uses a publicly available communications protocol (see below). So while some have proclaimed an imminent threat to robotic surgery, that’s simply not the case.


That said, the work does have interesting implications; as pointed out by Mr. Drajeske and co-founder Blake Hannaford, RAVEN II is a great platform for testing these type of security issues. Tamara Bonaci, a graduate student at the University of Washigton, led this study to test the security vulnerabilities that could threaten surgeons using these tools and their patients. In this simulation, they aimed to recreate an environment that would be more akin to using these robots in remote areas.


They tested a series of attacks on the RAVEN II system while an operator used it to complete a simulated task – moving rubber blocks around.


They found that not only were they able to disrupt the “surgeon” by causing erratic movements of the robot, they were able to hijack the robot entirely. They also discovered they were able to easily access the video feed from the robot.


One of the main use cases highlighted for surgical robots, or any number of medical robots for that matter, is that they can function in remote, difficult to reach, and underserved areas. In those areas, some of the conditions of this study are likely to be present – like having to use a relatively unsecured data network. And for cost reasons, using a more open-source platform may be important. So this study does however raise interesting questions about the use of medical robots – it just doesn’t mean that clinically used surgical robots are under some imminent threat.


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Health checks by smartphone raise privacy fears

Health checks by smartphone raise privacy fears | Healthcare and Technology news | Scoop.it

Authorities and tech developers must stop sensitive health data entered into applications on mobile phones ending up in the wrong hands, experts warn.

As wireless telecom companies gathered in Barcelona this week at the Mobile World Congress, the sector's biggest trade fair, specialists in "e-health" said healthcare is fast shifting into the connected sphere.

"It's an inexorable tide that is causing worries because people are introducing their data into the system themselves, without necessarily reading all the terms and conditions," said Vincent Genet of consultancy Alcimed.

"In a few years, new technology will be able to monitor numerous essential physiological indicators by telephone and to send alerts to patients and the specialists who look after them."

More and more patients are using smartphone apps to monitor signs such as their blood sugar and pressure.

The European Commission estimates the market for mobile health services could exceed 17.5 billion euros (19 billion euros) from 2017.

The Chinese health ministry's deputy head of "digital health", Yan Jie Gao, said at the congress on Wednesday that the ministry planned to spend tens of billions of euros (dollars) by 2025 to equip 90,000 hospitals with the means for patients to contact them online securely.

Patients are entering health indicators and even using online health services for long-distance consultations with doctors whom they do not know.

"There is a steady increase in remote consultations with medical practitioners," particularly in the United States, said Kevin Curran, a computer scientist and senior member of the Institute of Electrical and Electronics Engineers.

"Your doctor can be someone who's based in Mumbai. We have to be very careful about our data, because they're the ones who probably will end up storing your data and keeping a record of it."

- Cloud-based healthcare -

Other users are entering personal health data into applications on their smartphones.

This kind of "e-health" could save governments money and improve life expectancy, but authorities and companies are looking to strengthen security measures to protect patients' data before such services become even more widespread.

"I think tech companies are becoming more concerned with privacy and encryption now," said Curran.

"The problem quite often is that a lot of this data is stored not on the phone or the app but in the cloud," in virtual storage space provided by web companies, he added.

"We are at the mercy of who the app providers are and how well they secure the information, and they are at the mercy sometimes of the cloud providers."

Others fear that insurance companies will get hold of customers' health information and could make them pay more for coverage according to their illnesses.

Various sources alleged to AFP that health insurance companies have been buying data from supermarkets about what food customers were buying, drawn from the sales records of their loyalty cards, following media reports to that effect.

The kind of "e-health" indicator most sought after by patients is fitness-related rather than information on illnesses, however, said Vincent Bonneau of the research group Idate.

A study by Citrix Mobile, a specialist in wireless security, showed that more than three quarters of people using e-health applications were doing so for fitness reasons rather than for diagnosing illnesses.


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