Medical Device Security Under Fire At Black Hat, DefCon

Medical device security is an topic that has gone largely unnoticed until recent years. Similar to SCADA and ICS, it's an area of critical technology that seems to require high-profile vulnerabilities, like Dillon Beresford's Siemens vulnerabilities, before anyone takes notice. Sure, in 2008 pacemaker hacking got loads of press, but there hasn't been much discussed since.

Could it be that medical device security and electronic medical record systems are going through a similar dark age as SCADA and ICS?

In a recent blog post on the Digital Bond site, "The Lost Decade," Dale Peterson makes the argument that the state of SCADA security is essentially 10 years behind. Security researcher Shawn Merdinger left a comment stating he sees the same thing happening with medical devices and electronic medical record (EMR) systems. Even though vendors have been told that vulnerabilities exist, very little is being done to rectify them.

It's forums like Black Hat and DefCon where researchers are hoping to make a difference by shedding light on vulnerabilities in medical devices that could have lethal effects.

At Black Hat, Jerome Radcliffe presented his research surrounding insulin pumps and continuous glucose monitors. His testing showed that it's possible to remotely modify settings while the user is hooked up, yet completely unaware of the changes. Crank the dosages up too high or too low and it could have deadly consequences (see Dark Reading's "Getting Root On The Human Body").

At DefCon, Tim Elrod and Stefan Morris, security consultants with Fishnet Security, gave an excellent presentation, titled, "I'm Not a Doctor, But I Play One on Your Network." They gave a background on common technologies (HL7 & DICOM) in use by medical security devices, an overview of EMR systems, and they discussed some of the issues they've discovered firsthand in their work within healthcare systems.

For someone like myself with only peripheral experience with healthcare networks, the presentation was a great primer into the protocols, their usage, and EMR systems. I also appreciated that Tim and Stefan conveyed the information without the FUD that easily accompanies this type of information. The simple facts are: These devices and systems are out there, they help keep people alive, and they have vulnerabilities.

Thankfully, all of those fragile and vulnerable systems are kept completely isolated and air-gapped from the Internet. Right? Unfortunately, the answer is no. As we saw last year when ICS-CERT released an advisory (PDF) about SCADA systems being exposed by being directly connected to the Internet, there are healthcare providers out there hooking up their networks to the Internet and exposing these systems to attack. The presenters provided an example where they performed port scans and identified systems with ports open indicating they were likely running DICOM services.

What will it take to get the medical industry to sit up and take notice of medical device security? Does someone have to die due to an attacker exploiting a 4-year-old vulnerability in an infusion pump? Or maybe news of SQL injection in an EMR system that allowed an attacker to download medical records of hundreds of thousands of patients including major names in the political and financial world?

Let's hope that responsible disclosure of the vulnerabilities and cooperation with groups like CERT can bring about awareness and motivate vendors to take responsibility in fixing the issues.

For the updated slides and fuzzing code, see www.medifuzz.com.

John Sawyer is a Senior Security Analyst with InGuardians. The views and opinions expressed in this blog are his own and do not represent the views and opinions of his employer. He can be reached at [email protected]