Vulns in Open Source EHR Puts Patient Health Data at Risk

Security researchers from Bishop Fox have discovered several critical vulnerabilities in an emerging open source electronic health record (EHR) system from LibreHealth.

The vulnerabilities give unauthenticated attackers multiple ways to compromise the application's underlying server and gain access to sensitive patient health information and health records, security testing firm Bishop Fox said this week.

The vulnerabilities are present in LibreHealth EHR v2.0.0, an application that healthcare professionals can use to store and access a patient's health records electronically. Bishop Fox discovered the vulnerabilities in February and notified LibreHealth of the issues in March. Bishop Fox disclosed the flaws this week after LibreHealth released what the security firm described as "in-progress patches" for the bugs.

Chris Davis, security consultant at Bishop Fox, says there's no evidence that any of the vulnerabilities have been actively exploited yet. He describes the flaws as presenting a mixed bag from an ease-of-exploit standpoint. "Generally speaking, it's not a high bar for attackers to exploit these issues," Davis says. "The vulnerable software issues contains some known issues that have been around for a while and are well documented, making the likelihood of them being exploited in the wild higher." Davis says he doesn't know how many health records are potentially at risk from these vulnerabilities. 

In a blog post Tuesday, Davis said he had discovered a total of five high-risk flaws in LibreHealth EHR v2.0.0. They consisted of an SQL injection flaw leading to data disclosure; a local file inclusion error that could be used to break into the underlying server; a cross-site scripting error; and a cross-site request forgery issue that gave unauthenticated attackers a way to carry out a variety of attacks. In addition, the LibreHealth EHR app also contained multiple critical vulnerabilities that were inherited when the software was originally forked from the OpenEMR codebase.

The security of systems that are used to electronically store and deliver patient health information has become more important because of the increased use of telehealth services for most non-COVID-19-related health issues.

According to Davis, there has been a recent spike in interest in advisories that Bishop Fox has released in the past on vulnerabilities it has discovered in a variety of healthcare software products such as OpenEMR, SolisMed, Intersystems Cache, and OpenMRS. "All were affected by high-risk issues that could lead to patient data exposure," he says.

Since the beginning of the pandemic earlier this year, security vendors have noted a general increase in attacker interest not just in electronic health systems but in a variety of other services which have seen a recent surge in use. The most heavily targeted among them have been videoconferencing and other communication apps and tools.

Open Source Project
LibreHealth is part of Software Freedom Conservancy, a nonprofit group that helps promote the use of open source software. Several volunteer contributors from multiple open source health IT projects teamed up to form the LibreHealth community in November 2016. Some of the health IT projects that the founding members had previously worked on had thousands of installations worldwide, including within government agencies, nonprofits, and smaller organizations. A statement announcing the launch of LibreHealth described it as focused on building health IT software that would incorporate the best of previous projects.

LibreHealth EHR is one of three projects in which members of the community are currently involved. The other two are LibreHealth Radiology, for use by imaging and radiology professionals, and LibreHealth Toolkit, for creating other healthcare-related software.

Davis says that LibreHealth has not quite released a new version of the app that addresses all of the new identified vulnerabilities. "They've created some pulls in GitHub that address some of the issues but haven't yet merged these fixes into a complete merge and patched version," he says. "The vendor is in contact with us and is working toward the goal of an official patch."

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