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Securing IoT Devices Calls For New Ways Of Doing Business

Posted on June 8, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While new Internet-connected devices can expose healthcare organizations to security threats in much the same way as a desktop PC or laptop, they aren’t always procured, monitored or maintained the same way. This can lead to potentially major ePHI breaches, as one renowned health system recently found out.

According a piece in SearchHealtlhIT, executives at Intermountain Healthcare recently went through something of a panic when connected audiology device went missing. According to Intermountain CISO Karl West, the device had come into the hospital via a different channel than most of the system’s other devices. For that reason, West told the site, his team couldn’t verify what operating system the audiology device had, how it had come into the hospital and what its lifecycle management status was.

Not only did Intermountain lack some key configuration and operating system data on the device, they didn’t know how to prevent the exposure of stored patient information the device had on board. And because the data was persistent over time, the audiology device had information on multiple patients — in fact, every patient that had used the device. When the device was eventually located, was discovered that it held two-and-a-half years worth of stored patient data.

After this incident, West realized that Intermountain needed to improve on how it managed Internet of Things devices. Specifically, the team decided that simply taking inventory of all devices and applications was far from sufficient to protect the security of IoT medical devices.

To prevent such problems from occurring again, West and his team created a data dictionary, designed to let them know where data originates, how it moves and where it resides. The group is also documenting what each IoT device’s transmission capabilities are, West told SearchHealthIT.

A huge vulnerability

Unfortunately, Intermountain isn’t the first and won’t be the last health system to face problems in managing IoT device security. Such devices can be a huge vulnerability, as they are seldom documented and maintained in the same way that traditional network devices are. In fact, this lack of oversight is almost a given when you consider where they come from.

Sure, some connected devices arrive via traditional medical device channels — such as, for example, connected infusion pumps — but a growing number of network-connected devices are coming through consumer channels. For example, though the problem is well understood these days, healthcare organizations continue to grapple with security issues created by staff-owned smart phones and tablets.

The next wave of smart, connected devices may pose even bigger problems. While operating systems running mobile devices are well understood, and can be maintained and secured using enterprise-level processes,  new connected devices are throwing the entire healthcare industry a curveball.  After all, the smart watch a patient brings into your facility doesn’t turn up on your procurement schedule, may use nonstandard software and its operating system and applications may not be patched. And that’s just one example.

Redesigning processes

While there’s no single solution to this rapidly-growing problem, one thing seems to be clear. As the Intermountain example demonstrates, healthcare organizations must redefine their processes for tracking and securing devices in the face of the IoT security threat.

First and foremost, medical device teams and the IT department must come together to create a comprehensive connected device strategy. Both teams need to know what devices are using the network, how and why. And whatever policy is set for managing IoT devices has to embrace everyone. This is no time for a turf war — it’s time to hunker down and manage this serious threat.

Efforts like Intermountain’s may not work for every organization, but the key is to take a step forward. As the number of IoT network nodes grow to a nearly infinite level, healthcare organizations will have to re-think their entire philosophy on how and why networked devices should interact. Otherwise, a catastrophic breach is nearly guaranteed.

Wearable Health Trackers Could Pose Security Risks

Posted on February 1, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Last October, security researchers made waves when they unveiled what they described as a 10-second hack of a Fitbeat wearable health tracker. At the Hack.Lu 2015 conference, Fortinet security researcher Axelle Apvrille laid out a method for hacking the wearable through its Bluetooth radio. Apparently, Aprville was able to infect the Fitbit Flex from as much as 15 feet away, manipulate data on the tracker, and use the Flex to distribute his code to a computer.

Fitbit, for its part, denied that its devices can serve as vehicles for infecting users with malware. And Aprville himself admitted publicly that his demonstration was more theoretical than practical. In a tweet following the conference, he noted that he had not demonstrated a way to execute malicious code on the victim’s host.

But the incident does bring attention to a very serious issue. While consumers are picking up health trackers at a breathless pace, relatively little attention has been paid to whether the data on these devices is secure. Perhaps even more importantly, too few experts are seeking ways to prevent these devices can be turned into a jumping-off point for malware. After all, like any other lightly-guarded Internet of Things device, a wearable tracker could ultimately allow an attacker to access enterprise healthcare networks, and possibly even sensitive PHI or financial data.

It’s not as though we aren’t aware that connected healthcare devices are rich hunting grounds. For example, security groups are beginning to focus on securing networked medical devices such as blood gas analyzers and wireless infusion pumps, as it’s becoming clear that they might be accessible to data thieves or other malicious intruders. But perhaps because wearable trackers are effectively “healthcare lite,” used almost exclusively by consumers, the threat they could pose to healthcare organizations over time hasn’t generated a lot of heat.

But health tracker security strategies deserve a closer look. Here’s some sample suggestions on how to secure health and fitness devices from Milan Patel, IoT Security Program Director at IBM:

  • Device design: Health tracker manufacturers should establish a secure hardware and software development process, including source code analysis to pinpoint code vulnerabilities and security testing to find runtime vulnerabilities. Use trusted manufacturers who secure components, and a trusted supply chain. Also, deliver secure firmware/software updates and audit them.
  • Device deployment:  Be sure to use strong encryption to protect privacy and integrity of data on the device, during transmission from device to the cloud and on the cloud. To further control device data, give consumers the ability to set up user and usage privileges for their data, and an option to anonymize the data.Secure all communication channels to protect against data change, corruption or observation.
  • Manage security:  Include trackers in the set of technology being monitored, and set alerts for intrusion. Audit logging is desirable for the devices, as well as the network connections and the cloud. The tracker should ideally be engineered to include a fail-safe operation — dropping the system down to incapability, safely — to protect against attacks.

This may sound like a great deal of effort to expend on these relatively unsophisticated devices. And at present, it just may be overkill. But it’s worth preparing for a world in which health trackers are increasingly capable and connected, and increasingly attractive to the attackers who want your data.

NIST Goes After Infusion Pump Security Vulnerabilities

Posted on January 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As useful as networked medical devices are, it’s become increasingly apparent that they pose major security risks.  Not only could intruders manipulate networked devices in ways that could harm patients, they could use them as a gateway to sensitive patient health information and financial data.

To make a start at taming this issue, the National Institute of Standards and Technology has kicked off a project focused on boosting the security of wireless infusion pumps (Side Note: I wonder if this is in response to Blackberry’s live hack of an infusion pump). In an effort to be sure researchers understand the hospital environment and how the pumps are deployed, NIST’s National Cybersecurity Center of Excellence (NCCoE) plans to work with vendors in this space. The NCCoE will also collaborate on the effort with the Technological Leadership Institute at the University of Minnesota.

NCCoE researchers will examine the full lifecycle of wireless infusion pumps in hospitals, including purchase, onboarding of the asset, training for use, configuration, use, maintenance, decontamination and decommissioning of the pumps. This makes a great deal of sense. After all, points of network connection are becoming so decentralized that every touchpoint is suspect.

The team will also look at what types of infrastructure interconnect with the pumps, including the pump server, alarm manager, electronic medication administration record system, point of care medication, pharmacy system, CPOE system, drug library, wireless networks and even the hospital’s biomedical engineering department. (It’s sobering to consider the length of this list, but necessary. After all, more or less any of them could conceivably be vulnerable if a pump is compromised.)

Wisely, the researchers also plan to look at the way a wide range of people engage with the pumps, including patients, healthcare professionals, pharmacists, pump vendor engineers, biomedical engineers, IT network risk managers, IT security engineers, IT network engineers, central supply workers and patient visitors — as well as hackers. This data should provide useful workflow information that can be used even beyond cybersecurity fixes.

While the NCCoE and University of Minnesota teams may expand the list of security challenges as they go forward, they’re starting with looking at access codes, wireless access point/wireless network configuration, alarms, asset management and monitoring, authentication and credentialing, maintenance and updates, pump variability, use and emergency use.

Over time, NIST and the U of M will work with vendors to create a lab environment where collaborators can identify, evaluate and test security tools and controls for the pumps. Ultimately, the project’s goal is to create a multi-part practice guide which will help providers evaluate how secure their own wireless infusion pumps are. The guide should be available late this year.

In the mean time, if you want to take a broader look at how secure your facility’s networked medical devices are, you might want to take a look at the FDA’s guidance on the subject, “Cybersecurity for Networked Medical Devices Containing Off-the-Shelf Software.” The guidance doc, which was issued last summer, is aimed at device vendors, but the agency also offers a companion document offering information on the topic for healthcare organizations.

If this topic interests you, you may also want to watch this video interview talking about medical device security with Tony Giandomenico, a security expert at Fortinet.

Measuring Patient Discomfort Using Brainwave Activity

Posted on December 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Digital health opportunities are popping up everywhere and in every part of the nation. The IoT Journal (Internet of Things) recently profiled a hospital down the street from me who is exploring IoT’s potential to bring drug free relief to patients. Here’s a short excerpt from the article:

Until recently, when health-care providers wanted to gauge the level of discomfort a patient was enduring, they typically had to ask that individual to rate his or her pain—for example, on a scale of 1 to 10—and then use that information to plan treatment accordingly. If they wanted to ease the patient’s pain, they needed to administer medication.

Several months ago AccendoWave released an alternative solution that does not require medication and is personalized to each patient. The system was released in June 2015, says Martha Lawrence, AccendoWave’s founder and CEO, and has since been tested at several facilities. The company has spent seven years researching its solution for assessing patient discomfort levels, and is now using a headband that measures electroencephalography (EEG) activity and prompts a tablet PC to provide content aimed at reducing that discomfort.

The AccendoWave headband, which has seven EEG sensor leads built into it, transmits its brain-wave measurements to the tablet via a Bluetooth connection. The tablet, a Samsung Tab 4, uses its built-in AccendoWave software to process patient brain-wave data and then display diversionary content, including games, music, video clips and full-length movies. If, as a patient views a specific piece of content, the brain waves change to indicate increasing comfort, that content remains on the screen. If the content does not appear to have a positive effect on the brain waves, the software continues to select other content until it displays something appealing to the patient.

Pretty interesting approach. The article does note that they don’t use the brainwave data to determine how much medication to administer. They just use it as a way to assess the system’s effectiveness. They also do patient surveys to assess the impact of the device on a patient’s comfort. The article says that since the hospital implemented the system in the hospital, “1,600 patients have used the device to date, and more than 450 have completed surveys…More than 90 percent of responders reported viewing the system in a positive light.”

I’ve seen these EEG sensors for a while and they’re pretty neat. However, I always wondered how they’d actually be implemented and how they could be used to benefit patient care. No doubt it’s still early in their efforts to use and assess brainwaves, but it’s a pretty interesting solution to tie brain wave activity to soothing images. I’ll be watching to see how this evolves.