Okay, maybe I watch too much of the Canadian sitcom Letterkenny, and while it may be considered inappropriate for younger viewing audiences, there is one saying in there that I have tried to apply to my everyday life and that is “Pitter patter, let’s get ‘er.” 

What exactly does that mean?  Basically, let’s do it already, get it done, chop chop, right now.

What do we need to get done, you ask?  Well, cybersecurity of our medical devices, of course. 

Some of you have been watching the trends for years.  Unfortunately, many more wait for a problem to occur elsewhere before taking action. Even worse, others standby and just let a problem grow until it turns into a catastrophe that was completely avoidable.

An automobile is a good example.   It requires basic maintenance to stay in top running condition.  Things like oil changes, tire rotation and other basic maintenance ensure that when you cross the 100,000-mile mark on the odometer, your car is there with you for the long haul.  If you ignore that maintenance, then you could end up with a burdensome towing and mechanical repair bill.

Ignoring medical device cybersecurity, is much worse.  If you never change the oil in your car, the engine will eventually seize, possibly leaving you stranded. 

When lack of security maintenance to medical devices occurs, well, everyone gets hurt. 

In healthcare, we care for patients.  That is what we do.  It is our entire mission.  When our healthcare networks get breached, our patients suffer the most.  After all, it is their health and personal information that are at greatest risk due to vulnerabilities that exist in the health care market.

Now, back to “Pitter patter, let’s get ‘er.” How should we proceed to remediate our vulnerabilities?

If you listen to many of the vendors in the burgeoning field of healthcare cybersecurity, the initial answer to your question is, “You need an assessment.  It will tell you everything that is wrong, and we are great at assessing stuff!” 

Okay, I paraphrased a little bit, but that is a popular answer.  Let me be clear, it is not necessarily the wrong answer.  Nevertheless, is it the best answer? 

Going back to the oil change — oversimplified, I get it — analogy.  Do you want a mechanic to spend two hours with your car to come back and tell you every single reason why you need an oil change?  Such as, the oil has broken down, seriously impacting your engine’s lubrication abilities.  If you do not change it, the friction in your engine will build up heat until the metal warps, which will surely destroy it. 

By the way, that information costs $200, because I interviewed you, ran diagnostics and performed in-depth analysis of the oil in your car.

That is all good information to have no doubt, but at this point has the mechanic told you anything that has actually fixed your problem, or have you just paid someone for a good reason to change your oil?

I would like to touch upon a different approach for Cybersecurity of your medical devices in the now buzz-worthy world known as the Internet of Medical Things (IoMT). 

This approach is to fix the problems before they become bigger problems.

I get it.  Your next thought is, “how do I know what my problems are so I can fix them?”

The answer can be derived by answering some basic questions:

1. Do you have medical devices, such as CT Scanners, X-Ray machines, MRIs, Infusion Pumps, etc. connected to your wired/wireless networks? 
2. Are many of those vendor-maintained?
3. Do you have a process in place that monitors the operating systems they are running, and the last time they’ve been updated for the latest patch releases? 
4. Does this process not only identify vulnerabilities, but provide guidance to resolve them?
5. Does the process work with the device vendors during the remediation process to ensure the gaps are mitigated or closed?

If the answer to the first two questions is yes — You’re in healthcare, right? — and the answers to the follow-up questions are closer to “Ummm, Meh,” then you do not need to pay someone to tell you that again in a 100+ page report with painstaking detail.

Is not that like the mechanic giving you a 10-page diagnostic report explaining the chemical breakdown of the oil in your car over time?

Instead, we should have a conversation on the top items that all healthcare entities need to be doing to protect themselves.  Afterward, you could use those valuable, and oft constrained, budget dollars to address those elements.

A typical assessment could cost anywhere from $20,000 to $100,000, depending on the size and complexity of your organization and the scope of the assessment.  I am sure some of you have seen them cost more.

Instead of paying for that assessment, you could apply those dollars to actual remediation of those devices, while also gaining an understanding of the weaknesses that exist.

Interested yet?  I hope so.  Please bear with me a little longer.

Another question: Do you have a Security Information and Event Management (SIEM) system in place?

Your answer is likely accompanied by an eye-roll and is similar to, “Yes, yes, we do.  Since the 90’s, in fact, or at least the turn of the 21^st Century.”

The truth is, many of us do have them already.  They monitor networks, servers, workstations and numerous other things that have been the target of threats for years.  Also true is that many of them have done a good job of it. 

The concern is not around them protecting those devices they were made to monitor, but is around the blind spots they may have, especially in the medical device arena.

Next set of questions: Do you have any products that specifically monitor all the medical devices on your network, identifies when they are working out of the norms, and tells you how to remediate them? Do they perform all that passively, as to not impact the critical patient health traffic on the network?  Do they report all that information to your current SIEM, complementing your current environment rather than replacing it?

If most of the answers are, “No.”  Why not then use some of your budget dollars to remediate that situation now?  The right system could not only tell you everything an assessment could, but also help you track them real-time and give instructions for gap closure.

Final set of questions: What if you could get a pilot of this system, with the cybersecurity expertise to ascertain its best placement, set it up, monitor it and report out the findings, for less than the cost of the typical assessment? 

That would be much better than just a report.

There are several vendors with products in this field of expertise and they claim everything from signature-based vulnerability identification to machine-learning and Artificial Intelligence (AI) concepts.  The truth is, that some of these are much more mature than others and are no longer proof of concept (POC) exercises, but legitimate contenders to help you close the gaps in your medical device vulnerability area.

Additionally, you need a good partner.  Not one that provides an assessment and promises to come back in a year to see how you have done closing the gaps, but rather, one that works through the entire process of system selection, implementation, monitoring and remediation.  A partner that also provides education to your staff, works with them to mitigate gaps, and can also provide 24×7 Security Operations Center (SOC) services to spot, isolate and remediate any brand-new vulnerabilities that the malware community cooks up next. 

It all starts with an honest conversation around Cybersecurity and how best to protect the assets providing the most important tenet of all healthcare organizations, taking care of patients.

Pitter patter, let’s get at ‘er.

As we watch the news from Hurricane Florence (or experience it first hand), here is a timely, and timeless reminder from DHS to be careful in times that we are most inclined to give.  Phishing scams in times of disasters are some of the most lucrative for bad actors.  See the release from NCCIC below and share with those that may not be in the IT or Cyber world.

NCCIC warns users to remain vigilant for malicious cyber activity seeking to exploit interest in Hurricane Florence. Fraudulent emails commonly appear after major natural disasters and often contain links or attachments that direct users to malicious websites. Users should exercise caution in handling any email with a subject line, attachments, or hyperlinks related to the hurricane, even if it appears to originate from a trusted source. NCCIC advises users to verify the legitimacy of any email solicitation by contacting the organization directly through a trusted contact number. Contact information for many charities is available on the BBB National Charity Report Index. User should also be wary of fraudulent social media pleas, calls, texts, donation websites, and door-to-door solicitations relating to the hurricane.

NCCIC encourages users and administrators to review the following resources for more information on phishing scams and malware campaigns:

• The Federal Trade Commission articles on Wise Giving After a Hurricane and How to Donate Wisely and Avoid Charity Scams,
• Using Caution with Email Attachments, and
• Avoiding Social Engineering and Phishing Attacks.

You can’t protect what you don’t know. Getting a handle on the security of your medical and other connected devices in your healthcare facility starts with getting a handle on the inventory. Simple concept, yet why are so many healthcare organizations struggling to get a real accounting of what is being used to serve their enterprise? Many institutions feel they have a grasp on the inventory because they can point to accounting records for purchases. Once their project begins though, they are surprised to learn how inadequate accounting inventories tend to be. Historically, an organization decides to bring in a team of individuals to walk the facility and get an actual physical count of the equipment and its location along with age, operating parameters, and security features.

Today, the path forward to an accurate inventory count can be different. With the advent of big data analysis techniques and machine learning algorithms, vendors are taking advantage of the reams of data that network traffic sniffing tools can deliver and are discerning volumes of information from the data collected on their intranets. Working with small appliances placed on your network, typically at Layer 2, these appliances inspect large volumes of packet communications and run it through a deep machine learning algorithm to discern equipment type, manufacturer, model, operating system and many other factors of interest to clinical engineering and security professionals.

From AWS, BlueFlow and CloudPoint all the way to ZingBox, there are already many vendors who can provide you with an inventory discovery tool to include as part of you medical device security management program. Here are five quick questions you may want to ask to help you find your solution from this rapidly growing list of options:  1) How long have you been providing this solution? 2) How many healthcare deployments have you made? 3) Can you interface with my SIEM and other security management tools? 4) How many appliances will I need to install? 5) Can the solution augment network security architecture?

First is here to help you get answers to these questions and many more as you develop and/or improve your medical device security management program. We can even help you get answers to non-security aspects of these connected asset discovery tools. Given that they are always on and always monitoring device operations, many of these tools can also be put to use by your clinical engineering teams for resource leveling studies, new purchase planning and even reconfiguring maintenance schedules and equipment SLAs.