May 17, 2019

Jack Wagner • VP of Advisory Services

Cybersecurity for Medical Devices – Pitter Patter Let’s Get At ‘Er

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 21st 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.