Healthcare Delivery Organizations (HDOs) are arguably the most pressured organizations in 2020, not only needing to treat the many patients infected by coronavirus, but also defend themselves against a growing number of cyberattacks targeted at their industry.
HDOs present an appealing target to attackers because of high-value patient and medical data, as well as a low tolerance for downtime that could prevent patient care, which makes them likely to pay ransoms in order to recover systems. In the first half of 2020 alone 41 providers reported ransomware attacks, following on a warning from Interpol in April that it had detected a significant increase in the number of attacks against hospitals and other healthcare institutions.
Securing HDO networks presents a number of unique challenges, including many devices running legacy operating systems, a lack of segmentation and the use of insecure protocols. New research by Forescout Research Labs analyzed production network traffic from five consenting HDO companies to determine the impact of poor security practices and how it affects their overall attack surface.
Here are five cybersecurity challenges researchers found facing Healthcare Delivery Organizations today:
Windows Operating System Versions
Forescout found a reduction in the percentage of devices running operating systems supported only via the paid ESU program from 71% to 32% between 2019 and 2020. However, the percentage of devices running fully unsupported Windows versions like Windows XP and Windows Server 2003 remained constant at 0.4%. Although that is a small percentage of devices, they tend to be the most critical devices in an HDO and the trend indicates that the legacy problem is expected to continue in the future.
Number of Network Segments
Network segmentation is a fundamental measure to limit the attack surface in healthcare networks. Forescout observed that out of all the Virtual Local Area Networks (VLANs) containing at least one healthcare device, 60% have other non-healthcare IoT devices in the same segment. The team also observed that 90% of healthcare VLANs have a mix of healthcare devices and IT devices. For instance, computers and printers are often present in the same VLAN as healthcare equipment (e.g. Patient Monitors, X-Ray machines, etc.). Computers in the pharmacy or doctor’s workstations may also feature in this mix. By mixing devices inside segments, a vulnerable device may be used to compromise a more sensitive one.
Even more concerning are the instances of personal devices (such as smartphones, smartwatches, tablets) and OT devices on the same VLAN as sensitive healthcare equipment. These devices might contain vulnerable software or targeted malware which can make other devices on the VLAN susceptible to infection as well.
Devices with Default Passwords
Forescout identified healthcare equipment (specifically Patient Monitors and CT Scanners) with default credentials alongside other IT and IoT equipment. In these scenarios, the healthcare devices act as the weak links in the network.
External Communications
In four out of the five HDOs, researchers observed communications between public and private IP addresses using a medical protocol to exchange medical information in clear text, which can be easily read and leak sensitive patient information such as names, addresses, family information, allergies and test results. Two out of the five HDOs had medical devices communicating over IT protocols with external servers reachable from outside the HDO’s perimeter. Compromising these external servers to serve malicious files would be a potential entry point into the network for an attacker.
Insecure Protocols
Transport Layer Security (TLS) is a cryptographic protocol used to secure network communications of higher-level protocols, such as HTTPS. Older versions of this protocol, such as SSLv3, TLSv1.0 and TLSv1.1 are known to be insecure. Forescout found that these insecure versions are still used in all five HDOs both internally and externally. All HDOs also used obsolete versions of other protocols, such as SNMP versions 1 and 2 and NTP versions 1 and 2. Forescout researchers also found instances of Telnet in three out of the five HDOs. The clear-text Telnet protocol was specified in 1983, and has long-since been replaced by SSH, but is still commonly used by devices in HDO networks today.
More worryingly, many medical protocols used within HDOs are also insecure and can be abused to not only sniff but also tamper with patient data on the network, including real-time vital signs.
Each of these areas speaks to the bigger picture challenge facing healthcare delivery organizations. With the patient care on the line, HDOs will need to ensure they are taking the necessary steps to implement best practices and ensure their networks are protected in these unprecedented times.
