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Background: Modern healthcare devices can be connected to computer networks and many western healthcareinstitutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence thatcybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively,the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked.
Methods: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitalsand especially University Medical Center UMCs.
Results: The results show a strong correlation between the networking degree and the number of medical devices.The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual keyusers of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, NuclearMedicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medicaldevices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strongcorrelation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquiredhospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion ofcompetencies on an organizational level facilitates the right behavior here. Most hospitals rated themselvespredominantly positively in the self-assessment but also stated the usefulness of IT security insurance.Conclusions:Concluding our results, hospitals are already facing the consequences of omitted measures within theirgrowing pool of medical devices. Continuously relying on historically grown structures without adaption and trustingmanufactures to solve vectors is a critical behavior that could seriously endanger patients.
Technical and organizational steps are necessary to mitigate cyber threats and reduce risks. Human behavior is the last line of defense for many hospitals and is considered as equally important as technical security. Medical staff must be properly trained to perform such procedures. This paper presents the first qualitative, interdisciplinary research on how members of an intermediate care unit react to a cyberattack against their patient monitoring equipment. We conducted a simulation in a hospital training environment with 20 intensive care nurses. By the end of the experiment, 12 of the 20 participants realized the monitors’ incorrect behavior. We present a qualitative behavior analysis of high performing participants (HPP) and low performing participants (LPP). The HPP showed fewer signs of stress, were easier on their colleagues, and used analog systems more often than the LPP. With 40% of our participants not recognizing the attack, we see room for improvements through the use of proper tools and provision of adequate training to prepare staff for potential attacks in the future.
Sichere ABAP-Programmierung
(2009)
Seitenkanäle mit Untiefen: Manche Webanwendungen spielen Angreifern unfreiwillig Informationen zu
(2012)
KIM: Kaos In der Medizin
(2024)
Die sichere E-Mail-Infrastruktur für Ärzt*innen, Apotheker*innen, Krankenversicherungen und Kliniken in Deutschland, KIM - Kommunikation im Gesundheitswesen - ist mit über 200 Millionen E-Mails in den vergangenen zwei Jahren eine der am meisten genutzten Anwendungen in der Telematikinfrastruktur. Mit dem Ausgeben von S/MIME-Zertifikaten für alle medizinische Beteiligten in Deutschland verspricht KIM sichere Ende-zu-Ende-Verschlüsselung von E-Mails zwischen Heilberufler*innen in ganz Deutschland.
In diesem Paper analysieren wir die KIM-Spezifikation sowie eine beispielhafte KIM-Installation in einer deutschen Zahnarztpraxis. Wir zeigen, dass KIM kryptografisch ein sehr hohes Sicherheitslevel erfüllt, doch in der Verarbeitung der E-Mails bei den Clients eine schwerwiegende Sicherheitslücke besteht. Weiterhin zeigen wir zwei Sicherheitslücken in dem KIM-Verarbeitungsmodul eines großen deutschen Unternehmens für medizinische Software. Diese Defizite zeigen außerdem Mängel in dem verpflichtenden Zulassungsprozess der KIM-Komponenten auf.
Smart wearable devices become more and more prevalent in the age of the Internet of Things. While people wear them as fitness trackers or full-fledged smartphones, they also come in unique versions as smartwatches for children. These watches allow parents to track the location of their children in real-time and offer a communication channel between parent and child.
In this paper, we analyzed six smartwatches for children and the corresponding backend platforms and applications for security and privacy concerns. We structure our analysis in distinct attacker scenarios and collect and describe related literature outside academic publications. Using a cellular network Man-in-the-Middle setup, reverse engineering, and dynamic analysis, we found several severe security issues, allowing for sensitive data disclosure, complete watch takeover, and illegal remote monitoring functionality.
Medizinische Einrichtungen waren in den letzten Jahren immer wieder von Cyber-Angriffen betroffen. Auch wenn sich diese Angriffe derzeit auf die Office-IT-Infrastruktur der Einrichtungen konzentrieren, existiert mit medizinischen Systemen und Kommunikationsprotokollen eine weitere wenig beachtete Angriffsoberfläche.
In diesem Beitrag analysieren wir die weit verbreiteten medizintechnischen Kommunikations-Protokolle DICOM und HL7 sowie Protokoll-Implementierungen auf ihre IT-Sicherheit. Dafür präsentieren wir die Ergebnisse der Sicherheitsanalyse der DICOM- und HL7-Standards, einen Fuzzer “MedFUZZ” für diese Protokolle sowie einen Schwachstellenscanner “MedVAS”, der Schwachstellen in medizintechnischen Produktivumgebungen auffinden kann.
Modern implantable cardiologic devices communicate via radio frequency techniques and nearby gateways to a backend server on the internet. Those implanted devices, gateways, and servers form an ecosystem of proprietary hardware and protocols that process sensitive medical data and is often vital for patients’ health.
This paper analyzes the security of this Ecosystem, from technical gateway aspects, via the programmer, to configure the implanted device, up to the processing of personal medical data from large cardiological device producers. Based on a real-world attacker model, we evaluated different devices and found several severe vulnerabilities. Furthermore, we could purchase a fully functional programmer for implantable cardiological devices, allowing us to re-program such devices or even induce electric shocks on untampered implanted devices.
Additionally, we sent several Art. 15 and Art. 20 GDPR inquiries to manufacturers of implantable cardiologic devices, revealing non-conforming processes and a lack of awareness about patients’ rights and companies’ obligations. This, and the fact that many vulnerabilities are still to be found after many vulnerability disclosures in recent years, present a worrying security state of the whole ecosystem.
TLS is one of today's most widely used and best-analyzed encryption technologies. However, for historical reasons, TLS for email protocols is often not used directly but negotiated via STARTTLS. This additional negotiation adds complexity and was prone to security vulnerabilities such as naive STARTTLS stripping or command injection attacks in the past.
We perform the first structured analysis of STARTTLS in SMTP, POP3, and IMAP and introduce EAST, a semi-automatic testing toolkit with more than 100 test cases covering a wide range of variants of STARTTLS stripping, command and response injections, tampering attacks, and UI spoofing attacks for email protocols. Our analysis focuses on the confidentiality and integrity of email submission (email client to SMTP server) and email retrieval (email client to POP3 or IMAP server). While some of our findings are also relevant for email transport (from one SMTP server to another), the security implications in email submission and retrieval are more critical because these connections involve not only individual email messages but also user credentials that allow access to a user's email archive.
We used EAST to analyze 28 email clients and 23 servers. In total, we reported over 40 STARTTLS issues, some of which allow mailbox spoofing, credential stealing, and even the hosting of HTTPS with a cross-protocol attack on IMAP. We conducted an Internet-wide scan for the particularly dangerous command injection attack and found that 320.000 email servers (2% of all email servers) are affected. Surprisingly, several clients were vulnerable to STARTTLS stripping attacks. In total, only 3 out of 28 clients did not show any STARTTLS-specific security issues. Even though the command injection attack received multiple CVEs in the past, EAST detected eight new instances of this problem. In total, only 7 out of 23 tested servers were never affected by this issue. We conclude that STARTTLS is error-prone to implement, under-specified in the standards, and should be avoided.