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Emerging Threats
in the Healthcare
IT Ecosystem
Ralph Echemendia
HealthTech - Advisory Solutions
Ralph Echemendia
Advisory Solutions
About me
• Over 20years experience as Information security expert, researcher,
ethical hacker, forensics/expert witness and instructor in many IT areas.
• Specializing in Security of Virtualized Architectures
• Featured in many articles and reports in main media outlets
• As a consultant conducted security audits, technical education and
penetration tests for many Fortune 1000 companies including:
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Oracle
Microsoft
Google and American Express
Universal Picture and Summit Entertainment
• Government institutions such as:
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United Nations
NASA
FBI
DOD and GSA to name a few.
Overview
• History of Cyber-Threats
• Information Vulnerabilities
• Data Breaches
• Medical Cybercrime: The Next Frontier
• The Cloud
• The Future
Source : http://jeremiahgrossman.blogspot.com/
History of Cyber-Threats
Information Vulnerabilities
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Information security vulnerabilities are weaknesses that
expose an organization to risk.
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Understanding your vulnerabilities is the first step to
managing risk.
Data Leaks
• Unprotected or Unsafe Data
Data leakage filled the headlines in 2008 as corporations and government
proved themselves to be lax in protecting their confidential data.
• Organizations of all sizes are finding that today’s mobile and collaborative
workforce needs access to information inside and outside the office, along
with the ability to share data with co-workers and partners.
• Users are routinely using and sharing data without giving thought to
confidentiality and regulatory requirements.
• Almost 30 percent of organizations store contract, financial data, patient
information, contact details and personal account data on removable or
mobile media.
Data Leaks are everywhere!
Used hardware?
• Incidents were reported of confidential data ending up in the
public domain after old computer hardware, which had not been
securely erased, was sold on auction sites like eBay.
• Analysts suggest that there is a higher demand (and thus higher price
offered) for used hard drives on eBay than for brand new ones.
• Imagine the amount of confidential information that is potentially
recoverable.
Data Leaks cost MONEY????
•The average organizational cost of a data security breach in the
U.S. dropped 24 percent to $5.5 million in 2011 from $7.2 million in
2010, according to the latest report from the Ponemon Institute.
•Based on the data breach experiences of 49 companies from 14
industries, including healthcare, the average cost per record also
dropped from $214 to $194. This was the first time in the seven years
for which the Ponemon Institute has done this survey that this cost
declined.
That’s great news no?
Data Leaks cost MONEY????
NOT TRUE FOR HEALTHCARE
• The healthcare industry is apparently lagging behind other industries in
this regard.
• In an earlier report, Ponemon found that health data breaches increased
32 percent from 2010 to 2011 and that the average cost per organization
grew 10 percent last year. - Average per-capita cost of $240 per record.
• A recent Redspin report on the state of health IT security found that the
total number of health records breaches are up. Report says they
increased 97 percent from 2010 to 2011.
Largest
Healthcare
Data Breaches
http://www.datalossdb.org/
Data Leaks on Google?
Medical Cybercrime: The Next frontier
Eastern European gangs stealing
computer files with Americans'
health insurance information for
resale?
In late July, an interesting story came out of Chicago's suburbs:
Hackers broke into a small medical practice's server, encrypted patients'
electronic medical records (EMRs) and emails, and demanded a ransom.
Instead of paying the ransom, the Surgeons of Lake County turned the
server off and called police. It is not known whether the hackers who
targeted the Surgeons of Lake County also extorted other businesses--but
federal-mandated HIPAA records indicate 37 hospitals and doctors'
offices nationwide have been hacked since 2009, resulting in the theft or
damage of patients' medical records.
Source: Sophos
Medical Cybercrime: The Next frontier
Remotely hacking insulin pumps to
kill patients?
• A much more worrying--and dangerous--form of medical hacking is
creating counterfeit medical devices or hacking existing ones.
Counterfeit medical devices are a huge problem; according to the
World Health Organization.
• 8% of medical devices worldwide were counterfeit as of 2010.
• Although the counterfeit insulin pumps, condoms, contact lenses, and
surgical equipment are mainly found abroad, many find their way
Stateside due to insecure supply chains.
Source: Sophos
Medical Cybercrime: The Next frontier
Remotely hacking insulin pumps to
kill patients?
• At the 2011 Defcon in Las Vegas security expert and diabetic Jay
Radcliffe demonstrated how he discovered critical security lapses in
Medtronic insulin pumps that could let hackers remotely kill patients by
manipulating the amount of insulin pumped.
• Radcliffe successfully hacked his own insulin pump and discovered
massive loopholes that can be used cybercriminals.
• By manipulating insulin pumps remotely, criminals could kill or seriously
injure targets; their crime, meanwhile, would be likely to escape detection
from law enforcement unaware insulin pumps could be hacked.
Source: Sophos
Medical Cybercrime: The Next frontier
Remotely hacking insulin pumps to
kill patients?
• Two members of Congress have asked the Government Accountability
Office (GAO) to review the Federal Communications Commission's
approach to medical devices with wireless capabilities to ensure that the
devices are "safe, reliable, and secure.”
• Medical devices use poorly developed code that often leads to deaths,
injuries, or security lapses. There is no cross-medical industry protocol for
coding QA and testing; as a result, software holes often aren't discovered
until equipment fails in the field.
Source: Sophos
Medical Cybercrime: The Next frontier
Remotely hacking implantable
cardioverter-defibrillators to kill
patients?
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At the BreakPoint security conference in Melbourne Barnaby Jack demonstrated that
he could reverse engineer a pacemaker to deliver fatal shocks from within 30 feet and
rewrite the devices onboard software (firmware).
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The pacemaker also contained a “secret function” that could activate other cardiac
devices within a 30 foot-plus vicinity.
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“The worst case scenario that I can think of, which is 100 percent possible with these
devices, would be to load a compromised firmware update onto a programmer and
… the compromised programmer would then infect the next pacemaker or ICD
[implantable cardioverter-defibrillators] and then each would subsequently infect all others in
range.”
Source: Sophos
Cloud Computing
• A Brief Intro to IaaS
• What should your provider offer?
• What are the Future Challenges, Risks and
New Issues to deal with?
Cloud Drivers
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Provider offers a wide range of Managed Infrastructure Services
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Fast to Deploy, Scale up, Scale Down or Decommission
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Clients demands Latest Technology (refreshed!) and Capabilities
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Collective Intelligence of Professional Services Group, Vendors and
MSSP services is considerable
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Integrated Approach “should” save clients time, effort and costs
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Compliance Mandates and Risk Mitigation Techniques should map
directly to Provider Capabilities
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Risk and Compliance Management Capabilities are very advanced
due to “Rising Tide” effect
Iaas typical security that is “Built-In”
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Administrator Authentication: Password or optional Two Factor Authentication to access
Enterprise Cloud Portal
SSL Certificates and HTTPS encrypted sessions
Dedicated IP Addresses, Public and Private
Support of NAT to RFC1918 IP Address space
Support of Customer Provided IP Ranges
Storage location is only accessible by customer host environment
Individual Firewall Contexts/Rules managed and Accessed by Client Only
Load Balancer Context is customer managed
Private VLANS segregate customer networks
Virtual Machines are managed only by customer, service provider has no ability to
manage a client server unless specifically invited and credentials shared.
Dedicated Resources: Do not allow clients traffic/cpu/memory utilization peaks to affect
other client’s environments.
Ability to support any host based, network based, inline or span port security technology
that the customer requires to be installed into their cloud environment.
Support of IPSEC VPN’s
Distinct Firewall context
Cisco FW Modules in HA
Private Rulesets
Customer managed
Distinct LB context
Netscaler in HA
Customer managed
Portal Secured with SSL
Certificate
User authentication
Single or multifactor
NAT for inbound and
Outbound traffic
Private VLANs
Vmware vSwitch
DMZ and Internal Network
By default, more upon r
request
Virtual Machines with own
OS instances managed
By customers
Dedicated Resources
Customer can oversubscribe within
His/her own environment but does not
Affect other customers
Remote admin
Only via VPN
Dedicated IP addresses
Private and Public
Storage only accessible
Via customer Host
Optional security that is “Bolted-On”
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Managed Firewall
Managed Intrusion Detection/Prevention
Managed Log Aggregation and Correlation
Managed Security Event and Incident Management
Network Traffic Session (Netflow) Monitoring and Analysis
Full-packet capture and attack replay
Memory, Disk and Network Forensics
Data Leak Detection/Prevention
End User Metrics, Analytics and Root Cause Analysis
Content Filtering
Anti-DDoS
Application Firewalls
Network Access Control
2 Factor Authentication
Database Access Monitoring
File Integrity Management
And: Client Provided Security!
IPS, DLP, AV,
Application Whitelisting,
Content Filtering
Anti-DDoS , DNS-SEC,
Massive Scalability
and Peering, CDN
NIST Continuous Compliance, NAC,
Customer/DHS Mandated Equipment
Support for Virtual Appliances
Citrix VPX, Coradiant, and others
Vulnerability Scanning,
DB Access Monitoring
Citrix Application Firewall,
SSL Acceleration, Auto Reacting
Load Balancers, SLA Enforcement
Network Taps for Network
Full Packet Capture, NetFlow,
End User Analytics
Inter-VM Monitoring
SAML, PEB/CAC,SSO,
2FA, Role Based Access
Crypto Customer
provided, MTIPS
Bandwidth
Log Aggregation and
SEIM, File Integrity
Static and Dynamic Code Testing
Archival is Encrypted
Intel: Trusted Execution Technology
Memory: Capture for Forensics, Malware
Analysis, Anti- APT Proserve Efforts
Storage: DOD Wipes,
Data Spillage Procedures,
Forensic Capture
Challenges
• Lots of Moving Parts: SLA & Root Cause Analysis
• Forensics: Network, Disk, Memory
• New Issues to Deal with
• Mindset Change: From Point in time to Continuous
Compliance and Performance Assurance…
New Issues to Deal with:
• Old considerations for security and compliance
• Some new considerations for security and compliance
• Where is your Data?
• Each server is now a file
• Additional considerations for Incident Response
• Additional considerations for Forensics
• Storage systems much larger
• Additional considerations for Law Enforcement
• New Attack Vectors: Same as any outsourced datacenter or
hosting provider plus.. Guest to Guest, Guest to Host/VMM/HW, Guest to Self,
External to Host/VMM/HW, External to Guest, Host/VMM to All, Hardware to VM’s
New Threats
In addition to the “normal” information security
threats, we are increasingly focused on emergent
threat trends
•Medical device hacks
•Advanced Persistent Threats
•Application Layer Attacks
•Cloud Bursting
The Future
The Future
• Continuous Compliance
• Total Application Performance Assurance
• Somebody is going to get popped… the question is how fast
can the response be? “Intrusion Resilience”
• Updated: NIST and Federal Standards for Cloud Security
• Growth and increased adoption
The Future
• Growth in attack vectors
• Growth in complexity of attacks
• Increase of state-sponsored cybrecrimes
• Increase in arrests
• Increase in InfoSec budgets
• Increase in InfoSec education
• Increase in IT Security personnel
Thank You