The Challenges and Opportunities of Medical Device Cybersecurity

Connected medical devices offer many benefits, such as remote monitoring, data sharing, and improved efficiency. For instance, remote monitoring allows health care providers to track the status and conditions of patient’s, alongside the devices’ performance from a distance, reducing the need for frequent visits or hospitalizations. Data sharing enables health care providers to access and exchange relevant information about patients’ medical history, diagnosis, treatment, and outcomes across different platforms and settings. Improved efficiency results from the optimization of medical device operations and maintenance, such as automatic updates, alerts, and backups.

At the same time, connected medical devices also face many challenges and threats in terms of cybersecurity. This blog post delves into the challenges healthcare organizations face in securing medical devices and uncovers the opportunities they have to bolster cybersecurity measures.

A very complex ecosystem, just to start with

Researchers have identified the difficulty of implementing effective cybersecurity measures for medical devices. The health care environment is complex and dynamic, as it involves multiple actors, with diverse responsibilities, systems, and processes that interact with each other in various ways. These include medical device manufacturers, regulators, health care providers, patients, researchers, and more.

Each of these actors has different roles, interests, and capabilities in relation to medical device cybersecurity. For example, manufacturers are responsible for designing and developing secure medical devices, regulators are responsible for overseeing and enforcing the compliance of medical devices with cybersecurity requirements, health care providers are responsible for using and maintaining secure medical devices, patients are responsible for following the instructions and precautions of medical devices, and researchers are responsible for discovering and reporting cybersecurity vulnerabilities and solutions for medical devices.

However, these actors may not always have the same understanding, awareness, or alignment of medical device cybersecurity. For instance, manufacturers may not have sufficient knowledge or resources to implement security-by-design principles or to provide timely updates or patches for their medical devices, regulators may not have consistent or comprehensive standards or  regulations for medical device cybersecurity or to monitor or audit their implementation, health care providers may not have adequate training or support to use or maintain secure medical devices or to respond to cybersecurity incidents, patients may not have enough information or education to use secure medical devices or to protect their data, and researchers may not have clear or ethical  guidelines or channels to disclose cybersecurity vulnerabilities or solutions for medical devices.

These gaps or mismatches among the actors can lead to tradeoffs such as manufacturers prioritizing functionality or usability over security or privacy when designing or developing their medical devices, regulators imposing unrealistic or impractical requirements or expectations for medical device cybersecurity or failing to enforce them effectively, health care providers neglecting or compromising security or privacy when using or maintaining their medical devices or fail to report or mitigate cybersecurity incidents, patients misusing or abusing their medical devices or expose their data to unauthorized parties, researchers exploiting or publicize cybersecurity vulnerabilities or solutions for medical devices without proper authorization or consent.

As it is easily understood, the complex supply chain for medical devices can introduce security risks at multiple stages, from design to manufacturing and distribution. A breach at any point in the supply chain could compromise the integrity of the device and put patients at risk.

Challenges of Medical Device Cybersecurity

Variety of threats and risks

With the proliferation of connected medical devices, the healthcare sector has become an attractive target for cybercriminals. Hackers exploit vulnerabilities in devices to gain unauthorized access to patient data, disrupt hospital operations, or even manipulate medical equipment directly.

One of the main challenges of medical device cybersecurity is the variety and complexity of cybersecurity threats and risks that affect medical devices. These threats and risks can compromise the performance, reliability, and availability of medical devices, and potentially harm patients or health care providers.

Malware

Malware is any malicious software that can infect or damage a computer system or device. Malware can affect medical devices by altering their functionality, stealing or deleting their data, or disrupting their communication.

Ransomware

Ransomware is a type of malware that encrypts the data on a computer system or device and demands a ransom for its decryption. Ransomware can affect medical devices by locking them out of their data or functionality until the ransom is paid.  For example, in 2017, the WannaCry ransomware attack infected more than 200,000 computers in 150 countries, including many hospitals and health care organizations. The attack encrypted the data on the infected computers and demanded a ransom for its release. The attack affected several medical devices such as MRI scanners, causing delays and cancellations of medical procedures.

Denial-of-service

Denial-of-service attacks aim to disrupt or disable the normal functioning of a computer system or device by overwhelming it with excessive requests or traffic. Denial-of-service attacks can affect medical devices by preventing them from communicating with other devices or systems or accessing their resources. For example, in 2015, researchers discovered a vulnerability in Hospira infusion pumps that could allow hackers to launch denial-of-service attacks on the pumps. The vulnerability could potentially cause harm to patients by interrupting their medication delivery or causing an overdose.

Unauthorized access

Unauthorized access (i.e. the illegitimate access to a computer system or device by an unauthorized person or entity) can affect medical devices by exposing their data or functionality to unauthorized parties who may misuse or abuse them. For example, in 2016, researchers demonstrated how they could hack into an insulin pump and change its settings. The hack could potentially cause harm to patients by delivering too much or too little insulin.

Also, in 2018, Medtronic recalled more than 500,000 pacemakers due to a cybersecurity vulnerability that could allow hackers to access the pacemakers remotely and change their settings. The vulnerability could potentially cause harm to patients by altering their heart rate or depleting their battery.

Data breaches

Data breaches (i.e. any unauthorized or illegitimate disclosure of confidential or sensitive data from a computer system or device to an unauthorized person or entity) can affect medical devices by exposing their data to unauthorized parties who may exploit or leak them. For example,

in 2019, Quest Diagnostics reported that a data breach affected nearly 12 million patients who used its blood testing services. The breach exposed personal information such as names, dates of birth, social security numbers, and medical information such as test results.

Lack of Regulation and Standardization

Unlike the stringent regulations governing pharmaceuticals, healthcare organizations must navigate a complex landscape of regulations and compliance requirements. Standards and regulations are essential for establishing the minimum requirements and expectations for medical device cybersecurity, as well as for providing guidance and support for achieving them.

However, there is no universal or harmonized set of standards and regulations for medical device cybersecurity across different countries, regions, or sectors. Instead, there are multiple and diverse sources of standards and regulations that may vary in scope, content, quality, and enforceability.

These differences and inconsistencies among the standards and regulations can create confusion and uncertainty for the actors involved in medical device cybersecurity. For example, manufacturers may not know which standards and regulations to follow or how to comply with them when designing or developing their medical devices, regulators may not know how to evaluate or verify the compliance of medical devices with cybersecurity requirements or how to enforce them effectively, health care providers may not know how to use or maintain secure medical devices according to the standards and regulations or how to report or mitigate cybersecurity incidents, patients may not know what rights or obligations they have regarding their data processed by medical devices according to the standards and regulations, and researchers may not know what rules or procedures they have to follow when disclosing or reporting cybersecurity vulnerabilities or solutions for medical devices according to the standards and regulations.

Complexity and Diversity of Medical Devices

Medical devices span a wide range, from pacemakers to imaging systems, making it challenging to implement standardized security measures across the board. What we fee is important to discuss here is the difficulties faced by healthcare organizations in managing the security of diverse devices while maintaining interoperability and usability. Security and usability are both important aspects of medical device functionality and safety, as they affect the performance and satisfaction of the users and patients.

However, security and usability are often in conflict or competition with each other, as increasing one may decrease or compromise the other. For example, adding more security features or controls to a medical device may increase its protection or resilience against cyberattacks, but it may also increase its complexity or difficulty of use or maintenance. Conversely, simplifying or streamlining a medical device may increase its convenience or efficiency of use or maintenance, but it may also decrease its security or vulnerability to cyberattacks.

This trade-off between security and usability can create challenges or dilemmas for the actors involved in medical device cybersecurity. For example, manufacturers may have to balance between providing enough security features or controls to protect their medical devices from cyberattacks and providing enough usability features or controls to ensure their medical devices are easy to use or maintain by the users or patients, regulators may have to balance between imposing enough security requirements or expectations for medical device cybersecurity and imposing enough usability requirements or expectations for medical device functionality or safety, health care providers may have to balance between applying enough security measures or practices to use or maintain secure medical devices and applying enough usability measures or practices to use or maintain efficient medical devices, patients may have to balance between following enough security instructions or precautions to use secure medical devices and following enough usability instructions or precautions to use convenient medical devices, and researchers may have to balance between discovering enough security vulnerabilities or solutions for medical devices and discovering enough usability vulnerabilities or solutions for medical devices.

Interconnectivity and Network Vulnerability

The proliferation of interconnected devices, forming the Internet of Medical Things (IoMT), has expanded the attack surface for cybercriminals. Medical devices that rely on wireless communication to exchange data and updates can become entry points for hackers to infiltrate hospital networks and compromise patient data.

On the other hand, there are still active legacy systems, i.e. medical devices were designed before the era of modern cyber threats and lack robust built-in security features. These devices can become easy targets for cyberattacks, potentially leading to patient harm or unauthorized access to sensitive medical data.

Opportunities in Medical Device Cybersecurity

Despite the challenges and threats of medical device cybersecurity, there are also many opportunities and solutions that can enhance the cybersecurity of medical devices. These include the development of best practices and guidelines, the adoption of security-by-design principles, the use of encryption and authentication technologies, the establishment of coordinated vulnerability disclosure programs, and more.

Secure Design and Development Practices

Security-by-design principles are essential for ensuring that security is integrated into every stage of the medical device life cycle, from design and development to deployment and maintenance. They can help to prevent or mitigate potential cybersecurity threats and risks for medical devices by incorporating security features and controls into their architecture, functionality, and testing.

They can also help to improve the security and usability of medical devices by reducing their complexity and difficulty of use or maintenance. The implementation of emerging technologies like artificial intelligence (AI) and blockchain can also enhance medical device cybersecurity.

Advanced Encryption and Authentication

Secure communication protocols can safeguard data exchange between devices and healthcare networks, reducing the risk of unauthorized access. Hence, encryption and authentication technologies are essential for protecting the confidentiality, integrity, and availability of the data and communication of medical devices.

They can help to prevent or mitigate unauthorized access, data breaches, or denial-of-service attacks on medical devices by encrypting their data or communication with secret keys or codes that only authorized parties can access or decrypt. They can also help to improve the security and usability of medical devices by simplifying their access or communication with other devices or systems without compromising their protection or resilience.

Real-time Monitoring and Threat Detection

Implementing real-time monitoring solutions can help healthcare organizations detect anomalies and potential cyber threats. By analyzing device behavior patterns, abnormal activities can be identified and addressed promptly, minimizing the risk of a breach.

Collaborative Efforts and Information Sharing

The healthcare industry is increasingly recognizing the need for collaboration in addressing cybersecurity challenges. Healthcare organizations, medical device manufacturers, and cybersecurity experts can collaborate to share knowledge, best practices, and threat intelligence. Sharing information can enable healthcare professionals and manufacturers to collectively enhance the security of medical devices.

Coordinated vulnerability disclosure programs can also be considered for facilitating the identification and resolution of cybersecurity vulnerabilities for medical devices. They can help to encourage and enable researchers to discover and report cybersecurity vulnerabilities for medical devices in a responsible and ethical manner without causing harm or damage to the devices or their users or patients. They can also help to foster collaboration and communication among researchers, manufacturers, regulators, health care providers, patients, and other stakeholders involved in medical device cybersecurity by establishing clear and ethical rules or procedures for disclosing or reporting cybersecurity vulnerabilities or solutions for medical devices.

Regulatory Advancements

Regulatory bodies are beginning to address the cybersecurity gap in medical devices. Stricter regulations and guidelines are being developed to ensure manufacturers adhere to standardized security practices throughout a device’s lifecycle, from design to post-market surveillance.

User Education and Training

Improving the cybersecurity literacy of healthcare professionals and end-users is crucial. Comprehensive education and training programs can empower individuals to identify potential risks, adopt secure practices, and respond effectively in the event of a cyber-incident.

Conclusion

The integration of medical devices into modern healthcare has unlocked a world of possibilities, offering precise diagnostics and personalized treatments. However, this progress comes with the responsibility of safeguarding patient well-being in the digital age.

The challenges posed by medical device cybersecurity are complex and multifaceted, requiring a concerted effort from manufacturers, healthcare professionals, regulators, and patients themselves. Embracing the opportunities presented by advanced encryption, real-time monitoring, collaboration, and regulatory advancements will pave the way for a safer and more secure future in healthcare. As we navigate this evolving landscape, the commitment to protecting patient safety must remain paramount, ensuring that the benefits of medical technology continue to outweigh the risks.