Medical IoT Device Security: What are the risks?

The Internet of Things (IoT) has catalyzed a global network of interconnected smart devices that collect, process, and share data. The adoption of IPv6, which ensures that there are enough IP addresses for devices everywhere, significantly strengthens this network. IoT's impact is notably profound in healthcare, reshaping operational dynamics through various devices such as wearables, monitoring sensors, and implantable technology. This innovation enables remote patient monitoring and care, greatly enhancing accessibility for those with transportation challenges, the elderly, and residents of remote locations.

If you like my content, please visit Compliiant.io and share it with your friends and colleagues. Cybersecurity services, like Penetration Testing and Vulnerability Management, for a low monthly subscription. Pause or cancel at any time. See https://compliiant.io/

Surgence of Medical IoT Devices

The need to manage overcrowded facilities and reduce in-person contact accelerated IoT adoption in healthcare during the COVID-19 pandemic. As a result, the value of medical IoT devices is projected to surge from around $177.64 billion in 2021 to over $467.25 billion by 2027. Due to strict regulatory requirements regarding data security and privacy, the integration of IoT in healthcare initially moved slowly. However, the pandemic necessitated the swift adoption of emerging regulations to expedite the use of IoT in medical settings.

The widespread deployment of IoT in healthcare raises significant privacy and security concerns as these devices handle sensitive patient data. As we'll see in a minute, the inherent vulnerabilities of IoT devices can expose healthcare networks to data breaches and security incidents through various attack vectors. The pandemic underscored these risks with severe cybersecurity breaches leading to dire consequences, such as delayed medical treatments and significant ransomware costs to healthcare institutions—totaling $20.8 billion back in 2020.

Given the vast amount of personal information managed, it's no wonder that healthcare providers remain prime targets for cyberattacks. Moreover, the legal ambiguities surrounding who should bear responsibility for IoT data breaches—technology providers or healthcare organizations—especially when devices operate outside hospital networks, further exacerbate the complexity.

Healthcare organizations should adopt comprehensive cybersecurity measures to fortify their defenses against future IoT threats. Naturally, this is a lot easier said than done.

OWASP IoT Top 10

OWASP, or the Open Web Application Security Project, is an international nonprofit organization dedicated to improving the security of software. Its mission is to make software security visible so that individuals and organizations worldwide can make informed decisions about true software security risks.

OWASP accomplishes this through community-led open-source software projects, hundreds of local chapters worldwide, tens of thousands of members, and by hosting educational and training conferences. If you are in information security, it's likely you are familiar with the Top 10 lists.

The OWASP IoT Top 10 identifies the top ten security vulnerabilities found in Internet of Things (IoT) devices. This list is an essential resource for developers, manufacturers, enterprises, and security professionals to understand and mitigate IoT technology's most critical security risks. The purpose is to raise awareness and promote best practices for securing IoT systems.

Medical IoT manufacturers, please take notice!

Here are the OWASP IoT Top 10 vulnerabilities as of the latest update:

1. Weak, Guessable, or Hardcoded Passwords: Using easily guessed or hardcoded passwords makes devices easy targets for attackers.
2. Insecure Network Services: Vulnerabilities in the network services of IoT devices that could be exploited to cause harm or extract information.
3. Insecure Ecosystem Interfaces: Poorly secured interfaces (like APIs, web interfaces, and cloud connections) that could allow unauthorized access and data leakage.
4. Lack of Secure Update Mechanism: The absence of a secure method to update the device leaves it vulnerable to attacks that exploit old vulnerabilities.
5. Use of Insecure or Outdated Components: Utilization of outdated or vulnerable hardware and software components that compromise device security.
6. Inadequate Privacy Protection: Inadequate safeguards are in place to protect the data that IoT devices collect and process, putting users' privacy at risk.
7. Insecure Data Transfer and Storage: Unencrypted or poorly encrypted data transfers and storage that could be intercepted or accessed unauthorizedly.
8. Lack of Device Management: Inadequate mechanisms to manage and secure devices throughout their lifecycle lead to potential vulnerabilities.
9. Insecure Default Settings: Devices shipped with insecure defaults, such as open ports or default passwords, could provide attackers with easy access.
10. Lack of Physical Hardening: Insufficient physical security measures on devices make them susceptible to tampering.

These vulnerabilities are a major concern as IoT devices increasingly permeate all aspects of personal and professional life, controlling everything from home appliances to critical infrastructure and patient medical devices. Addressing these vulnerabilities is crucial for ensuring the security and integrity of medical IoT devices and the environments they operate in.

Medical IoT Security Mitigation Strategies

Here are some helpful mitigation strategies. Although not an exhaustive list, this is a great starting point:

1. Weak, Guessable, or Hardcoded Passwords

• Enforce strong password policies that require complex, unique passwords, and implement mechanisms to prevent the use of default or weak passwords. Regularly update passwords and consider the use of multi-factor authentication to enhance security.

2. Insecure Network Services

• Secure network services by using up-to-date and encrypted communication protocols like TLS, regularly auditing and updating network services, and disabling unnecessary services to minimize potential attack surfaces.

3. Insecure Ecosystem Interfaces

• Secure all interfaces by implementing rigorous authentication and authorization checks, encrypting all communications, and conducting regular security assessments of APIs, web interfaces, and app connections to identify and mitigate vulnerabilities.

4. Lack of Secure Update Mechanism

• Establish a secure firmware/software update process that includes automatic, authenticated, and encrypted update mechanisms. Use cryptographic signatures to verify the integrity of updates before installation.

5. Use of Insecure or Outdated Components

• Regularly review and update the components used in IoT devices, such as libraries and frameworks, to ensure they are not vulnerable or outdated. Employ a secure software supply chain management approach to maintain security throughout the lifecycle of the device.

6. Insufficient Privacy Protection

• Implement data minimization practices to only collect necessary information, ensure data is encrypted both in transit and at rest, and apply strong access controls to protect personal and sensitive data.

7. Insecure Data Transfer and Storage

• Use strong encryption for data at rest and in transit, apply robust access controls, and ensure that security configurations are correctly set to prevent unauthorized access to data.

8. Lack of Device Management

• Develop comprehensive device management policies that include regular security audits, timely patch management, and secure authentication. Enable capabilities for remote management and patching to ensure devices remain secure throughout their operational life.

9. Insecure Default Settings

• Change default configurations to secure settings before device deployment, disable unnecessary ports and services, and ensure that devices do not ship with default credentials.

10. Lack of Physical Hardening

• Enhance physical security measures to protect devices from tampering or unauthorized access, including the use of tamper-resistant and tamper-evident designs and secure boot mechanisms that verify hardware and software integrity at startup.

By implementing these strategies, manufacturers can significantly reduce the risks associated with medical IoT use and development. Medical IoT manufacturers and developers must prioritize secure-by-design in device creation, supporting robust cybersecurity practices crucial for mitigating risks associated with devices.

In response to these challenges, the International Medical Device Regulators Forum established a working group in March 2020 and released guidelines for medical device cybersecurity. These guidelines serve as a framework for manufacturers to effectively manage vulnerabilities and respond to incidents. Additionally, the National Institute of Standards and Technology (NIST) contributed to these efforts with a report in September 2021, which consolidates industry-wide cybersecurity concerns related to IoT, particularly those affecting medical devices.

As IoT continues to integrate into medical technology, the potential for innovation and improvement in patient care is significant. However, the ongoing security risks necessitate vigilant, coordinated efforts across the industry to safeguard against potential threats and ensure the integrity of healthcare services.

If you like my content, please visit Compliiant.io and share it with your friends and colleagues. Cybersecurity services, like Penetration Testing and Vulnerability Management, for a low monthly subscription. Pause or cancel at any time. See https://compliiant.io/