CYBER SECURITY


Minimising the cyber risks unique to hospitals


Callum Bartholomew, Operations Manager – Health Technology Integrations, at not-for-profit private health service provider, Cabrini Health Melbourne in Australia, discusses some of the major cybersecurity risks facing hospitals and other healthcare facilities, and outlines the company’s own approach to minimising the risk of so-called ‘cyberattacks’. He also suggests some of the key steps that other healthcare organisations can take to maintain the integrity and security of their own connected assets.


Cyber risk in health continues to grow, with more and more attacks being reported. Attacks can cause disruption to mission critical services, loss of data, and breaches of privacy, but unique to hospitals are the risks to our patients and staff arising due to the co-existence of medical devices on modern unified and shared network infrastructure. US-based not-for-profit, the ECRI


Institute, listed cybersecurity attacks at the top of the list of hazards for 2022 due to the large volume of connected devices in hospitals, both medical and non-medical. Cyber vulnerabilities are published frequently by manufacturers and vendors of software, building control systems, and Internet of Things (IoT) and medical devices, that require corrective action ranging from software patching through to replacement or isolation.


Complications on undefined responsibility Added complexity arises due to undefined responsibility for asset management, monitoring sources of vulnerability alerts, and remediation across all disciplines. Hospital IT Departments often purposely exclude active management of networked building control systems and medical devices on the assumption that these will be appropriately managed by others, often the vendor or service provider. The real risk is not knowing what you don’t know. It is unrealistic to expect to maintain a


level of detail in the asset database that accounts for every connected device’s relevant connectivity attributes which includes information such as location,


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Inventory High Level Stats 13,306


Corporate


2,845 Medical


4,959 Online


275 OT


11,516 High risk


6,155 IoT


1 Compromised


27,683 Devices


14,420 Guest


18,408 IT


1,336 New this week


Figure 1: A breakdown of the wide range of ‘connected devices’ seen across Cabrini Health’s corporate and and guest networks, and the associated cybersecurity risks.


operating system, version, vulnerabilities, IP address, and MAC address, without the use of an automated discovery tool. Cabrini Health is a Catholic, not-for-


profit private health service located in the south-east of Melbourne, Australia. Inspired by the mission and ethic of care of the Cabrini Sisters, it has provided care to its community for over 70 years. With hospitals in Malvern, Brighton, and Elsternwick, it offers a comprehensive range of acute, rehabilitation, palliative care, mental health, and homecare services. At Cabrini Health there are 27,683


connected devices that have recently been seen across the corporate and guest networks, of which only 2,845 are medical (see Figure 1). Of these, 11,516 are identified as high-risk due to unmanaged vulnerabilities, while 275 devices are identified as operational technology (OT), which includes items such as building access controllers. It is not until an inventory is built that the magnitude of the issue becomes apparent. Compared with many public hospitals,


At Cabrini Health there are 27,683 connected devices that have recently been seen across the corporate and guest networks, of which only 2,845 are medical. Of these, 11,516 are identified as high- risk due to unmanaged vulnerabilities


Cabrini is far more basic, as it does not have an electronic medical record that requires many devices to be networked, and some legacy connected equipment cannot be seen by discovery tools, because it is on physically segregated networks.


Prioritisation and location are key Resources are always limited, so risk stratification is an important way to allow prioritisation of an ongoing programme of work. It is also worth noting that high-level controls – such as VLAN segregation and firewalls, can provide a safe zone for devices identified as high- risk, which cannot be hardened, or where they are no longer supported by the vendor, which is very common in building control systems and medical devices. Asset location visibility is not only useful for management personnel, but also for containing an attack; this, however, becomes difficult at scale, especially if departments and individuals add new IoT and IoMT devices to your network without your knowledge. This shadow IT challenge can turn ugly if any of these devices have default passwords or lax security. Without you knowing they have entered your environment, there is no way to secure them appropriately. The location of fixed devices can be managed through a variety of different tools, but typically an asset management software tool can include location information and port numbers. In this


May 2024 Health Estate Journal 25


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