CYBER RISKS CALLUM BARTHOLOMEW – OPERATIONS MANAGER, CABRINI HEALTH MELBOURNE, AUSTRALIA
Attacking cyber risks unique to hospitals
Cyber-attacks can pose a unique risk to hospitals and their patients and staff due to modern medical devices’ reliance on unified and shared network infrastructure, as Callum Bartholomew, operations manager – health technology integrations, Cabrini Health Melbourne, explains.
Cyber risk in health continues to grow, with more and more attacks being reported. Attacks can cause disruption of 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 coexistence of medical devices on modern unified and shared network infrastructure.
US-based, not-for-profit the Figure 1. Inventory high-level statistics.
ECRI Institute has listed cyber security attacks at the top of the list of hazards 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, internet of things (IoT), and medical devices, that require corrective action ranging from software patching through to replacement or isolation. 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 do not know.
Asset management 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, operating system, version, vulnerabilities, IP address, and MAC address – without the use of an automated discovery tool. For example, at Cabrini Health there are 15,281 connected devices that have recently been seen across the corporate and guest networks, of which only 2,675 are medical. Also noting that 2,721 are identified as high-risk due to unmanaged vulnerabilities (Fig 1). Some 217 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 to many public hospitals, Cabrini is far more basic, as it
Callum Bartholomew
Callum Bartholomew is operations manager – health technology integrations at Cabrini Health Melbourne. Callum is a seasoned professional in biomedical and health technology, bringing
extensive experience in managing technical teams across diverse industries, including ICT hardware, biomedical,
telecommunications, and asset management. His strong
understanding of technology and ability to create positive outcomes for customers enables him to quickly identify and address obstacles to success, whether related to people, processes, systems, or products.
IFHE DIGEST 2024
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 is key Resources are always limited, so risk stratification is an important way to allow prioritisation of an ongoing
program of work. Also noting that high level controls such as VLAN segregation and firewalls can provide a safe zone for devices that are identified as high-risk, cannot be hardened, or where they are no longer supported by the vendor, which is very common in building control systems and medical devices.
Location Asset location visibility is not only useful for management but also for containing an attack – this becomes difficult at scale, especially if departments and individuals add new IoT and internet of medical things (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. 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 way, cross-referencing can be used to determine location of the device if the switch port and patching information is available. Tracking down mobile equipment can be a challenging task, but standard network tools can be used to assist. Figure 2 depicts wireless mobile devices found using a common wireless location device.
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