Cybersecurity: in healthcare, encryption Is not enough
The recent news that one major video conferencing provider is to backtrack on previous refusals to provide end-to-end encryption to free users is a major victory for the activists and civil liberties organisations campaigning for privacy and digital protection. Data transmission is one of the most vulnerable areas of video communication and ensuring a comprehensive level of security is paramount for those taking part in digital conversations – whether that’s personal, for business, or in a healthcare environment. During a video conversation, data travels over multiple networks - both public and private – and encryption is the foundation of protecting this data in transit.
Security is vital
The news comes at a turning point for video conferencing. As we continue to move through the COVID-19 pandemic, most businesses are still navigating widespread remote working practices. Video conferencing use has skyrocketed. For many industries, this shift to remote working is unprecedented, and maintaining productivity in the face of significant disruption has been the key priority for most organisations. Security and compliance considerations have all too often been an afterthought. The recent campaign for access to encryption has highlighted how vital security is to video communications – but this is something heavily regulated industries like healthcare have known for a long time.
In healthcare, end-to-end encryption is not enough – in fact, it’s expected. Video conversations contain highly sensitive personal information and medical records – they must meet the same levels of patient confidentiality as in-person consultations. Zoom-bombing – where an unauthorised stranger intrudes on another’s Zoom conversation – may be damaging in a business meeting, or even comical during a personal conversation. In a healthcare environment, this type of security breach can lead to clinical, legal and phycological repercussions – not to mention a substantial damage of trust between doctor and patient.
Getting video right in healthcare
Even before the COVID-19 pandemic, video conferencing technology use in healthcare was increasing exponentially, with developing use cases in remote post-discharge programs, as well as specialist consultations such as speech therapy and dentistry boosting demand. And although randomised controlled trials (RCT) into the use of video conferencing in healthcare are still limited, – particularly into patients with long term chronic conditions – suggest video conferencing adoption can enhance care and management, improve access to care, improve patient outcomes, narrow health disparities and reduce healthcare costs overall.
Travel and consultation restrictions imposed by governments globally during the COVID-19 pandemic have acted as a substantial catalyst for video conferencing adoption in healthcare. The ability for the technology to protect patients – both for those where travel is challenging or untenable due to reduced services, as well as those at particular risk of illness – is clear.
Quickly putting virtual systems in place during the pandemic has been vital in enabling even the most vulnerable in society to continue to communicate with medical professionals. At the same time, this has also ensured medical professionals have minimal physical contact with patients, reducing the potential for workplace transmission for some of the country’s most essential workers.
Going beyond encryption
Over recent months, organisations across all industries have been struggling to meet the challenge of quickly delivering seamless virtual connectivity. Under unprecedented pressure to roll out new technology, it can be easy to overlook the more fundamental requirements, in favour of rolling out new services and capabilities at speed. Enabling doctors, nurses and healthcare practitioners to meet and treat patients virtually should not come at the cost of privacy and security.
End-to-end encryption technology – which is vital for privacy and security and will now soon be available via even the most basic video conferencing solutions – is not enough to meet the high standards healthcare requires. Instead, authentication is the key to ensuring the growing adoption of video conferencing in healthcare meets the same high standards delivered to patients in-person.
Authentication provides a double layer of trust, ensuring both patient and care giver can be confident that they are speaking to the right person within an entirely confidential virtual space. Only by ensuring video conversations are both end-to-end encrypted and authenticated can healthcare professionals provide the same level of privacy and security afforded to patients during a face-to-face consultation. This ensures the identity of every conference participant – whether that’s a doctor, patient, carer, interpreter, or parent -– is fully authenticated before the conference is initiated.
Looking to the future
The authentication process is simple, but hugely effective. It represents the first step in a more digital, video-driven healthcare future – providing all the necessary foundations for patient security and privacy. In the future, 2020 will undoubtedly be looked at as a year that changed healthcare forever – globally. The world has been at war with a novel virus and the effects have been profound. But as the great military, Sun Tzu, said, “In the midst of chaos, there is also opportunity.” Social distancing, lockdown and travel restrictions have forced us to rethink how we deliver essential services and given us the opportunity to roll out cutting edge technology. But while the results are already hugely positive, we need to ensure we are laying the right foundations for new innovation – building security and privacy in now – not later.
Why are healthcare networks so vulnerable to attacks?
Forescout Research Labs has published a study on the vulnerabilities impacting the healthcare industry’s connected devices. The research division of Forescout Technologies has published the report as part of its Project Memoria, and it reveals that healthcare organisations are affected five times more by TCP/IP vulnerabilities than any other sector.
Elisa Costante, a software engineer and Forescout's Vice President of Research, explains why this is and how to prevent it.
What is Project Memoria?
Project Memoria aims to improve the security of TCP/IP stacks and understand what the main security issues are. TCP/IP stacks are a very core component of every network device, whether it's an iPhone connected to the internet, or a robot controlling the process of manufacturing. If they're connected to the internet they need to have a piece of software controlling communication.
There are several variants of this software and we're analysing them to understand if they have security bugs or vulnerabilities that if misused by attackers, could lead to disruption of the device itself, and to the network at large. Our goal is to make the industry aware of the problem, and engage with stakeholders as well as the customers.
Why is healthcare particularly vulnerable?
This is what the data is telling us. We have a device cloud, which is like a data lake of device information. This device cloud has a lot of information about the devices, like who the vendor is, what the role of the network is, and which vertical this is. We are able to leverage this information, and join it with the intelligence we have from Project Memoria to understand which devices are vulnerable.
We found that in healthcare there was a huge spike in the number of devices that are vulnerable - as much as five times more than in other verticals. The reason seems to be because of the number of devices, and because of the intrinsic difficulty of addressing the problem.
The problem surrounding TCP/IP stacks is that there is not one single vendor that is vulnerable; on average, a healthcare organisation has 12 vendors that are vulnerable.
Let's say that on average we have 500 devices per healthcare organisation. Then you need to contact 12 vendors for each of these. These vendors then need to issue a patch to secure the device, and this patch cannot just be automatically delivered and installed in 500 devices. You have to be realistic and think about whether each of the devices is critical, for example if it goes down will it turn the lighting system off, or stop the MRI machine from working.
Patches are very complex to deploy. On top of that, the patch needed might not even be available. That's why we want to understand this problem better so we can provide solutions.
How much of the responsibility of keeping a device secure lies with the vendor?
There are responsibilities that lie with all the different stakeholders, and one of these is the vendor. There might be multiple vendors involved, which makes it very complex from a management perspective.
For instance the device at the end of the chain, which might be an MRI, contains a board that has a connectivity module, and this has one of the stacks that is vulnerable, which could have four different vendors.
If the vendor responsible for the TCP/IP stack releases a patch, this patch has to go down the chain. We identified chains with a length of six vendors, so you can imagine how complex this is. Some vendors have good hygiene security and some don't because they don't know how to deal with it - they need training.
This is a new issue related to the software bill of materials, which is being tabled for legislation at the moment to create policies regarding the complexity of the supply chain. We need to shed light on this issue so that legislators can put these policies in place to help with security.
What can healthcare providers do themselves to stay secure?
Visibility is important; they need to know what they have in their network. In the case of vulnerable devices they should find out if there's a patch available. If there isn't, because it's an old device for example, but it's still critical to the system, they may want to isolate it so it only communicates with the devices it really needs to.
Interestingly enough, our research found that most of the healthcare organisations we analysed had a flat network, which means they don't have isolated devices. For instance, a drugs dispensing machine, which you typically find in pharmacies, is connected to a building automation light system, which is connected to a switch. This is also connected to an IoT sensor device. Why would you have all of them together in the same place?
The first step is having this information, which often comes as a surprise. Then you can take action; you can segment a network, and if you can't do that you can control the network's access by isolating devices that are risky.
How can Forescout help healthcare organisations?
Forescout is uniquely positioned to help. We provide visibility end-to-end, which means having a full inventory of devices that includes quite granular detail, so they can know what the operating system is, who the vendor is and so on. Then we enable them to do network segmentation.
This enables organisations to write policies around how to secure their networks, for example if a device is vulnerable specify which connected devices must be isolated, or which device it must communicate with exclusively.