There is a perfect storm of consumer electronics, mobile communications and customer need - the need to help people manage chronic disease like Parkinson, diabetes and MSA and sustain life with pacemakers and ICDs
1. Mob Sec Mobile Security Conference 4/11/2010 Herzliya
Danny Lieberman – Software Associates.
v6
2. Agenda
Mobile medical is hot
Applications
Threat scenarios
A threat model framework for secure code
Summary
3. Mobilemedicaldevices arehot
Mobile consumer electronics creates
potential for life-saving applications
that are cheaper and more
accessible than any other
alternative.
The FDA is not there yet.
Neither is traditional IT security.
Applications
Threat scenarios
Countermeasures
4.
5. Datatracking
Who: Patients, care-givers, doctors
What: Data acquisition
Why: Controlling symptoms of chronic
illness requires tracking data over long
periods of time.
• Glucose
• Heart rate
• Blood pressure
• Dosage (insulin, dopamine …)
• ...
Platforms : Smart-phones, data &
location-based services.
Diabetes
Parkinson/MSA
Alzheimer
Asthma
6. Life-sustaining
Who: Patients
What: Implanted devices for cardiac
pacing, defibrillation, drug delivery…
Why: Sustain life
Platforms : Embedded devices with
mobile connectivity for remote
monitoring & programming.
Chronic heart disease
Epilepsy
Diabetes
Depression
“…the latest technology in a full complement of patient-focused CRM products”
7.
8. Threatscenariotemplate
An attacker may exploit
vulnerabilities to cause damage to
assets.
Security countermeasures mitigate
vulnerabilities and reduce risk.
Asset
Vulnerability
Attacker
9. Radioattackscenario
Patient with ICD
Clear
text
protocol
Threat T1 – A malicious attacker may exploit a clear text
protocol and instruct an ICD to deliver a shock that would
cause sudden cardiac death.
Vulnerability V1 – Clear text communications protocol
Countermeasure C1 – Encrypt network link
Countermeasure C2 – Validate messages using secure
tokens.
Attacker
10. Implantable CardioverterDefibrillators
In 2008, approximately 350,000
pacemakers and 140,000 ICDs were
implanted in the US.
Forecasted to $48BN in 2014.
Proof of concept attack:
• Reverse-engineered commands
• Intercepted vital signs, history
• Reprogrammed therapy settings
• DoS to deplete battery
• Directed the ICD to deliver 137V
shocks that would induce
ventricular fibrillation in a patient.
2008 ICD vulnerability study
11. Devicedefectattackscenario
Patient
Life
Software
defects
Device
malfunction
Threat T2 – An internal short circuit is undetected by the
device control software and may be fatal.
Vulnerability V2 – Software doesn’t monitor hardware
malfunctions
Countermeasure C3 – Notify customer service when
hardware issue identified.
Countermeasure C4 – Implement fail-safe function
12. FDAdevicerecalls
The FDA issued 23 recalls of
defective devices in H1/2010.
All were “Class 1” :
“reasonable probability that use of
these products will cause serious
adverse health consequences or
death.”
At least 6 recalls were
probably caused by
software defects.
14. Mobileclinicalassistants
Mobile imaging analysis devices
used by hospital radiologists had
unplanned Internet access.
Over 300 devices infected by
Conficker and taken out of service.
Regulatory requirements mandated
that the impacted hospitals would
have to wait 90 days before the
systems could be modified to remove
the infections and vulnerabilities.
15. WhereistheFDA?
The FDA has refocused regulation
from patient safety to auditing
manufacturers’ compliance with
their own standards.
If the FDA has approved a medical
device, consumers cannot sue.
“Riegel v. Medtronic “, 2008
20. Prioritizecountermeasures
Product management has 1
dollar in their pocket:
Countermeasure C1 –
Encrypt network link to ICD
Countermeasure C21 –
Validate POST requests
with secure tokens.
Countermeasure C3 –
Wearable “cloaker” to ensure
that only authorized
programmers can interact
with the device.
21. Driveprofits
Transparency means more eyeballs
can look at issues.
More eyeballs reduces cost.
More eyeballs means safer devices.
Safer devices means more revenue.
Medical
device threat
models are
transparent.
22. Sources
Riegel v. Medtronic, Inc.
http://www.law.cornell.edu/supct/html/06-179.ZS.html
Pacemakers and implantable cardiac defibrillators: Software radio
attacks and zero-power defenses.
Daniel Halperin et al.
Proceedings of the 29th Annual IEEE Symposium on Security and
Privacy, May 2008.
http://www.secure-medicine.org/icd-study/icd-study.pdf
Software transparency in imbedded medical devices
http://www.softwarefreedom.org/resources/2010/transparent-medical-
devices.html
Prof. Nir Giladi,Tel Aviv Souraski Hospital Neurology Department,
personal communication on data tracking for MSA patients
Biotronik – cellular pacemaker, http://www.biotronik.com/en/us/19412