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Readers Write: Lessons Learned from the CHS Breach

September 3, 2014 Readers Write 2 Comments

Lessons Learned from the CHS Breach
By John Gomez

In early 2014, a group of security researchers began to suspect that some implementations of SSL — a commonly used method to encrypt data — were not as secure as the name would imply. Their thesis was rather elegant, actually more art than science, but fascinating just the same.

They hypothesized that although the cryptographic algorithms may well be secure and protect over-the wire data (data sent across a network) from prying eyes, the actual programming used to implement the algorithms may have flaws. If there was a flaw in the underlying implementation — such as how memory is managed, for instance — then SSL could become a tool for nefarious agents to exploit and compromise network security.

On April 1, 2014, two groups of security researchers (Neel Mehta of Google and Codenomicon) announced that such a flaw did exist in SSL, specifically in OpenSSL. This vulnerability came to be known as Heartbleed.

Within hours of the vulnerability being announced, sites around the world were compromised, including the Canadian Revenue Agency, Mumsnet in the UK, and others. Early estimates showed that well over a million sites and X.509 certificates were at risk of attack. On April 12, 2014, University of Michigan reported that a server in China had attacked a decoy server at U of M with advanced tools to exploit the Heartbleed vulnerability.

The revelation of the Heartbleed impact created shock waves. Some, like the Electronic Frontier Foundation, called it “catastrophic,” and Forbes columnist Joseph Steinberg declared, “Some might argue that [Heartbleed] is the worst vulnerability found (at least in terms of its potential impact) since commercial traffic began to flow on the Internet.”

Within days of the disclosure, the Federal Bureau of Investigation released a private industry notice (or PIN) to the healthcare industry that stated, “The healthcare industry is not as resilient to cyberintrusions compared to the financial and retail sectors, therefore the possibility of increased cyberintrusions is likely.”

Flash back to February 2014, when a group of hackers known as Unit 61398 was suspected of launching cyberattacks against a variety of US industries, specifically the financial, transportation, energy, and healthcare sectors. Unit 61398 is believed to be, according to cybersecurity firm Mandiant, a top-secret unit of the People’s Liberation Army based in Shanghai.

Since February 2014, it has been learned that Unit 61398 is not specifically tasked with cyberattack missions, but it is believed to have developed highly sophisticated software and hardware tools that could be used for cyberwar, typically known as cybermunitions. Speculation is that these tools are made available to independent hacker groups for “testing purposes only,” although this has never been confirmed.

One such group believed to have gained access to these tools is APT 18, a well known and highly sophisticated group of Chinese hackers with branches in Shanghai, Hong Kong, Singapore, and the United States. APT is shorthand for a type of cyberattack known as Advanced Persistent Threat. APT 18 specializes in conducting those attacks.

It is believed that within hours of the Heartbleed disclosure on April 1, APT 18 started customizing the tools from Unit 61938. One they possibly created is a Remote Access Tool (or RAT.) A RAT works by using a carrier to gain access to network systems, usually by rather simple means. For example, a RAT can be deployed inside a network as a result of a user watching a video, reading an e-mail, or opening a file.

A highly common way of distributing a RAT is through a trusted third-party communication, which is typical in exchanges between business associates and covered entities in healthcare. A RAT could also be deployed to a medical device with a vulnerable call-home feature and network access.

The RAT allows remote control of a network, servers, devices, and much more. Just like a real rat, a cyber-RAT is infectious and can cause severe damage. The current thinking is that APT 18 targeted Community Health Systems (CHS) and successfully introduced a RAT before CHS could apply the Heartbleed patches to all of its systems. This is speculation, but highly probable.

It is also probable that APT 18 was successful because it had started targeting the healthcare industry in February 2014. Heartbleed was a fortunate development. It is also believed that CHS is not the only targeted healthcare entity and APT 18 may have compromised other healthcare organizations that may not have discovered the compromise yet. APT 18 may have used other vulnerabilities to infiltrate the CHS system, but for purposes of this article, we will continue to embrace the common thinking that Heartbleed was the key mechanism.

Criticizing CHS would be wrong. It acted quickly and there’s no evidence that it was negligent or dismissive. A better use of our time as an industry would be to learn from the CHS experience. The healthcare information technology sector is under attack by sophisticated enemies who will continue to persist their attacks on healthcare infrastructure as a means to undermine patient confidence in our ability to provide quality care and security.

We should be thankful that the CHS breach was limited to data because a RAT can take over an MRI, CT scanner, or EMR system to impact patient safety. Other cybersecurity researchers have demonstrated how to attack X-ray machines and other medical devices. The risk of attack on medical devices prompted the FDA to issue a memorandum on security to medical device manufacturers in June 2013. Although some manufacturers have responded to the memo in a positive manner, some have ignored its warning.

The most important lesson we can take away from the CHS breach is that we as an industry, to echo the FBI PIN, are “…not as resilient as other industries.” Which leaves us with the question: how do we improve our security stance and become more resilient?

Security takes money and a lot of it. There is no way to sugarcoat that fact or to make it more politically correct. NBC News recently reported that the annual cost of healthcare breaches is approximately $5.9 billion. Being secure means educating the board of directors and making it a core investment of the healthcare organization. There is no cheap answer or strategy.

Then, consider how to become aggressive about cybersecurity. Not assertive, but aggressive. Here’s an analogy.

Think of a healthcare system as a castle. Castles had multiple layers of security — intelligence, physical deterrence, internal and external defensive tools and strategies, propaganda, community allegiance, and, “Oh, crap, everything has failed” plans.

The safest castles — the ones that truly focused on protecting their inhabitants, allowing them to pursue a happy and high quality life — had the best layers of coordinated defense and offense. The castles that simply deployed the basics — a moat, drawbridge, some pots of tar, and maybe a few archers — soon learned that a persistent and determined attacker, like APT 18 or others like them, would eventually defeat these strategies.

In today’s terms, that means if you have firewalls, intrusion detection, penetration testing, DLP and similar tools, and policies and procedures, you either have been breached or you will be breached, just like the simpleton castle that did only the basics. A Level III castle.

If you take things up a notch, maybe employ a CISO, get advanced tools, and offer community education and compliance monitoring, you’re on the right track. Still, the odds are that you will get taken out. Your castle is a bit more sophisticated as a Level II castle. You added some alligators to the moat, armed the citizens, and took survival a bit more seriously. A good job, but you could do better. You are assertive, not aggressive.

The best castles invest in leading edge tools, form regional security councils to share ideas and help each other, create crisis response plans, educate their business associates, and use tools for real-time compliance monitoring, data discovery, classification and categorization, and locking down medical and mobile devices. This is a Level I castle. Just like in medieval times, it has not only strong external defenses, but also internal mazes, secret passages, trap doors, nightingale alarms, and have remote forces that can respond at a moment’s notice to surround the enemy.

It’s true that someone can get into even a Level 1 castle, but a Level I castle will survive longer than a Level II or III castle. In fact the odds are that a Level I castle will repel attacks and be standing after an APT or coordinated persistent attack.

If you had to put your family and loved ones in a castle that was going to be attacked, you would choose the Level I castle. You would do anything to safeguard the lives of those you love. In this day and age and within our industry, cybersecurity is not about privacy any longer. It is about safeguarding patient lives.

It doesn’t matter how the CHS attack happened. It is a wake-up call. Vendors, providers, and allied health entities need to build a Level I castle because they are at risk of coordinated and focused attacks. APT 18 is just one of hundreds of organized entities and thousands of independent attackers who are targeting healthcare and your castle.

To give you an example of how the stakes have been raised, ISIS (yes, the Middle East terror group) has several hundred computer programmers and hackers on their payroll. Take a few moments to let your mind wander about the damage a group like ISIS could cause to your castle. Some of those attackers will be happy with just taking data, while others won’t be happy until they take a patient’s life. 

CHS has shown that life for all of us in healthcare information technology has changed. The only remaining question is, whose castle will be next?

John Gomez is CEO of Sensato of Asbury Park, NJ.

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Currently there are "2 comments" on this Article:

  1. John Gomez’s description of the issues surrounding security are very thought provoking and creates a platform for the necessary discussion. Hopefully, those in authority can comprehend just how vulnerable our healthcare system is and invest the necessary resources. This might turn into “penny smart – pound foolish” if not supported and executed upon for the healthcare industry. Kudos, John Gomez.

  2. Maybe I’m behind on my news reading but is there any evidence CHS was breached in Feb 2014 at the outset of the HeartBleed vulnerability?

    If that’s the case, they were the first targets of a newly disclosed bug then sure CHS shouldn’t be blamed. I’ve just not seen a timeline detailing that as fact.







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