Gulf Critical Infrastructure: Protecting What Matters Most

Richard Staynings with Padam Kafle, Head Of Information Technology & Automation, Aster Hospitals, UAE, Nada Chehab, Director of Clinical Education, American Hospital Dubai, Dr Mustafa Hasan Qurban Ph.D, CIO of King Fahd Military Medical Complex, Saudi Arabia, Ahmad Yahya, CIO, American Hospital Dubai, & Himanshu Puri, CIO, Kings College Hospital London UAE.

Protecting GCC critical infrastructure industries from increasingly frequent and ever more devastating cyber-attacks is a concern for many of us. But when attackers focus their attention on medical systems that keep people alive, then it becomes a major concern for every GCC national government and a matter of national security.

Growing digital interoperability of health information technology has combined with a massive increase in connected medical devices and a rising popularity of medical wearables, to greatly expand the potential attack surface. Highly valuable PHI, PII, clinical research, and innovative new procedures has made the theft of healthcare data very lucrative for both cyber criminals and pariah nation states. 

The criticality of national critical industries including healthcare has also made the industry a popular target for ransomware cyber-extortion gangs as well as proxies for pariah nation states wishing to coerce or to send a less than diplomatic message to the peoples and governments of nations that refuse to back totalitarian autocracy and global power plays. 

2021 set new record highs for global healthcare data breaches. An increase of 32% over 2020. But the risk is not just data theft, extortion and other attacks against systems availability are now a major risk to patient safety. In 2021, governments worldwide saw a 1,885% increase in ransomware attacks, and the health care industry faced a 755% increase in ransomware attacks. The threats are plainly increasing but are we adopting the right approach to cyber defence?

Richard Staynings gives the opening keynote to a packed house of technology senior executives from across the GCC region at the Shangri-La in Dubai.

This was the subject to my opening keynote address to the CIO Middle East Conference in Dubai today where I had the pleasure to address the region's top executives technology and security leaders including a healthcare panel with Padam Kafle, Head Of Information Technology & Automation, Aster Hospitals, UAE, Nada Chehab, Director of Clinical Education, American Hospital Dubai, Dr. Mustafa Hasan Qurban Ph.D, CIO of King Fahd Military Medical Complex Saudi Arabia, Ahmad Yahya, CIO, American Hospital Dubai, & Himanshu Puri, CIO, Kings College Hospital London UAE.

Balancing patient-centric care and privacy protection with new cybersecurity risks is a new concept to much of the Gulf, but risks are a growing concern and a major distraction from improving patient care and outcomes which help to drive improvements in population health.

Richard Staynings with Salwa Hawath from Misor UAE, Gary Sorrentino, Global CIO Zoom, and catching up with Himanshu Puri CIO of Kings College Hospital London UAE after their healthcare panel together.

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Ransomware Gang Demands $10m to restore French Hospital

The Center Hospitalier Sud Francilien (CHSF), a 1000-bed hospital located in Corbeil-Essonnes 28km SE from the center of Paris, has been virtually paralyzed by a cyberattack. Nearly all IT systems appear to have been taken off-line by a ransomware attack discovered on August 21, which has resulted in the medical center referring patients to other establishments and postponing appointments for surgeries. Non-critical services have had to be directed elsewhere, and staff are now working with limited resources.

"Each day we need to rewrite patients' medications, all the prescriptions, the discharge prescriptions," said Valerie Caudwell, the president of the medical commission of the CHSF hospital. "For the nurses, instead of putting in all the patients' data on the computer, they now need to file it manually from scratch."

Medical imaging has been particularly impacted resulting in all PACS and other imaging services currently being off-line. Many medical devices were highly susceptible to the cyber-attack and may have been at the core of the ransomware attack. Like most hospitals, patching of medical devices against known security vulnerabilities appears to have been lax, making them an easy target for hackers to establish a foothold on the medical network.

“Without security enclaving or segmentation of vulnerable medical devices, these systems wouldn’t have stood a chance,” claims Richard Staynings, Chief Security Strategist at healthcare security company Cylera. “It’s impractical or impossible to patch devices where manufacturers have not released a patch, so you really need to isolate high-risk systems as a form of compensating security control,” he added.

CHSF serves an area of 600,000 inhabitants, so any disruption in its operations can endanger the health, and even lives, of people in a medical emergency. Unlike a similar ransomware attack in 2020 against Düsseldorf University Hospital, where a 78 year old woman suffering from an aortic aneurysm died after being redirected to a different hospital 32km away, no deaths have been reported at CHSF.

The hospital has refused to pay a ransom demand of ten million dollars and is rebuilding its IT systems from scratch while restoring patient data from backup, a process which it expects to take many days.

Police specializing in cybercrime are investigating. Cyber-attacks targeting hospitals in France have been increasing recently, with 380 last year, a 70 percent rise from 2020.

"An investigation for intrusion into the computer system and for attempted extortion in an organized gang has been opened to the cybercrime section of the Paris prosecutor's office," a police source told Le Monde, also specifying that "the investigations were entrusted to the gendarmes of the Center fight against digital crime (C3N)".

While police and cybersecurity experts continue to investigate this attack, “the Tactics, Techniques, and Procedures (TTPs) indicate a LockBit 3.0 infection,” according to Jordan Rogers, head of cyber threat intelligence at Cylera. However, if LockBit 3.0 is responsible for the attack, it will violate the Ransomware as a Service (RaaS) program's rules, which prohibit affiliates from encrypting systems of healthcare providers.

At this time, the attribution to the particular threat group hasn't been confirmed yet, and LockBit 3.0's extortion site contains no entry for CHSF yet, so their involvement remains a hypothesis. Gang affiliates using this RaaS are known to operate primarily in Russia and Belarus. 

This article was first published here:

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NHS 111 Services Held to Ransom by Cyber Attack

NHS 111 services are down for much of the UK following a cyber-attack Thursday morning against the infrastructure of software vendor 'Advanced'. The company's Adastra system is used by call handlers to dispatch ambulances, to book urgent care appointments, and for out of office hours emergency prescriptions. It’s Caresys software is used extensively across more than 1,000 care homes, while Carenotes, Crosscare and Staffplan are used extensively by providers. Advanced supplies software to NHS facilities and doctors nationally, including hospitals, doctors’ offices, care homes and mental health services, so disruption has been widespread.

The systems outage is causing significant delays as call handlers are forced to use other systems or to revert to paper. Emergency ambulance dispatch is taking priority it has been reported, meaning that everyone else has to wait. Meanwhile, applications managed by Advanced have been isolated to prevent lateral spread of malware to other NHS systems.

According to the Telegraph, the cyber-attack appears to have been conducted by an organized criminal ransomware group looking to shut down crucial systems rather than a hostile state-actor as had been originally feared. Healthcare and other critical national infrastructure services have been on high alert since the start of the war in Ukraine given heightened tensions with Moscow. The UK’s National Cyber Security Centre is working with the NHS as it attempts to recover systems from backups and restore services.

UK businesses have been warned about paying ransoms and incentivizing extortionists. According to the Telegraph last month, the head of the UK’s National Cyber Security Centre (NCSC) and the Information Commissioner warned businesses that they risked “incentivizing” attacks by cybercrime gangs by paying ransom demands.

According to Sky News, Advanced, said the issue was contained to "a small number of servers" representing 2% of its health and care infrastructure. Chief operating officer Simon Short added: "We continue to work with the NHS and health and care bodies as well as our technology and security partners, focused on recovery of all systems over the weekend and during the early part of next week."

This latest cyber-attack against the NHS is an unwelcome test of its resiliency and preparedness for various outages including cyber-extortion. As a critical infrastructure industry, the NHS is a target for pariah nation state attack, although in this case evidence appears to suggest that the attack was orchestrated by a Russian criminal gang. Given the known close working relationship between the Russian government and the country’s organized crime gangs, the Kremlin may not be entirely off the hook in this case. A forensic investigation of the cyberattack will take time and a positive attribution of the attackers may be many months away.


NSH 111 services previously known as ‘NHS Direct’ is used for non-emergency Urgent Care services and puts callers in touch with highly trained advisers supported by healthcare professionals. It was designed to reduce the call volume on the UK’s 999 Emergency services (similar to the US’s 911 call system) for non-critical healthcare issues, or to force patients to have to wait several days for an appointment with their general practitioner / primary care provider. The free 111 service is widely used and can be accessed by anyone dialing the number from within the UK.

Advanced is owned by Vista Equity Partners and BC Partners.

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Meta sued for violating patient privacy

Facebook’s parent company Meta is facing two proposed class-action lawsuits for using the Meta Pixel tracking tool on health system websites to target ads.

This is not the first time that Meta-Facebook has been dragged through the courts and sued for a breach of privacy. In this case the problem stems from the company’s wholesale vacuuming up of all kinds of metadata whenever a user visits a web page containing its Pixel tracker functionality.


Pixel is contained in a few lines of JavaScript code and is found widely embedded into various web applications. It appears unlikely that the providers using these web applications were aware of the code contained in their portal pages, or that highly confidential HIPAA protected information is being sent to and used by Meta-Facebook without patients' express written permission being obtained. This is especially so because Meta is not a duly authorized HIPAA Business Associate, a requirement before HIPAA Covered Entities (CE) can share protected health information with a third party, nor is Meta a HIPAA CEin its own right. Based upon recent research, it’s probable that hundreds of healthcare portals contain the Meta Pixel code unbeknownst to most providers and that millions of patients could be affected.


The big question is whether Meta Corporation failed to realize that it was illegally being sent PHI data from Pixel, as it continued to monetize this data to sell directed advertising to unsuspecting patients. This point may become a pivotal argument in pending lawsuits and any regulatory enforcement actions. Based upon previous privacy violations, Meta-Facebook is supposed to have implemented business tools to identify sensitive health data and to filter this out from its advertising revenue generating systems. 


In what will likely be a double blow, the collected data was not just innocuous de-identified medical information. “The data Meta received reportedly contained medical symptoms & conditions, prescription information, doctors’ names, IP addresses, and other data defined as HIPAA identifiers. It would therefore be relatively easy to reverse engineer this PHI data to determine the patient identity. It all comes down to the number of data points held in the Meta advertising database,” claimed Richard Staynings, Chief Security Strategist with Cylera. “This could end up being labeled as a massive breach of highly sensitive and confidential regulated HIPAA data.”


In addition to the recently announced class action it seems likely that the Office of Civil Rights (OCR), the enforcement division of Health and Human Services (HHS) is spinning up a task force to investigate this breach and will be assigning a large team to examine potential violation of  HIPAA, the 1996 federal Health Insurance Portability and Accountability Act.

Not only does Meta Corporation likely face HIPAA regulatory concerns, but it also seems likely that various states Attorney Generals (AGs) will be looking very carefully to determine if the Pixel code is present in their jurisdictions on web pages where there is an expected right of privacy. This is especially so on healthcare portals. Finally, it also seems likely that OCR and AGs will be looking carefully at healthcare providers to examine their policies, standards, procedures and guidelines around due-diligence for acceptance of web application technologies and enabled functionality.


“This is an extreme example of exactly how far the tentacles of Big Tech reach into what we think of as a protected data space,” said Nicholson Price, a University of Michigan law professor who studies big data and health care. “I think this is creepy, problematic, and potentially illegal” from the hospitals’ point of view.


In 2019, the Federal Trade Commission (FTC) imposed a $5 billion penalty on Facebook and required it to submit to new restrictions and requirements to hold the company accountable for its data privacy decisions. This included the promised use of a sensitivity filtering mechanism.
 

Systemic Problem

Many of these privacy issues stem from a fundamental imbalance between the rights of individuals in the United States to remain anonymous and their data kept private, versus the rights of large corporations to collect and mine data for profit. This is a balance that has been addressed in Europe through GDPR - the 2016 General Data Protection Regulation which has quickly become a global standard for Privacy outside of the United States.
 
The federal nature of the US however has resulted in 50 very different and separate state privacy regulations that make it hard to enforce privacy standards for individuals given so much cross-state commerce. Attempts by the federal government to catch up to other OECD nations with a revised national privacy act have met with opposition from some states concerned that a federal law will dumb down their existing provisions, while other state representatives oppose the imposition of something similar to GDPR which they regard as an undue constraint on businesses. 
 
The latest in a long line of attempts to update US privacy laws is currently working its way through congress. It remains to be seen whether the highly fractured nature of US law making results in national privacy changes or goes the way of prior attempts.

 
 

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Challenges for UK Life Sciences

The Challenges for UK Life Sciences Companies

Excerpted from Business Innovations Magazine UK May 2022

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How Concerned Should we be about a Russian State Cyberattack against the US?

Russia’s invasion of Ukraine appears to be bogged down if the reports coming out of the country are to be believed. Indeed troops around Kyiv are currently reported to be withdrawing back to Belarus to regroup and re-arm. The surgical Blitzkrieg to take over the country and replace its elected leaders with Putin-friendly surrogates has failed, and now Russia has been forced to re-evaluate its military objectives and to focus on liberating Donbas and Luhansk from Ukraine and the Ukrainian people who live there. The area is one of many across the former Soviet Union seeded by Stalin with Russian diaspora after annihilating much of the indigenous population in one of many genocidal purges of opponents. In this case, it was a mass purge of Ukrainians.
 
Indeed the Holodomor (Ukrainian: Голодомо́р) in which 4 million Ukrainians were purposely starved to death by Stalin between 1932 and 1933 in order to suppress Ukrainian desires for independence, is perhaps one of the reasons why Ukraine has been so vociferous in its defense against Russian invasion.
 

An Invasion Falling Apart

But as casualties mount, and in particular the deaths of a large number of Russian General Officers, Putin’s hold over the military and therefore political power, looks to be increasingly tenuous. Reports in the media of tanks being driven over commanding officers by unhappy starving soldiers who were misled and lied to by their leadership, poorly trained and led troops shooting unarmed civilians indiscriminately, and a growing realization by Russian troops that they are pawns in an illegitimate conflict with neighbors most of whom speak their own language, is drawing into question the abilities of the Russian military and its leadership.
 
As the Russian body bag count continues to rise and a growing number of funerals are announced back home in Russia of all kinds of senior military officers, so the public will increasingly be aware of the costs of Putin’s folly. The closure of most foreign stores, the inability to fly anywhere as planes are grounded, and a Ruble which has structurally lost 40% of its value since February will be sure to reinforce concerns that Putin is engaged in a conflict much bigger than he has led on.

 

But military power is not all that Putin can muster in his battle with the west. As President, Putin has at his disposal the considerable state cyber forces of the Russian FSB and GRU. These are groups with no shortage of highly destructive cyber weapons, many of which have been used against Ukraine since 2015, and some of which date to the cyber-attacks against Georgia, Estonia, Azerbaijan, and Chechnya,  all the way back to the 1990s. 
 
Putin also has access to the considerable forces of Russian organized cybercrime in return for historically turning a blind eye to their lucrative criminal activities. Indeed, some investigators have concluded an even tighter more collaborative relationship between the Russian President and mob bosses. Putin in other words, has many options open to him for direct and indirect cyber-attacks, though few would believe any claims in current times that Russian organized crime totally operates outside of the influence of Putin and the Kremlin.
 

Russia and Cyberwarfare

The west has in fact been in an ongoing cyberwar with Russia since the turn of the millennium when Russian gangs realized that they could operate their craft of cyber theft and extortion with total impunity from within the bounds of the Russian Federation. Putin and the almost ineffective forces of Russian law enforcement simply turned a blind eye to the gangs and their activities. Perhaps the reported back-handers to police officers helped. Perhaps the sheer power of these gangs was enough to intimidate law enforcement officers. Either way, the illicit foreign exchange inflows of untraceable cryptocurrency continues to boost the struggling Russian economy.

 

The connection between Russian organized crime syndicates and the Kremlin in recent months looks to be a lot less deniable, with evidence suggesting that crime gangs are acting on instruction from the Kremlin and perhaps maybe receiving payment for the acquisition of intelligence gained in their attacks. Take for example the SolarWinds Orion attack, which was attributed to ‘Nobelium’, a group reportedly being directed by the Russian intelligence to infiltrate US federal agencies, while another Russian cybercrime group, ‘DarkSide’, was busy at the exact same time with a high profile and distracting ransomware attack against the Colonial Pipeline cutting off fuel supplies to the southeast of the entire United States.
 

Is Putin likely to respond to increasing western military support of Ukraine?

So far at least, Putin appears to have held back his arsenal of cyber weapons. Supposition is that Putin is concerned that any massive cyber-attack against the west would be sure to result in a powerful response from the west against Russian critical infrastructure including the power grid. It would then be almost impossible for Putin to continue to dupe the Russian people with propaganda stories of an almost insignificant special military operation to rid Ukraine of Nazis. The cat would be out of the bag regardless of whether conscript bodies are returned to their mothers or not, and Putin would be facing enemies from within as well as abroad. It was the unpopularity of the wars in Georgia and Chechnya back home that forced a Russian withdrawal, and the unpopularity of the war in Afghanistan that eventually bankrupted and lead to the collapse of the Soviet Union before it.
 
Indeed, this is perhaps what Putin fears most – a popular uprising against his rule by the very lumpenproletariat he claims to represent. So far however, the Kremlin propaganda machine still appears to be working well and Putin can claim wide-scale popular support at home from the babushkas that believe everything they are told by the state media outlets.

 

While Russia may have some devastating cyber weapons up its sleeve, the NSA is widely regarded to have bigger more devastating cyber weaponry in is arsenal. These include weapons able to effectively take Russia back to the nineteenth century and presumably include the capability to turn off Russia’s power grid, its water, oil, and gas systems, its flight control systems, transportation, and a heap of other critical infrastructure. This would deny Russians, and the Russian war machine with the ability to operate at anything other than at minimal levels and could wreak havoc on military resupply and other logistics.
 
The NSA is not alone however, other Five Eyes nations are thought to have comparable cyber capabilities and would no doubt respond as a group if attacked by Russia. The EU is thought to also have some offensive cyber capabilities, while Israel, less involved in the support of Ukraine against Russian invasion, would likely join in to support the USA and its other allies, despite its current free pass from Russia to attack Hezbollah terrorists operating inside Syria in return for staying neutral. Israel is thought to have some very nasty tricks up its sleeves and based upon its past performance, is less inclined to hold back if ever attacked.
 
So with cyber armies lined up against each other, perhaps we have reached the modern day equivalent of Mutually Assured Destruction (MAD). This was a principle that ensured the global peace between totalitarian east and liberal democratic west, around the use of nuclear weapons from the late nineteen forties to the present day. Given the impact to all of us of an all-out cyberwar between Russia and the west, let’s hope that MAD will keep the cyber weapons firmly locked up.

 

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Can Healthcare Tackle IoT, Medical Device Security Challenges?

Join SCMedia Editor Jessica Davis and Cylera's Chief Security Strategist Richard Staynings for a FireSide Chat at VIVE2022 -  the new CHIME / HLTH conference in Miami Beach FL, as they explore the challenges of medical device security.

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Could Russia orchestrate cyberattacks against the west?

As concerns rise about the likelihood of increased cyberattacks against the west by Russian cyber forces, so the west is attempting to ready itself. Both the UK and US governments have this week issued warnings to citizens of the rising threats of an attack and urged increased diligence.

Many consider a cyber attack almost inevitable given continuing western military support for Ukrainian defense, a growing army of hackers joining forces with Anonymous that have very successfully and daringly taken down or defaced critical Russian web sites including that of the Kremlin, and a proclivity by Putin to use grey or hybrid warfare against those who dare to challenge his supreme authority.

So far however, all we have seen is the usual ransomware and other criminal cyber-extortion activities of Russia's extensive criminal underworld of organized crime syndicates. A proxy army in waiting that Putin can rely upon to act on his instructions, and one that he can claim any involvement with and plausible deniability when their activities are discovered.

Indeed, Putin is now a master of subterfuge being trained by the Soviet KGB in the art of spy craft and disinformation. Putin has very conveniently turned a blind eye to the criminal activities of Russia's organized crime syndicates for many decades, in part because of their usefulness and in part perhaps because of the reported illicit financial and other support Putin receives from these groups.

But should the west be worried and what steps should westerners take to shore up their own cyber defenses? These are questions that were posed by Stephen and Ellie on the UK's GB News Breakfast show this morning.

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Impact of the Russian Invasion of Ukraine

The Russian military invasion of Ukraine has unified the free world against acts of aggression by dictators and autocrats who threaten the territorial integrity of their neighbors. 

After years of bullying, threats and intimidation by Putin and Kremlin against what it regards as one of its vassal states, Russian troops were ordered across the Ukrainian border on Thursday February 24th, 2022. This resulted in almost immediate global financial and trade sanctions by the west and the isolation of the Russian economy. This included a closure of the skies to Russian airlines and other aircraft across Europe, Canada and America and the freezing of Russian state and Oligarch assets all around the world and the sequester of many Russian Oligarch assets including some multi-million dollar luxury yachts. It also included agreement to supply defensive weapons to Ukrainian forces from NATO countries and as far away as Australia.

But concerns have risen sharply that such tacit support of Ukraine against Russia could result in cyber attacks against the west and in particular the United States by Russia's considerable arsenal of GRU and FSB cyber weapons, or the letting lose of Russian organized crime syndicates to launch their own cyber attacks.

In the light of such concerns, University of Denver University, College faculty leaders agreed to come together this evening to examine the impact of the Russian invasion of Ukraine. They were joined by other Colorado academics from Colorado State University and the University of Colorado. 

Join moderator Arianna Nowakowski and panelists Jack Buffington, Eric Fattor, and Richard Staynings as they adeptly navigate complex topics pertaining to the short-term and long-term consequences on security, supply chain, media, and globalization.

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Cotswold Radio - The need to secure healthcare IoT

Securing Healthcare and the growing complexity of interoperable health IT / IoT systems and medical devices. Richard Staynings discusses this with James Cunningham, CEO of Core To Cloud, based in Cirencester, Engalnd, and Tony Dale host of the evening Cotswolds Radio broadcast.

Listen to a recording of the live broadcast below:

 

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Russia ready to launch cyber attacks on the West in retaliation for economic sanctions

Western governments and companies need to be on a “heightened state of preparedness” for the “high probability” of cyber attacks, as economic sanctions on Russia begin to bite, a senior cyber security expert has told GB News. And it is expected Russia will soon step up its campaign against the West with cyber attacks.

Critical national infrastructure and the banking sector could be the main targets of any attack ordered by Vladimir Putin, according to Richard Staynings, chief security strategist at cyber security firm, Cylera.

He said: “I would say there's a fairly high probability, based upon the types of hybrid warfare that Putin and the Kremlin have executed in the past, that cyber attacks will be launched in this conflict.

“In Chechnya in the 90s, Russia launched its cyber weapons against opposing forces. We've seen it in Georgia and South Ossetia. We've seen it in other parts of the World, where Russia has wanted to extend its influence and to coerce and to bully its neighbours or adversaries.

“I think it's a weapon that's being held in reserve right now, but we certainly need to be on a heightened level of preparedness.

“That means we need to make sure that systems are patched. We need to make sure that we've got adequate cyber defences in place to protect our businesses, our schools and universities, our hospitals our power and oil systems and other critical infrastructure across the country.”

Experts warn although the threat from cyber warfare can seem quite abstract, it has potential real world consequences.

Recent attacks on the health service caused significant disruption. The multiple computerised systems within the West’s aviation sector are also vulnerable to attack.

Cyber security teams are already on high alert. Executives at some of the West’s leading banks and financial institutions have expressed their concern about the possibility of Russian attacks on the banking system in retaliation for being kicked out of the Swift international payments system.

Apart from an attack on some of Ukraine’s critical systems in the initial stages of the invasion, there has been no concerted effort by Russia to attack Western infrastructure in recent weeks, according to security sources.

The leadership in Moscow knows that any cyber attack on the West will be met with a significant response from Western Governments, whose offensive cyber capabilities have been significantly enhanced in recent years.

But if Vladimir Putin decides to give the go ahead for technological attacks, he can also utilise a network of organised criminal gangs to hep him out, according to Professor Ciaran Martin, from the University of Oxford.

Professor Martin, who is the former head of the the UK’s National Cyber Security Centre, said that any Russian cyber attack would come on multiple fronts.

“As well as being one of the most formidable cyber powers in terms of government capabilities, Russia also has the largest concentration by far of serious organised cyber criminals on the planet.” He said.

“In 2021, we saw those criminals disrupt petrol supplies in America, healthcare in Ireland, schools in England, food retail in Sweden, the list goes on.

None of that individually is catastrophic. But if the Russian state were to unleash its ransomware capabilities, its cyber criminal capabilities, while not catastrophic, that could get pretty unpleasant.

Although the West’s computer systems are better protected these days, there are still inherent weaknesses and vulnerabilities that adversaries could seek to exploit, according to Richard Staynings.

“There are certainly still weaknesses in the system.” He said.

“Much has been done to shore up a lot of the critical infrastructure across the UK, particularly the NHS since the WannaCry ransomware attack in 2017.

“A lot of older systems have been replaced and we have new regulations that are forcing NHS trusts and NHS digital to move forward in that space.

“The data security protection tool-kit for example is driving enhancements around IOT medical devices which are inherently vulnerable in our health system today and that is forcing health systems to improve their capabilities.

“But there are still gaps in the fabric, there are still chinks in the armour that we need to be aware exist and we need to take precautions in order to ensure that perpetrators can't get through that armour.”

For now, as Russia concentrates on conventional warfare, it is already fighting off multiple attacks from Western computer hackers, who have turned away from their traditional targets of big business and governments at home, focussing their disruptive talents on Moscow instead.

 

Reproduced from GB News. Original post 18 March 2022. https://www.gbnews.uk/news/russia-ready-to-launch-cyber-attacks-on-the-west-in-retaliation-for-economic-sanctions/250614

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Ditial Health Rewired - Smart Health In Practice

Digital Health Rewired was full of highly informative presentations and discussions across many areas of healthcare, but perhaps most forward thinking were 2 days of sessions under the banner of Smart Health in Practice at the Smart Health Stage at the front of the show.

I was proud the share the stage with 4 'greats' in the space of smart health innovation: Declan Hadley UK&I Lead for Cisco, Andy Callow, CDIO at University Hospitals of Northamptonshire, Stephen Dobson, CIO at Lancashire Teaching Hospitals, and Matt Dugdale, Head of Clinical & Digital Innovation, North West Ambulance Service NHS Trust. 

Our discussions focused around a presentation provided by Matt on how the North West Ambulance Service team has transformed its ambulances and offices to become 'Smart' using new smart technology to improve efficiency and the patient experience at the same time. 

Smart hospitals are just one of many changes occurring across NHS trusts, as discrete HIT and HIoT digital systems are integrated and made interoperable by advanced new technology from Cisco, Cylera and others. But as these changes are implemented, we run the risk of gap being created between functional IT and secure IT unless cybersecurity is included from the outset. With a growing number of systems and discrete devices now 'connected' to hospital networks, patient safety and cybersecurity have become major areas of concern.

With warnings by the government to batten down the hatches across critical infrastructure industries like healthcare in the light of rising threat of cyber attack from Russia, keeping patients safe and health IT / IoT systems up and running will be a major challenge if we are to avoid another WannaCry.

My thanks also to a great audience which continued to ask questions off-stage well after our allotted time had gone and almost into the next session.

 

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Should we be worried about state-sponsored cyber-attacks against hospitals?

We ABSOLUTELY should!

For the past decade and a half, the criminal underworld, Russian Mafia and other organized crime syndicates in the former Soviet Union have provided a constant reminder of both the fallibility of modern IT systems and the tenacious expertise of Russian hackers and their cyber-criminal community. In what now seems like background white noise, these highly organized perpetrators have executed a near constant campaign of cyber-theft, cyber-extortion, and denial of service attacks. 

Attacks have included a long list of crippling ransomware campaigns that have disabled almost the entirety of national health systems like the Irish HSE and Irish Health System, to the near bankrupting of several large private US health systems, to causing small medical and dental practices to have to close up shop, all in the past year.  This has denied critical medical services to thousands of patients and contributed to increases in patient morbidity and mortality. Yes, Russian cyber criminals have killed innocent people, perhaps not directly or intentionally, but nevertheless their greed and lack of ethical restraint has caused great pain and suffering to thousands. But, the capabilities of these gangs pales into insignificance when compared to the resources and capabilities of nation states.

WannaCry which in 2017 crippled much of UK NHS as well as other providers of health services around the word was a (flawed) cyber weapon created by the DPRK to raise hard currency following international sanctions on Kim Jong Un’s autocratic hermit kingdom. The DPRK’s subsequent cyber weapons have been much less flawed, and have drained many cryptocurrency exchanges and large sums from the Bank of Bangladesh among a long list of other victims. With the exception of its attack against Sony Pictures, Lazarus Group and other DPRK cyber forces operate very similarly to any other criminal enterprise raising cash for the Kim family’s lavish living and to purchase rocket fuel for his pet ICBM and nuclear weapons programs.

Not Petya, a highly destructive wiperware which initially masqueraded itself as a fake ransomware attack, hit the world right on the heels of WannaCry and was quickly attributed to the Russian government, specifically the SandWorm hacking group within the GRU Russian military intelligence organization. Initially designed to target the Ukrainian MeDoc tax accounting application in a software supply chain attack, it quickly spread worldwide to any company and country doing business in Ukraine and took down many of the world’s largest companies including shipping company Maersk, FedEx, pharmaceutical giant Merck, and French firm Saint-Gobain. Each of these organizations spent hundreds of millions of dollars to restore data and systems that NotPetya had encrypted beyond repair. Not Petya destroyed tens of thousands of computer systems and resulted in losses in excess of $10bn USD globally. Already a pariah, the Russian state after this devastating attribution, became synonymous with cybercrime and cyberwarfare across the international community. In a major home goal, NotPetya ended up also wiping a large number of computer systems in Russia for organizations that also conduct business with Ukraine

 

Step forward a few years to 2022 and Russia is up to its old tricks again. A few hours before Russian tanks began rolling into Ukraine, Microsoft raised the alarm warning of a never-before-seen piece of “wiper” malware that appeared aimed at the country’s government ministries and financial institutions. ESET Research Labs, a Slovakia-based cybersecurity company, said it too had discovered a new ‘wiper’ while security experts at Symantec’s threat intelligence team said the malware had affected Ukrainian government contractors in Latvia and Lithuania and a financial institution in Ukraine. ESET has called the malware which renders computers inoperable by disabling rebooting, HermeticWiper, while Microsoft has named it'd discovery FoxBlade.

The trouble with any kind of cyber weapons, no matter how targeted they are, is that these weapons do not recognize national boundaries (just as Putin didn’t recognize Ukraine’s) and so are bound to get out into the global community of interconnected IT systems. Fortunately, and so far at least, the HermeticWiper malware does not appear to be self-propagating, whereas NotPetya was deliberately designed to spread laterally and stealthily. There are no doubt many other offensive cyber weapons being deployed against Ukraine and its allies this week as Putin escalates his attack.

But the real danger is not just in the powerful nation state weapons, but with the semi-professional hackers and organized crime syndicates. Russia has the world’s largest non-state criminal cyber infrastructure employing tens of thousands who are engaged full time in cybercrime, cyber-theft, and cyber-extortion. Putin for various reasons has turned a blind eye to their criminal activities for decades allowing these groups to grow and prosper. These criminals are already using the smokescreen of conflict in Ukraine to launch fresh ransomware attacks against the west, and evidence suggests that Putin has recently instructed them to go all-out to help Mother Russia. Putin has organized a personal crusade of military kinetic and cyber offensive capabilities and paired this with an extensive criminal underground in an attempt to overwhelm the west.

On the other side, the call has gone out for Ukrainian cyber gangs to launch an all-out offensive against the institutions of the Russian Federation, and they have been joined by Anonymous and many other international hacktivists. If we are to believe the reports coming out of Russia, then many of the Kremlin’s public systems have been taken down by cyber-attacks. This tit-for-tat action risks serious escalation, and Russia which is widely acclaimed to have invented the concept of cyber-warfare during its two brutal wars against Chechen separatists, is sure to have some very powerful, very devastating cyber weapons in its war chest. Of course so too does the USA, UK, and many other countries. These weapons if ever launched would wreak devastation akin to a nuclear war and wipe out just about anything electronic. Given our reliance upon IT systems today, especially in hospitals this would not end well for patients, resulting in a significant rise in patient morbidity and mortality. The trouble for the west is, that these cyber weapons would cause far greater damage to advanced western institutions than to former Soviet ones in Russia, Belarus, Kazakhstan, and Chechnya supporting Putin where computerization is less prevalent.

We should be taking every precaution to patch all systems, ensuring the legitimacy of patches by examining hash values before deploying, by enforcing multi-factor authentication for all users, and by disconnecting and isolating systems which cannot be properly secured. Staff should be briefed on the need for heightened awareness and told to take extra precautions in their day-to-day activities. 

 

But first however, we need to fully understand what is connected to our networks and who is accessing our systems. In this day and age of heightened threats, we need to understand what is 'normal' so that abnormal or 'anomalous behavior' can be flagged and quickly isolated. The inconvenience of kicking a user off of a system and inconveniencing them, should be far less of a concern than the safety of a patient on life support being kept alive by a collection of connected medical devices.

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Podcast: A Career in Cybersecurity

What is 'Cybersecurity', why is it so important today, and why do developed western societies need better cyber protection? Join Denver University Adjunct Professor and Chief Security Strategist for Cylera, Richard Staynings, as he describes the risks, rewards and opportunities for those seeking a career in this rapidly growing field.

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Pueblo Community College Cybersecurity Lecture

 

It was great to present to the students and faculty of Pueblo Community College in southern Colorado this past week. The opportunities for those entering the profession from ICT cybersecurity and Healthcare programs like those at PCC are tremendous. My thanks to the faculty for organizing such a great event and to Mike Archuleta, CIO at nearby Mt San Rafael Hospital and fellow Health Informatics and Cybersecurity Luminary who also presented to students.

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Challenges for 21st Century Healthcare

Healthcare currently faces many unique challenges. It is an industry currently undergoing the most dramatic transformation in its history. Covid-19 ravaged hospital finances and forced providers to pivot from lucrative consults and elective surgeries to pandemic emergency care. This in turn led to the need for another (long overdue) pivot towards telehealth, telemedicine and remote health services as patients were told to avoid hospitals. And of course, this all happened during an industry-wide move towards digital transformation, interoperability, a massive growth in the number of medical and other healthcare IoT devices, and enhanced adoption and deployment of artificial intelligence across the industry, each bringing its own unique security challenges.

As if these transformational challenges were not enough, healthcare is also one of 16 US Critical Infrastructure Sectors under PPD-21, and therefore a potential target of nation-state cyber-warfare attacks against the United States. Given a long history of such attacks by the Russian GRU against other countries and a proclivity by the Kremlin to give carte blanch to Russian Mafia proxies engaged in cybercrime, risks are high that an imminent attack could be launched against US healthcare.

A cyberattack against healthcare is not just an act of cyber extortion or cyber warfare, it risks the lives and safety of patients. When HIT and HIoT systems are not available because of cyberattack, patient morbidity and mortality rates increase, just as they did under the North Korean 'Wannacry' or Russian GRU 'Not Petya' attacks of 2017.

In 2022, the ability of hospitals and other providers to withstand a devastating ransomware or other cyberattack has improved, but providers are in no way impregnable. The industry lacks the material and people resources necessary to mount a full defense. It is therefore vulnerable and in need of supplementary security services. Services that are perhaps best addressed by managed security services providers (MSSPs) and others with deep security domain expertise.

Clinical, technological and security resourcing across healthcare has been stretched to the limit exacerbated by clinicians leaving the industry en-masse and a global shortage of cybersecurity professionals in which healthcare has found it increasingly hard to compete for scarce resources. There has also been a skills mismatch as re-skilling of staff has not kept up with the adoption and implementation of new technologies. 

Given the growing challenges of securing healthcare and keeping patients safe, I challenged four leading technology and security executives with these problems at the recent Denver Managed Security Services Forum. Hear their thoughts in the video recording below.

Panelists:

Mike Archuleta, Chief Information Officer, Mt San Rafael Hospital
Kevin Coston, Sr. Technical Security Specialist Healthcare, Microsoft
Randall Frietzsche, Enterprise Chief Information Security Officer, Denver Health
Howard Haile, Chief Information Security Officer, SCL Health

Moderator:

Richard Staynings, Chief Security Strategist, Cylera

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The New Reality of Securing Healthcare

Securing healthcare has never been either easy or straight forward given the patient safety dynamic of the industry, but after nearly two years of dealing with the global COVID pandemic, that challenge is now a whole lot harder.

COVID19 caused a massive an immediate pivot across healthcare as patients consults were forced to go online via telehealth and telemedicine. At the same time non-clinical healthcare workers were sent away from hospitals to work from home. Combined this resulted in a significantly changed threat surface that cyber perpetrators were quick to exploit and take advantage of with a succession of ransomware and other extortion attacks and by nation-state sponsored theft of COVID clinical research and vaccine drug formulations.

Since the pandemic there has been a 600% increase in cyber attacks against healthcare entities and many have been knocked off-line for multiple weeks trying to recover from attack. This has resulted in some critical healthcare services not being available to some areas of the country at a very critical time in public health safety. It has also been a very unwelcome distraction to those caring for COVID infected patients and others with non-COVID related diseases seeking treatment.

Despite evidence to the contrary in the latest Healthcare Innovation Survey, many significant healthcare cyberattacks, go unreported or are down-played by CEOs wishing to minimize reputational and financial damage to the organizations they are in charge of. Many are paid based upon on the value of stock or other financial KPIs so this is hardly surprising and its likely that many providers have yet to discover that they have, were, or are still being attacked given the stealthy nature of APT attacks.

Join Hussein Syed, CISO at RWJBarnabus Health, Mark Hagland, Editor-in-Chief at Healthcare Innovation, and Richard Staynings, Chief Security Strategist at Cylera, as three veterans of healthcare security discuss the new reality of securing this industry and keeping patients safe.

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Securing Healthcare in a Post-Covid World

Plainly COVID has changed the paradigm of global healthcare delivery. The industry was forced to pivot quickly to a new and alarming reality and make changes that were necessary but largely unplanned. The pandemic brought about the greatest change to Healthcare technology and working practices ever seen outside of war.

COVID forced us to quickly provide new forms of remote delivery of healthcare services to our patients via telehealth, telemedicine and other remotely delivered services. It forced non-clinical healthcare staff out of dangerous hospitals to their homes where they could work remotely. But all these changes greatly altered the risk posture of healthcare providers and expanded the threat surface to likely attacks.

While diligent security teams have been reassessing risk and security, and slowly implementing new controls to protect against new threats and vulnerabilities, there is still a concerns of what might have been missed. 

Despite new controls, what do we need to consider to make sure that these COVID changes have not exposed our HIT / HIoT systems to elevated risks or more importantly, our patients to new safety concerns?

Cybersecurity has been a secondary consideration for hospital CEOs and their boards for decades, permeated only by minor inconvenient changes to regulations like HIPAA, Joint Commission and HITECH. But the reality is that the healthcare industry is now the target of attack by cyber criminals looking to monetize stolen PHI, PII and research IP, or to hold providers of health services to ransom. 

Plainly, this places consumers of health services at increased risk of patient morbidity and mortality. Patient safety and cybersecurity are now the same thing, interchangeable terms to describe risks to providers and consumers of health services. Yet the reality has not fully sunken in for many. There is a higher chance of you as a patient (and we are all patients at some point in our lives) being negatively impacted by a cyberattack than at any time before. Its no longer a question of convenience, cyber attacks are a question of patient safety.

Listen the the following 38 minute Fireside Chat with Janette Wider, Managing Editor of Healthcare Innovation as Richard and Janette explore the new reality of securing healthcare in a post-pandemic world.

 

 

 

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Securing Patient Data, Ensuring Privacy, and Building Trust

With thousands of new medical devices and healthcare applications being designed and developed each year it's no wonder that hospitals have such a hard time securing them against cyber attack. 

With new innovative technologies that improve patient care and clinical outcomes there are many costs and concerns. Integration with other HIT and HIoT systems to accomplish true interoperability becomes increasingly difficult with legacy undocumented systems. 

There are also sometimes risks that need to be considered, and in today's environment of near constant cyber attack against healthcare providers and other critical infrastructure industries. Often these attacks are launched by powerful and well equipped belligerent nation states and organised crime syndicates that operate with apparent impunity from behind the iron curtain.  

But if only new HIT and HIoT systems were designed with security from the outset perhaps securing these technologies would be less difficult. This was the basis of discussion at a recent MedHealth Matchmaking Mixer where HIT / HIoT innovators and manufacturers came together with technology and security experts in the health IT space.  

Follow the discussion in the video below:

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The Challenge of Securing Healthcare

What are the biggest challenges facing healthcare security leaders today and how do leaders navigate the almost insurmountable obstacles placed in their way? 

How can we overcome a long list of clinical, financial, operational, and technology risks to secure patient safety and ensure greater operational resiliency for healthcare services?

Join me for an in-depth panel discussion on the challenges and opportunities that healthcare cybersecurity leaders are presented with today.

Speakers:

• Esmond Kane, CISO Steward Health Care
• Richard Staynings, Chief Security Strategist, Cylera and Teaching Professor, University of Denver University College
• Michael Katz, Security Sales Specialist, Infloblox 
• Moderated by Janette Wilder, Managing Editor, Healthcare Innovation

Panel hosted by Healthcare Innovation as part of the NorthEast Health IT Summit and Cybersecurity Forum.

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The cybersecurity of our medical health devices

 

Left-right: Richard Staynings, Chief Security Strategist, Cylera; Jonathan Bagnall, Ph.D., Cybersecurity Global Market Leader, Philips; Andrew Pearce, Senior Digital Health Strategist, HIMSS Analytics (Moderator)

 

Healthcare is plainly a target of cyber criminal and offensive nation-state actors. Not a week goes by without at least one hospital or clinic somewhere being targeted by cyber extortionists or thieves. When COVID started to spread outside of China, university health systems, pharmaceutical companies, and biomedical labs were the target of state cyber actors, out to steal research and formulations into treatment programs, new drugs or vaccines.

Since the world partially shut down, hospitals and clinics have been the target of organized crime syndicates, plying their ransomware tools and other forms of extortion against overwhelmed and under-protected healthcare providers. This is as true for providers in Asia Pacific as it is in the Americas or Europe.

Healthcare was forced to pivot very quickly to remote services like telehealth and telemedicine for patient services, while non-clinical staff quickly found themselves working from home or on furlough, as hospitals scrambled to figure out how they were going to pay their bills, without the usual elective surgeries and other revenue-generating activities that forms the basis of a typical independent health provider's business model.

New technologies, in many cases rapidly implemented, without the usual security assessments and testing, exposed a highly distracted industry to risks. Risks that perpetrators quickly took advantage of and used to their advantage.

This is what we are beginning to describe as the 'Attackers Arbitrage'.

 

Read the Healthcare IT News article for more on this subject.

Watch the linked on-demand video of the subsequent panel discussion between Jonathan Bagnall, Cybersecurity Global Market Leader, with Philips Healthcare; Richard Staynings, Chief Security Strategist with Cylera; and Andrew Pearce, Senior Digital Health Strategist, Analytics, HIMSS

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The ‘TRUE’ Cost of a Cyber Attack

It seems that every year the negative impact of a cyber attack reaches dizzying new levels – overlapping regulatory fines, restitution and identity / credit monitoring, punitive damages, and of course incident handling and clean-up costs for fixing what should have been fixed in the first place, had the organization understood the risks and not chosen to ignore them.

But it’s not just as simple as writing off some vast sum of operating profit and having to explain that loss to shareholders or governing boards. Longer term damage to reputation can take years to recover from – if at all. I know of many firms and individuals that will never do business again with an entity that lost their data and caused them so much pain. Do executives and their governing boards even consider the long-term costs of the loss of their reputation?

And what happens when someone dies as a result of a cyber-attack as happened recently at University Hospital Düsseldorf where prosecutors opened a homicide case against the Russian perpetrators of a ransomware scheme? What will be the long-term impact to the university hospital’s funding, to its patient numbers, its standing in the academic and local communities, and how many medical students, doctors and other medical professionals will want to study or work there?

Medical malpractice suits already run to tens of millions of dollars in the US. What is going to be the financial and reputational costs to a healthcare provider when patients expire on the operating table, or while connected to a medical device that is hacked by cyber criminals? Criminals seeking extortion payments or simply trying to expand their foothold on healthcare networks, while inadvertently breaking critical life-sustaining medical devices?

At this point many executives might be accusing me of raising fear uncertainty and doubt or FUD as its also known. But am I? Doesn’t the German woman who died in Düsseldorf when hospital IT systems were attacked with ransomware make this very real? I would wager that the recent German case is not alone and that many other deaths caused by hackers or weak cybersecurity have simply been reported in a different way, conveniently covering up failures in IT and IoT equipment so as to absolve providers from potential legal liability from families and regulators.

Ethical hackers like Barnaby Jack were demonstrating how easy it is to hack a medical device nearly a decade ago. Ever since, security conferences have featured numerous hackathons of medical equipment, and on-stage demonstrations how to hack an infusion pump, XRay machine, or other piece of medical equipment.

Researchers at Ben-Gurion University of the Negev demonstrated last year how easy it was to intercept medical PACS images and change them to add or remove tumors fooling the majority of radiologists and AI software alike. While Cylera last year, discovered an attack vector that can change the content of a medical DICOM image to include malware that can be used to infiltrate the healthcare network, simply by sharing or viewing a PACS image, something that happens thousands of times a day in every hospital.

This is not science fiction or FUD. This stuff is out there in the public domain and working exploits are most definitely in the wild. Another hospital or an entire health system the size of UHS could be attacked tomorrow and rendered unable to treat patients by a cyber attack against vulnerable IT or IoT assets. 

Healthcare providers the world over need to gain a better understanding of what assets they have connecting to their networks and what risks each of those assets represents not only to any patients which may be attached to the device, or being treated by such a system, but also to the broader healthcare network. Any endpoint asset could be used as an infiltration vector and foothold for expanding the attack. You don't need a wooden Trojan horse to get inside the perimeter of a hospital network, just access to an insecure endpoint device. Identifying and risk assessing all your assets is absolutely critical today, and preferably to NIST SP 800-30 standards, which after all is a requirement of the HIPAA Security Rule.

But it’s not just a risk analysis that is needed to protect patients, providers also need to ensure that they have put in place adequate protections and compensating security controls. This is where many HDOs come unstuck - they simply don't have the staff cycles to even evaluate the risks, let alone remediate potential life threatening problems, even though they may already have some of the tools in place to segment high risk devices from the rest of the network.

The Cylera MedCommand platform automates this entire security risk management workflow identifying and then adding assets to an asset management system, risks to GRC and risk management tools, identifying IOCs and creating alerts via an existing SIEM or MDR, while talking directly with an existing NAC to automatically isolate and quarantine any compromised endpoints before patients are put at risk. Learn more or request a demo to understand how Cylera has used artificial intelligence and machine learning to simplify and automate what would otherwise be a labor intensive and cumbersome task.

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Ryuk: Protecting Clinical Engineering from Ransomware Attack

An uptick in the Russian language criminal underground in the run up to the 2020 US presidential election, suggested a massive coordinated campaign to disrupt the United States by destructive ransomware attacks against US hospitals and other healthcare delivery organizations. Whether this was party motivated by the Kremlin to weaken democratic resolve and confidence in the US election systems is so far unknown, as is any intended manipulation of results to favor one presidential candidate over another. What is known however, is that the United States government in coordination with Microsoft and other technology companies, managed to take down the majority of an extensive global Trickbot network a few weeks before this threat was first discovered, so this may have been an attempted retribution for cyber-criminals. Trickbot is used to infect computers with Ryuk and other malicious ransomware software.

The threat was considered so great, and so many prime US hospitals mentioned by name in criminal underground conversations, that the CISA, FBI and HHS held several joint briefings for hospital executives and those who support them. These briefings outlined the nature of the threat, and advised HDOs to be on the look out for anomalous activity that could be an indicator of compromise (IOC), while patching known attack vectors and other security vulnerabilities with all due haste.

The American College of Clinical Engineering in support of its members, requested that Cylera and its threat intelligence entity CyleraLabs based in Madrid, provide a deeper drive on the Ryuk ransomware family, and brief the ACCE membership on IOCs while providing advice to member hospitals how to prevent and recover from any such attack. The following briefing and panel discussion with MDs, security leaders and clinical engineers is the result of that request.

 

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