Hacking Acute Care: A Qualitative Study on the Healthcare Impacts of Ransomware Attacks Against Hospitals

Boven, Liselotte van; Kusters, Renske W J; Tin, Derrick; Osch, Frits van; Cauwer, Harald De; Ketelings, Linsay; Rao, Madhura; Dameff, Christian; Barten, Dennis G.

doi:10.1101/2023.02.13.23285854

Cited by 2 publications

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References 19 publications

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“…Although it is unknown whether this also represents better preparedness, several studies have shown that cybersecurity in hospitals can be significantly improved. 22,23…”

Section: Discussionmentioning

confidence: 99%

Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey

Barten,

Janssen,

De Cauwer

et al. 2023

Preprint

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BackgroundWorkplace violence, including violent extremism, is a growing concern in the healthcare environment. Furthermore, there has been a disproportionate rise in the rate of terrorist attacks on hospitals during the past two decades. Hospitals are vulnerable targets due to their easy accessibility and their high density of patients, staff and visitors. Nonetheless, little is known about the hospitals’ awareness of these risks, and to which extent these facilities protect themselves from violent extremism and terrorist attacks.MethodsThis was a cross-sectional survey study among emergency managers of acute care hospitals in the Netherlands. The questionnaire included 42 items across six themes: demographic (hospital) data; general and emergency department (ED) access control; ED security and preparedness; online security and offline transparency; violence, terrorism and warfare; and impact of the COVID-19 pandemic. Responses were collected and stored in a secured online database, and subsequently exported to an Excel spreadsheet for descriptive analysis. Continuous data were reported as means or as medians with interquartile ranges (IQR), using SPSS. Categorical data were reported as absolute numbers and as valid percentages.ResultsThe questionnaire was completed on behalf of 33 out of 71 hospital organizations (46%), representing 38 out of 82 EDs (46%). Hospitals had broadly different policies with regards to patient and visitor registration, and the presence of security guards. Most hospitals had controlled vehicle access for the parking lot and ambulance bay, but this was not 24/7 in all hospitals. A paragraph on terrorist attacks was included in 34% of hospital disaster plans. Eighteen percent of hospitals had previous experience with acts of violent extremism and 55% of hospitals had sustained (attempted) cyberattacks. Whilst the likelihood of a physical terrorist attack was deemed low at 3.6 (median 4, IQR 2.6) on a 10-point Likert scale, the likelihood of a cyberattack was considered high at 7.3 (median 8, IQR 2.3). A significant proportion of emergency managers reported to experience an increased risk of violence since the onset of the COVID-19 pandemic.ConclusionPractice variation with regards to counter-terrorism defence measures in Dutch hospitals is high. The preparedness of hospitals for terrorist attacks or acts of violent extremism could be improved and may benefit from uniform, evidence based hospital security policies.

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“…Although it is unknown whether this also represents better preparedness, several studies have shown that cybersecurity in hospitals can be significantly improved. 22,23…”

Section: Discussionmentioning

confidence: 99%

Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey

Barten,

Janssen,

De Cauwer

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Even critical life-saving devices, such as pacemakers and insulin pumps, have been demonstrated to be vulnerable to attacks [20], [103]. The fragility of our technology also provided the conditions to allow ransomware attacks on hospitals and electrical companies which have put countless lives at risk [136], [199].…”

Section: Introductionmentioning

confidence: 99%

Towards rigorous evaluation of binary testing and analysis

Bundt

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Towards Rigorous Evaluation of Binary Testing and Analysis by Joshua BundtComputer security research is an ever-evolving field that aims to make technology more secure.Attackers constantly seek out vulnerabilities in systems, and defenders strive to introduce new controls to prevent these attacks. Attack research typically involves demonstrating the validity of an attack through a proof of concept. In contrast, defense research requires a higher level of rigor to substantiate that defenses are secure under various conditions and against a willful adversary. In this thesis, we examine the state of rigor in a specific area of defense research: binary testing and analysis. Binary testing and analysis encompasses the tasks and techniques required to evaluate binary code, which is the machine-readable representation of software programs, in order to understand program behavior, identify vulnerabilities, and ensure correctness and security. To assess the robustness of the current techniques and to provide a more rigorous methodology, we first examine the utility of synthetic bug generation as a solution to the scarcity of real bugs for fuzz testing evaluation. We conducted a large-scale measurement study evaluating existing synthetic bug generators with eight fuzzers on 20 software libraries and found that synthetic bugs are easier to discover than organic bugs and the most popular synthetic bug benchmark, LAVA-M, exhibits fundamental flaws that make it unsuitable to recommend for future research. Second, we propose a new workflow to enable humans to more effectively assist fuzz testing through compartment analysis. An empirical study of seven software libraries revealed that compartment analysis can significantly improve a fuzzing campaign even when conducted after a few hours of fuzzing. Finally, we consider the fragility of neural network binary disassemblers at the task of function boundary detection. When comparing traditional disassemblers to neural binary disassemblers, we found the latter to be vulnerable to adversarial attacks which allows the attacker to degrade function boundary detection. In response, we proposed an expanded set of benchmarks and adversarial techniques to provide a better evaluation of neural binary disassemblers. Throughout this dissertation, we propose and demonstrate improved methodologies for rigorously examining and assessing binary testing and analysis efficacy. v AcknowledgementsThe PhD journey starts with someone agreeing to take a long term risk on you despite knowing little more than your resume. For taking the initial risk, I would like to thank my advisor Wil Robertson who has guided me from start to finish while providing advice, unwaverable optimism, and tremendous patience. A special thanks to Tim Leek who took on mentoring me long before I started at Northeastern and continues to provide keen insight and frank opinions that shape my research efforts. I would also like to thank the rest of the members of my committee Pete Manolios, Guevara Noubir, and Davide Balzarotti who pr...

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Hacking Acute Care: A Qualitative Study on the Healthcare Impacts of Ransomware Attacks Against Hospitals

Cited by 2 publications

References 19 publications

Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey

Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey

Towards rigorous evaluation of binary testing and analysis

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