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#RSAC
Daniel	Miessler
Securing	Medical	Devices	Using	Adaptive	Testing	Methodologies
ASD-R10
Director of Advisory Services
IOActive, Inc.
@danielmiessler
SESSION	ID:SESSION	ID:
#RSAC
Daniel	Miessler
Securing	Medical	Devices	Using	Adaptive	Testing	Methodologies
ASD-R10
Director of Advisory Services
IOActive, Inc.
@danielmiessler
#RSAC
About
3
18	years	in	information	security	
Technical	testing	background	(net/web/mobile/IoT)	
Director	of	Advisory	Services	at	IOActive	
Previously	a	founding	member	and	principal	at	HPE	Fortify	on	Demand	
Work	on	a	number	of	OWASP	projects:	IoT	Security,	and	OWASP	Game	
Security	Framework	Project	
Read,	write,	podcast,	table	tennis
#RSAC
Agenda
4
Why	we	care?	
The	problem	
Adaptive	Testing	Methodology	
Practical	takeaways
#RSAC
Why	do	we	care?
#RSAC
6
- J&J	insulin	pump	(Animus	OneTouch	Ping)	
- Jay	Radcliffe,	diabetic	and	researcher		
- Unencrypted	command	traffic	
- Could	send	unauthorized	insulin	injections
Recent	Issues:	Johnson	&	Johnson
Image:	REUTERS	/	Weigmann
#RSAC
7
- St.	Jude	pacemaker	
- Many	vulnerabilities	found		
- PR	+	Shorting	of	stock	
- Vulns	included	wireless	god	key	
- MedSec	found	the	vulns	
- Muddy	Waters	shorted	stock
Recent	Issues:	St.	Jude
#RSAC
8
Hospitals	being	ransomed:	US	Hospitals
Hollywood	Presbyterian	Hospital	
Tried	to	get	help	from	authorities,	ended	up	paying	$17,000	
Methodist	Hospital	
Refused	to	pay,	had	to	shut	down	part	of	the	hospital		
Many,	many	more
#RSAC
9
Hospitals	being	ransomed:	NHS
One	NHS	area	had	to	transfer	patients	because	they	were	shut	down	
34%	of	Health	Trusts	in	the	U.K.	hit	with	ransomware	within	the	last	18	
months	
60%	of	Scottish	trusts	
Other	countries	affected	as	well,	including	Germany
#RSAC
10
Bitcoin	Readiness	(a	depressing	state)
When	ransomware	happens	the	payment	is	usually	in	bitcoin	
Companies	getting	hacked	often	don’t	know	anything	about	bitcoin	
The	time	it	takes	to	learn	about	and	acquire	bitcoin	often	costs	
companies	massive	amounts	of	money		
Many	are	hiring	law	firms	to	acquire	and	hold	bitcoin	for	them	in	case	
they	get	hacked	
I	like	the	preparation	piece,	but	it’s	still	quite	depressing
#RSAC
11
A	Dangerous	Combination
- Home	users	
- Schools	
- Governments	
- Small	businesses
#RSAC
12
A	Dangerous	Combination
- The	medical	space	is	
extremely	vulnerable	to	
these	issues.
#RSAC
The	problem
#RSAC
Recent	Issues
14
-	Lots	of	vulnerabilities	found
#RSAC
A	Disconnect
15
The	attack	surface	for	medical	devices	is	simply	larger	than	the	maturity	
of	standardized	procedures	to	test	those	surface	areas.
0
25
50
75
100
Current	A/ack	Surface Future	A/ack	Surface Tes8ng	Maturity
#RSAC
The	Attack	Surface
16
- Hardware	physical	interfaces	
- Physical	networking	ports	
- Debug	/	admin	ports	
- WiFi	/	RF	
- Data	transfer	and	storage	
- Cryptographic	implementations	
- HL7	implementations	
- Hardware	sensors	
- Input	parsing	/	validation	
- Command	/	data	authentication
#RSAC
Attack	Surface	vs.	Testers
17
- How	many	devices	are	there	already?	
- How	many	have	been	tested?	
- How	many	devices	will	there	be?	
- How	many	testers	will	be	required	to	
look	at	them?
#RSAC
Problem:	Tester	Desensitization
18
- Comprehensive	testing	methodologies	
are	usually	massive	
- Testers	can	usually	only	read	them	once	
or	twice	
- They	can’t	use	them	over	time	
- You	only	get	a	couple	of	strikes	
regarding	irrelevant	content
#RSAC
The	Adaptive	Testing	
Methodology	approach
#RSAC
Adaptive	Testing	Methodology
20
Contextual	testing	based	on	
attributes	of	the	target	or	situation
#RSAC
Adaptive	Testing	Methodology
21
Contextual	testing	based	on	
attributes	of	the	target	or	situation	
Can	apply	to	web	apps,	hosts,	IoT,	
medical	devices,	etc.
#RSAC
Adaptive	Testing	Methodology
22
Contextual	testing	based	on	
attributes	of	the	target	or	situation	
Can	apply	to	web	apps,	hosts,	IoT,	
medical	devices,	etc.	
Attribute	types	(potential)	
Target	attack	surfaces	
Time	available	
Tools	available	
Skill	level	available
#RSAC
23
#RSAC
24
OWASP	IoT:	Medical	Device	Testing
#RSAC
25
#RSAC
Real-world	Usage
26
Third-party	testing	requirements	
Trying	to	avoid	tester	fatigue	from	vendors	
Profile	a	piece	of	hardware	using	Adaptive	Testing		
See	which	surface	areas	are	in	play	
Create	a	customized	testing	methodology	for	that	device/ecosystem	
Reduce	the	size	of	a	testing	methodology	by	50-300%	
Every	section	is	relevant
#RSAC
Lessons	learned	over	the	years
27
Visibility	is	king	in	security	
You	can’t	defend	what	you	can’t	see	and	don’t	understand	
Medical	devices	have	many	unseen	attack	surfaces	
Because	it’s	an	ecosystem,	flaws	in	one	can	lead	to	overall	weakness	
With	vulnerabilities,	1	+	1	+	1	often	equals	7
#RSAC
Takeaways
28
Visibility	is	problem	#1
#RSAC
29
Monolithic	testing	
methodologies	can	lead	to	
tester	fatigue
Takeaways
#RSAC
30
Simple	methodology	is	
consumable,	and	consumable	
methodology	gets	used
Takeaways
#RSAC
31
Simple	methodology	is	
consumable,	and	consumable	
methodology	gets	used
Takeaways
#RSAC
32
Friends	don’t	let	friends	ship	things	without	understanding	the	attack	
surface
Takeaways
#RSAC
33
Friends	don’t	let	friends	buy	things	without	understanding	the	attack	
surface
Takeaways
#RSAC
34
Friends	don’t	let	friends	install	/	implement	things	without	
understanding	the	attack	surface
Takeaways
#RSAC
35
Place	stress	on	approachable	simplicity	for	understanding	attack	
surfaces
Takeaways
#RSAC
36
Modularize	and	streamline	your	testing	methodologies	to	avoid	
them	being	disregarded.
Takeaways
#RSAC
37
Focus	on	breadth	before	depth	when	covering	attack	surfaces.
Takeaways
#RSAC
Resources
38
OWASP	Internet	of	Things

https://www.owasp.org/index.php/
OWASP_Internet_of_Things_Project	
I	Am	The	Cavalry

https://www.iamthecavalry.org
#RSAC
Future	work:	Medical	Security	Scenarios	Project
39
Medical	Security	Scenarios	Project
#RSAC
Future	work:	Medical	Security	Scenarios	Project
40
Medical	Security	Scenarios	Project	
Attack	surface	
Vulnerability	type	
Skill-level	required	
Life-threatening	or	not
#RSAC
Thanks
41
Email:	daniel.miessler@ioactive.com	

												daniel@danielmiessler.com		
Twitter:	@danielmiessler	
Podcast:	Unsupervised	Learning

																danielmiessler.com/ul	
Reach	out	any	time!	Participate.	
We’re	always	hiring	at	IOActive!

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Securing Medical Devices Using Adaptive Testing Methodologies