A Comprehensive Guide to Medical Device Vulnerability Management

In recent years, the healthcare industry has been fueled by rapid digital transformation, enabling advancements in patient care ranging from enhanced diagnostics and treatment options to clinical decision support. However, the same connected medical devices, hardware infrastructure, and software applications responsible for shaping the future of healthcare have also caused myriad challenges, particularly in cybersecurity. As a result, medical device vulnerability management has emerged as a crucial part of medical device cybersecurity, to ensure the security and integrity of healthcare environments. This comprehensive guide aims to shed light on the importance of medical device vulnerability management, provide insights into the key challenges associated with implementation, and details the requirements of a strong vulnerability management framework.  

What is Medical Device Vulnerability Management?

Medical device vulnerability management is the process of identifying, assessing, and mitigating vulnerabilities in medical devices to ensure their security and to protect them from cyber threats. Vulnerabilities in medical devices can come from many different sources including misconfigurations, software bugs, outdated components, or design flaws — among others. For healthcare delivery organizations (HDOs), medical devices are part of a larger scope known as the internet of medical things (IoMT). IoMT devices include remote patient monitoring (RPM) machines, medical imaging systems, sensors that track medication orders, infusion pumps that administer medications, biosensors located in wearables or implanted inside the human body that monitor vital signs, and more. IoMT devices have more severe consequences than any other cyber-physical systems (CPS) due to the patient risks associated. Unlike other connected devices, if IoMT devices are compromised, they can endanger patient safety. As such, HDOs require strong risk-based vulnerability management (RBVM) strategies to tackle the most pressing healthcare cybersecurity challenges. 

Challenges of Medical Device Vulnerability Management 

Achieving successful medical device vulnerability management comes with several challenges, many of which are unique to the healthcare sector and the nature of medical devices. Some of the most pressing challenges include:  

• Inaccurate device inventory: Without an accurate inventory of medical devices — including device attributes such as operating system and software version — it is almost impossible to make proper risk based decisions. This is arguably one of the most important, yet likely the most overlooked, considerations as HDOs build out their vulnerability management programs. 

• Legacy systems: Many times, medical devices have decades long life cycles and are in use for extended periods of time. As a result, they may be operating on outdated software or firmware that may no longer be receiving regular security updates or patches — leaving them vulnerable to cyber threats.  

• Resource constraints: Many HDOs face resource constraints related to limited staff and a lack of funding. Without the proper business units in place, organizations may struggle with delays in implementing security measures or apply updates. Similarly, HDOs that suffer from a lack of funding may have limited ability to invest in comprehensive vulnerability management workflows.  

• Regulatory compliance: Compliance with healthcare regulations can be extremely complex, making it difficult for HDOs to understand what is required of them and how to implement necessary vulnerability management tactics. Without the right personnel or budget available, HDOs may find it difficult to implement and maintain industry regulations, which are constantly evolving and being updated. 

• Utilization of standard solutions: Traditional security solutions and conventional wisdom guide vulnerability prioritization based on the common vulnerability scoring system (CVSS), rather than based on exploitation likelihood. This method of vulnerability prioritization has caused many HDOs often-already overburdened personnel to expend resources prioritizing vulnerabilities that are or will not ever be exploited.

How to Build a Strong Vulnerability Management Framework 

When HDOs set out to mitigate medical device vulnerabilities they often run into challenges when it comes to how to prioritize them. By building out a strong vulnerability management framework HDOs can determine which vulnerabilities to mitigate first, by focusing on the ones that matter most to their unique environment. This process begins with the following considerations for medical device vulnerability management :  

1. Discover Devices: At the basis of any successful vulnerability management program is device discovery. You must first understand which devices are connected to your clinical environment before you are able to make proper risk-based decisions. This can be achieved by partnering with a healthcare cybersecurity solution that provides multiple, highly flexible discovery methods that can be mixed and matched to deliver full visibility in the manner best suited to your distinct needs. Armed with full asset discovery details — including asset type, model, device manufacturer, IP address, and device location — HDOs can effectively prioritize and manage their most critical vulnerabilities. 

2. Identify Vulnerabilities: Once HDOs have successfully discovered all devices in their environment, they can then identify the vulnerabilities present. By correlating their device inventory with common vulnerabilities and exposures (CVEs) and other weaknesses they can then pinpoint vulnerabilities and uncover risk blind spots. 

3. Prioritize Vulnerabilities: Finally, once devices are discovered and vulnerabilities are uncovered, HDOs can then prioritize their most important vulnerabilities based on which ones are — or are most likely to be — actively exploited. The most effective way to do this is through the Known Exploited Vulnerabilities (KEV) catalog and Exploit Prediction Scoring System (EPSS). By partnering with a healthcare cybersecurity solution provider that automatically enriches and assigns all vulnerabilities to priority groups based on the latest current and predicted exploitability indicators from KEV and EPSS, HDOs can more effectively, efficiently, and easily understand and prioritize the vulnerabilities that matter most to them.

Healthcare organizations are faced with unique challenges when it comes to establishing a strong medical device vulnerability management program. As the global threat landscape continues to evolve, the steps we discussed today can help organizations cut through the noise associated with the vast quantity of medical device risk — and help them focus on prioritizing the most relevant risks in their environment. With an award-winning healthcare IoT solution, like Medigate by Claroty, HDOs can better understand their medical device risk posture, allocate their existing resources more efficiently to improve it, and accelerate their healthcare cybersecurity journey — no matter where they are now or where they want to be.