Incident: Cybersecurity Flaws in NHS Hospital Workstations Pose Critical Threat.

Published Date: 2019-06-17

Postmortem Analysis
Timeline 1. The software failure incident mentioned in the article occurred in May 2017 [Article 85693].
System 1. Workstations in hospital wards connected to the internet [85693] 2. Microsoft Windows CE operating system [85693]
Responsible Organization 1. Cybercriminals (Article 85693)
Impacted Organization 1. NHS hospitals [85693] 2. NHS trusts [85693]
Software Causes 1. Security flaws in hospital workstations connected to the internet [85693] 2. Previously disclosed error in the Microsoft Windows CE operating system [85693]
Non-software Causes The non-software causes of the failure incident mentioned in the articles are: 1. Lack of basic security against cyber attackers in the NHS systems, leading to vulnerability [Article 85693]. 2. Out-of-date computer systems, such as Windows XP and Windows 7, that had not been updated to secure them against attacks [Article 85693]. 3. Failure to provide basic security measures against cyber attackers, resulting in the spread of the virus via email and locking staff out of their computers [Article 85693]. 4. Slow installation of software updates to reduce the risk of hacking due to reasons like lack of understanding, insufficient resources, or the sheer number of devices that need to be updated [Article 85693].
Impacts 1. Nearly 20,000 hospital appointments were cancelled due to the NHS failing to provide basic security against cyber attackers [85693]. 2. 47 NHS trusts were initially reported to be affected by the WannaCry ransomware attack, but the National Audit Office found that the impact was far greater, with 81 trusts being hit by the attack [85693]. 3. Computers at almost 600 GP surgeries were victims of the WannaCry attack [85693]. 4. Nearly 19,500 medical appointments were cancelled, including 139 potential cancer referrals, as a result of the WannaCry attack [85693]. 5. Five A&E departments had to divert ambulances away at the peak of the WannaCry crisis [85693].
Preventions 1. Implementing timely software updates and patches to address security flaws in the Microsoft Windows CE operating system [85693]. 2. Conducting regular security assessments and audits on hospital workstations connected to the internet to identify and mitigate vulnerabilities [85693]. 3. Enhancing cybersecurity measures within NHS hospitals to prevent unauthorized access to medical devices and software by cybercriminals [85693].
Fixes 1. Implementing software updates to address the security flaws in hospital workstations connected to the internet [85693]. 2. Enhancing cybersecurity measures within NHS hospitals to prevent unauthorized access to medical devices and software [85693]. 3. Conducting unannounced inspections of IT security in hospitals to ensure systems are secure against cyber threats [85693].
References 1. CyberMDX, a US-based cybersecurity firm [85693] 2. Jon Rabinowitz, vice president of marketing at CyberMDX [85693] 3. Professor Alan Woodward, a computer security expert at the University of Surrey [85693] 4. NHS Digital [85693] 5. Becton Dickinson, the manufacturer of the workstations [85693] 6. The Medicines and Healthcare Products Regulatory Authority [85693]

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization, multiple_organization (a) The software failure incident related to potential hacking into medical devices used in NHS hospitals has happened before within the same organization. The article mentions that concerns over the security of NHS computer systems have been rife ever since more than a third of hospital trusts had their systems crippled in the WannaCry ransomware attack in May 2017 [85693]. (b) The software failure incident related to potential hacking into medical devices used in NHS hospitals has also happened at other organizations. The article mentions that the US-based cybersecurity firm CyberMDX identified security flaws in hospital wards' workstations connected to the internet, indicating a broader vulnerability across multiple organizations [85693].
Phase (Design/Operation) design, operation (a) The software failure incident related to the design phase is evident in the security flaws discovered in hospital workstations connected to the internet, which could allow cybercriminals to gain access to medical software controlling IV pumps and potentially harm patients by disrupting drug delivery [85693]. (b) The software failure incident related to the operation phase is highlighted by the WannaCry ransomware attack in 2017, where the NHS systems were crippled due to the lack of basic security against cyber attackers, leading to the cancellation of thousands of hospital appointments and the disruption of essential healthcare services [85693].
Boundary (Internal/External) within_system (a) within_system: The software failure incident reported in the articles is primarily within the system. The security flaws in hospital workstations connected to the internet, the vulnerability of medical software to hacking, and the potential consequences such as disrupting the flow of electricity to care-critical infusion pumps and altering drug delivery all point to internal system vulnerabilities [85693]. Additionally, the previously disclosed error in the Microsoft Windows CE operating system, which contributed to the flawed system, is an internal factor [85693]. The slow installation of software updates to reduce the risk of hacking due to lack of understanding, insufficient resources, or the sheer number of devices that need to be updated also falls within the system [85693].
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident occurring due to non-human actions: The software failure incident in the NHS hospitals was due to security flaws in hospital workstations connected to the internet, allowing cybercriminals to potentially hack into medical devices like IV pumps and disrupt the delivery of chemotherapy drugs or tamper with insulin doses [85693]. (b) The software failure incident occurring due to human actions: The risk of the software failure incident was exacerbated by the slow installation of software updates that could reduce the risk of hacking. This delay was attributed to factors like a lack of understanding, insufficient resources, or the sheer number of devices that needed to be updated [85693].
Dimension (Hardware/Software) hardware, software (a) The software failure incident occurring due to hardware: The software failure incident reported in the articles is related to a security flaw in hospital workstations connected to the internet, which are used in NHS hospitals. The flaw in the workstations, which are connected to IV pumps, could potentially allow cybercriminals to control and cut off IV pumps, leading to catastrophic consequences such as blocking the delivery of chemotherapy drugs or tampering with insulin doses [85693]. (b) The software failure incident occurring due to software: The software failure incident is also attributed to a previously disclosed error in the Microsoft Windows CE operating system, which contributed to the flawed system in the workstations made by Becton Dickinson. The slow installation of software updates that could reduce the risk of hacking is mentioned as a contributing factor due to reasons like a lack of understanding, insufficient resources, or the sheer number of devices that need to be updated [85693].
Objective (Malicious/Non-malicious) malicious, non-malicious (a) The software failure incident related to the security flaws in hospital workstations connected to the internet, which could allow cybercriminals to hack into medical devices used in NHS hospitals, falls under the category of a malicious objective. The incident involves the potential for hackers to gain access to medical software controlling IV pumps, which could lead to catastrophic consequences such as blocking the delivery of chemotherapy drugs or tampering with insulin doses [85693]. (b) On the other hand, the software failure incident related to the WannaCry ransomware attack in May 2017, which affected a significant number of hospital trusts and led to the cancellation of thousands of appointments, falls under the category of a non-malicious objective. This incident was caused by the spread of the ransomware via email, locking staff out of their computers and demanding payment to release files, resulting in disruptions to hospital operations and patient care [85693].
Intent (Poor/Accidental Decisions) poor_decisions (a) The intent of the software failure incident related to poor decisions can be seen in the article where it mentions that concerns over the security of NHS computer systems have been rife ever since more than a third of hospital trusts had their systems crippled in the WannaCry ransomware attack in May 2017. The report reveals that nearly 19,500 medical appointments were cancelled, including 139 potential cancer referrals, and five hospitals had to divert ambulances away at the peak of the crisis due to the failure to provide basic security against cyber attackers [85693]. Additionally, the article highlights that software updates that reduce the risk of hacking are often slow to be installed due to a lack of understanding, insufficient resources, or the sheer number of devices that need to be 'fixed' [85693]. These instances point towards poor decisions or negligence contributing to the software failure incident.
Capability (Incompetence/Accidental) development_incompetence, accidental (a) The software failure incident related to development incompetence is evident in the article as it highlights security flaws in hospital workstations connected to the internet, which could allow cybercriminals to gain access to medical software controlling IV pumps [85693]. The flaws in the system were attributed to a previously disclosed error in the Microsoft Windows CE operating system, indicating a lack of professional competence in addressing and mitigating known vulnerabilities. Additionally, the slow installation of software updates to reduce the risk of hacking was mentioned, pointing towards potential shortcomings in the development and maintenance processes. (b) The accidental aspect of the software failure incident is also apparent in the article, particularly in the context of the WannaCry ransomware attack that affected NHS hospital trusts in 2017 [85693]. The attack, which spread via email and locked staff out of their computers, was described as ripping through the out-of-date defenses used by the NHS, indicating an accidental exposure to vulnerabilities due to inadequate security measures. The report also mentioned that the cyber-attack could have been easily prevented, suggesting that the incident was not intentional but rather a result of negligence or oversight in maintaining secure systems.
Duration temporary (a) The software failure incident described in the articles is more likely to be temporary rather than permanent. The incident involves security flaws in hospital workstations connected to the internet, which could potentially allow cybercriminals to hack into medical devices and disrupt the delivery of medications to patients [85693]. The vulnerability in the system is attributed to a previously disclosed error in the Microsoft Windows CE operating system, indicating a specific contributing factor that can be addressed through software updates [85693]. Additionally, the articles mention that software updates to reduce the risk of hacking are often slow to be installed due to various reasons such as lack of understanding, insufficient resources, or the sheer number of devices that need to be updated [85693]. This suggests that the failure is not permanent but rather temporary and can be mitigated through appropriate measures.
Behaviour other (a) crash: The software failure incident mentioned in the articles does not specifically describe a crash where the system loses state and does not perform any of its intended functions [85693]. (b) omission: The incident does not mention a failure due to the system omitting to perform its intended functions at an instance(s) [85693]. (c) timing: The incident does not involve a failure due to the system performing its intended functions correctly, but too late or too early [85693]. (d) value: The software failure incident does not involve a failure due to the system performing its intended functions incorrectly [85693]. (e) byzantine: The incident does not describe a failure due to the system behaving erroneously with inconsistent responses and interactions [85693]. (f) other: The behavior of the software failure incident in the articles can be categorized as a potential security vulnerability where cybercriminals could hack into medical devices used in NHS hospitals, gaining access to medical software that would enable them to control and cut off IV pumps, potentially leading to catastrophic consequences [85693].

IoT System Layer

Layer Option Rationale
Perception processing_unit, network_communication, embedded_software (a) sensor: The software failure incident reported in the articles does not specifically mention any sensor-related errors or failures. (b) actuator: The incident does not directly point to any actuator-related errors or failures. (c) processing_unit: The failure mentioned in the articles is related to security flaws in hospital workstations connected to the internet, which could allow cybercriminals to disrupt the flow of electricity to care-critical infusion pumps, falsify pump status information, and alter drug delivery. These issues are more aligned with processing_unit errors as they involve manipulating the operation of the machines and altering drug delivery processes [85693]. (d) network_communication: The incident involves security flaws in hospital workstations connected to the internet, which could potentially allow hackers to introduce their own computer programs hidden inside software updates, take control of the systems, and access patients' private information. These aspects relate to network communication vulnerabilities that could be exploited by cybercriminals to gain unauthorized access and control over the hospital networks [85693]. (e) embedded_software: The software failure incident is attributed to a previously disclosed error in the Microsoft Windows CE operating system, which is part of the embedded software running on the hospital workstations. The manufacturer of the workstations mentioned that the flawed system arose due to this embedded software error, indicating a vulnerability in the software that could be exploited by hackers to compromise the devices [85693].
Communication connectivity_level The software failure incident reported in the articles is related to the connectivity level of the cyber physical system that failed. The incident involved security flaws in hospital workstations connected to the internet, which could potentially allow cybercriminals to gain access to medical software controlling IV pumps and disrupt the delivery of critical medications like chemotherapy drugs and insulin [85693]. This failure is attributed to vulnerabilities in the network or transport layer of the system, indicating a connectivity-level issue.
Application TRUE The software failure incident reported in the articles was related to the application layer of the cyber physical system. The incident involved security flaws in hospital workstations connected to the internet, which could allow cybercriminals to gain access to medical software controlling IV pumps, potentially leading to catastrophic consequences such as blocking chemotherapy drug delivery or tampering with insulin doses [85693]. This type of failure falls under the application layer category as it involves vulnerabilities in the software application itself that could be exploited by hackers.

Other Details

Category Option Rationale
Consequence harm, property, delay, non-human, theoretical_consequence (a) death: People lost their lives due to the software failure - There is no direct mention of people losing their lives due to the software failure incident reported in the articles [85693]. (b) harm: People were physically harmed due to the software failure - The article mentions that if hackers were to block the delivery of chemotherapy drugs or tamper with insulin doses due to gaining access to medical software, it could lead to 'catastrophic' consequences [85693]. (c) basic: People's access to food or shelter was impacted because of the software failure - There is no mention of people's access to food or shelter being impacted due to the software failure incident reported in the articles [85693]. (d) property: People's material goods, money, or data was impacted due to the software failure - The article discusses the potential impact of hackers gaining access to hospitals' networks, introducing their own computer programs, and possibly getting hold of patients' private information [85693]. (e) delay: People had to postpone an activity due to the software failure - The article mentions that nearly 20,000 hospital appointments were cancelled due to the WannaCry ransomware attack in May 2017, which affected the NHS systems [85693]. (f) non-human: Non-human entities were impacted due to the software failure - The article discusses the potential harm to patients if compromised medical devices were used to administer vital medicines such as chemotherapy drugs and insulin [85693]. (g) no_consequence: There were no real observed consequences of the software failure - There were observed consequences discussed in the articles related to potential harm and impact on patients and hospital systems [85693]. (h) theoretical_consequence: There were potential consequences discussed of the software failure that did not occur - The article mentions concerns over the security of NHS computer systems and the potential catastrophic consequences of successful attacks on medical devices, although cybercriminals had not gained access to any NHS devices at the time of reporting [85693]. (i) other: Was there consequence(s) of the software failure not described in the (a to h) options? What is the other consequence(s)? - There is no other consequence mentioned in the articles beyond the potential harm, impact on appointments, and security concerns discussed [85693].
Domain health (a) The failed system was related to the healthcare industry, specifically affecting medical devices used in NHS hospitals [85693]. (j) The incident impacted the healthcare industry, particularly concerning the security flaws in hospital workstations connected to the internet and the potential consequences of hackers gaining access to medical software controlling IV pumps and medication delivery [85693].

Sources

Back to List