Implantable Medical Devices:
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1 Implantable Medical Devices: Security Privacy for Pervasive, Wireless Healthcare Presenter: Kevin Fu Yoshi Kohno & William Maisel CMOS Workshop, February 18, 2009 UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
2 Many Collaborators William H. Maisel, MD, MPH -Director, Pacemaker and Defibrillator Service, Beth Israel Deaconess Medical Center -Assistant Professor, Harvard Medical School Tadayoshi Kohno -Assistant Professor, CSE, University of Washington Students -Shane Clark, Benessa Defend, Tamara Denning, Dan Halperin, Tom Heydt-Benjamin, Andres Molina, Will Morgan, Ben Ransford, Mastooreh Salajegheh UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 2
3 IMD Security & Privacy is Hard Background Unintentional medical malfunctions Intentional medical malfunctions Pacemaker & Implantable Cardioverter Defibrillator (ICD) Security analysis of a pacemaker/icd Violate patient privacy Induce a fatal heart rhythm Defensive methods Protect the battery, proper use of cryptography The Future UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 3
4 Unintentional Malfunctions in Medical Care UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
5 Unintentional Accidents IEEE Computer 1993 UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 5
6 Is a malicious intentional malfunction a risk of real concern? UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
7 Bad People Do Exist UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 7
8 Background: Pacemaker & Defibrillator 101 UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
9 Photos from: Medtronic 9
10 Photos from: Medtronic 9
11 Networking + Wireless! Photos from: Medtronic 9
12 Pacemakers: Regulate heartbeat UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 10
13 Pacemakers: Regulate heartbeat UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 10
14 Pacemakers: Regulate heartbeat > Energy spent on radio & computing, etc. overhead! < Energy for pacing! UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 10
15 ICDs: Resynchronize the heart Implantable Cardioverter Defibrillator (ICD) Related to pacemaker Large shock: resync heart Monitors heart waveforms Heart UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 11
16 Our Tested Pacemaker + ICD Physical characteristics: ~5-year battery Waveform memory Radio interface w/ programmer Therapies:* Steady pacing shocks 35 J defibrillation shocks * detail in [Webster, 1995] UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 12
17 Implantation Scenario 1. Doctor sets patient info 2. Surgically implants 3. Tests defibrillation 4. Ongoing monitoring Device Programmer Photos: Medtronic; Video: or-live.com UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 13
18 Implantation Scenario 1. Doctor sets patient info 2. Surgically implants 3. Tests defibrillation 4. Ongoing monitoring Photos: Medtronic; Video: or-live.com UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 13
19 Implantation Scenario 1. Doctor sets patient info 2. Surgically implants 3. Tests defibrillation 4. Ongoing monitoring Photos: Medtronic; Video: or-live.com Home monitor UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 13
20 Adversaries Do Not Play by the Rules UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
21 WiFi Sniper Yagi UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 15
22 Uninvited Radio Suitcases Mobile_Covert_Bluetooth_Attack_and_Infection_Device.html UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 16
23 Our Security Analysis of a Pacemaker + ICD UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
24 Computer Security Computer Security (Informal Definition): Study of how to design systems that behave as intended in the presence of determined, malicious third parties Security is different from reliability The malicious third party controls the probability distribution of malfunctions Security researchers focus on understanding, modeling, anticipating, and defending against these malicious third parties [This description drawn from the work of Prof. Yoshi Kohno with permission] UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 18
25 Build Your Own Clinic ~10 cm (un-optimized)
26 Method: Eavesdrop Private Info
27 Method: Eavesdrop Private Info Diagnosis
28 Method: Eavesdrop Private Info Diagnosis Hospital
29 Method:Implanting Eavesdrop Private Info physician Hospital Diagnosis
30 Method:Implanting Eavesdrop Private Info physician Hospital Diagnosis Also: Device state Patient name Date of birth Make & model Serial no.... and more
31 Method: Sniff Vital Signs Eavesdropping setup ICD emits reconstructible vital signs Issue: Vital signs can say plenty.
32 Replay Traffic ~10 cm Photo: Medtronic
33 Method: Drain Energy Implant designed for infrequent radio use Radio decreases battery lifetime
34 Method: Drain Energy Implant designed for infrequent radio use Radio decreases battery lifetime Are you awake? Are you awake?
35 Method: Drain Energy Implant designed for infrequent radio use Radio decreases battery lifetime Are you awake? Are you awake? Now I am!
36 Replay: Turn Off Therapies Stop detecting fibrillation. Device programmer would warn here Issue: Can quietly change device state.
37 Replay: Affect Patient s Physiology Induce fibrillation which implant ignores Again, at close range In other kinds of implant: Flood patient with drugs Overstimulate nerves,... Photo: or-live.com Issue: Puts patient safety at risk.
38 Defensive Direction: Zero-Power (No time today. Google for pacemaker zero-power ) UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
39 Prototype Defenses Focus on sleep deprivation In zero power (harvested RF energy) Challenge-response authentication Patient notification mechanism Sensible key exchange Human is in the loop UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 27
40 Prototype defenses against some of the attacks. Main idea: defend without using battery.
41 B.Y.O.P. WISP = RFID + computation [Ubicomp 06] WISPer = WISP + our code Maximalist crypto [RFIDSEC 07] Prototype: 913 MHz RFID band Goal: External party pays for power.
42 Patient notification ICD
43 Patient notification Auth ICD
44 Patient notification BZZZZZZZZZZZZZZZ Auth Go ahead! ICD
45 WISPer as Gatekeeper Authenticate against WISPer WISPer to ICD: OK to use radio Acoustic patient notification How to deter enemies? (Open question!) 1 External party WISPer 2 Implant 3
46 Sensible key exchange Session setup Programming head Tissue 1 cm Key material Modulate ICD ~4 khz acoustic wave
47 Testing WISPer: Simulated Torso 1 cm bacon WISPer 6 cm chuck Energy harvesting through tissue is possible.
48 How WISPer Could Work Auxiliary device (possibly integrated) Audible or tactile patient alert Patient detects activity: am I in a clinic? Fail open: sensible, tactile key exchange UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 34
49 IMDs+Wireless+Internet: The Future (Condensed version of the future. Ask Kevin for details.) UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
50 Future Home Care Sacramento Bee, May 17, 2008 Yet some remarkable changes are on the horizon, said Dr. Larry Wolff, a UC Davis Medical School professor who specializes in implanting defibrillators. "I believe over time we could make programming changes on the telephone," he said, although that's not possible now. UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 36
51 Future Healthcare Infrastructure UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 37
52 Going the Distance Eventually, Vanu s [software radio] technology could be used to create a phone. UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 38
53 Future Threats: Viruses? Software updates? SQL injection? Buffer overflows? Radio as infection vector? Computer viruses, full circle? Image credit: Health & Development Initiative, India 39
54 Medical Device Trends Further computerization of care Longer range communication Tight integration with the Internet Cooperation among devices Issue: All of these bring risks. UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 40
55 Summary of IMD Sec. & Priv. Risks today: Unintentional interference Radio interference Threats: Metal detectors, accidents, misidentification Future risks: Intentional interference Threats from wireless and Internet connectivity Malware: Human-computer-immunodeficiency (HCI) virus? Tough problems: Software updates, remote monitoring,... UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 41
56 Challenging Technology Landscape! Auditability Safety (open access) Patient Usability High Impact Psychological Effects Security (closed access) IMD Response Time Storage Constraints Battery Life
57 Wireless + Internet Can Improve Healthcare But not without fully understanding security and privacy Insulin pump Artificial pancreas Neurostimulators Artificial vision Obesity control Programmable Vasectomy UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science
58 Extra slides Google us for more information. UNIVERSITY OF MASSACHUSETTS AMHERST Department of Computer Science 44
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