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wide array of industries and services that are interconnected

with healthcare delivery and operations.
The affected industries include:
• Healthcare Providers: Hospitals, clinics, and private
practices rely on medical technology for patient care.
Cyber attacks can disrupt clinical operations, delay
treatments, and compromise patient safety.
• Healthcare Technology Companies: Firms that
develop and maintain medical software and devices can
suffer from intellectual property theft, loss of customer
trust, and financial losses due to cyber attacks.
• Insurance Companies: Insurers may face claims
related to cyber attacks on medical technology,
including costs associated with data breaches, system
restoration, and liability claims.
• Pharmaceuticals and Biotech: These industries rely
on medical data for research and development. Cyber
attacks can lead to the loss of proprietary research data
and disrupt the supply chain for critical medications.
• Healthcare IT Services: Companies providing IT
support and services to healthcare organizations can be
indirectly affected by cyber attacks on their clients,
leading to reputational damage and financial losses.
Abstract – This document highlights the cyber threats to medical • Government and Regulatory Bodies: Government
technology and communication technology protocols and outlines health agencies and regulatory bodies may need to
the potential risks and vulnerabilities in these systems. It is designed respond to cyber attacks on medical technology,
to help healthcare organizations and medical professionals affecting public health and potentially leading to
understand the importance of securing their technology systems to regulatory changes.
protect patient data and ensure the continuity of care.
• Emergency Services: Cyber attacks that disrupt
medical technology can lead to delays in emergency
I. INTRODUCTION response and patient transfers, affecting ambulance
The integration of Internet of Things (IoT) devices in the services and emergency medical care
healthcare and public health sectors has brought about • Legal and Compliance Services: Law firms and
significant advancements in patient care and operational compliance consultants may see an increase in demand
efficiency. However, these benefits come with a set of for their services as healthcare organizations navigate
cybersecurity challenges and threats that need to be addressed to the legal ramifications of cyber attacks.
protect sensitive health information and ensure the continuity of • Cybersecurity Firms: These attacks can lead to
healthcare services. Here's a comprehensive overview of the increased demand for cybersecurity services, as
cybersecurity threats in these sectors, focusing on devices like healthcare organizations seek to bolster their defenses
pacemakers, smart infusion pumps, MRI machines, and the against future incidents.
broader implications for medical technology and • Patients and the Public: Ultimately, the public is
communication protocols. affected as patients may experience compromised care,
privacy breaches, and a loss of confidence in the
The security of digital technologies in the healthcare and healthcare system.
public health sector is paramount for protecting patient safety,
privacy, and the integrity of medical services. Healthcare III. GENERAL VULNERABILITIES AND THREATS
organizations must adopt a comprehensive approach to data The healthcare and public health sector is increasingly reliant
security, network security, and device security, implementing on digital technologies for managing patient information,
encryption, secure communication protocols, and robust medical procedures, and communication. This digital
network and device security measures. Compliance with HIPAA transformation, while beneficial, introduces significant security
regulations and adherence to best practices and standards, such risks, including data breaches, unauthorized access, and
as those provided by CISA, HHS, and DICOM, are essential for cyberattacks, which can compromise patient safety, privacy, and
mitigating cyber threats and ensuring the secure use of digital the integrity of medical services
technologies in healthcare
Common cyber threats to medical technology and
II. INDUSTRIES communication technology protocols include disruption,
degradation, and destruction of devices, data poisoning, theft of
Cyber attacks on medical technology can affect a wide
personal and proprietary data, and unauthorized access to
range of industries beyond the immediate healthcare sector. The
medical software. These threats are exacerbated by the
ripple effects of a cyber attack on medical technology can
expansion of the interoperable IT/OT environment in healthcare,
extend far beyond the immediate healthcare sector, impacting a
the use of artificial intelligence (AI) and machine learning (ML)-
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enabled medical devices, and the increasing reliance on wireless IV. ADDRESSING RISKS
connectivity, including 5G. Addressing these risks requires a comprehensive approach to
Medical devices, such as pacemakers, smart infusion pumps, data security, network security, and device security.
and MRI machines, may be vulnerable to cyber incidents due to
A. Data Security
lack of data encryption protocols, poor network segmentation,
and unpatched vulnerabilities. Additionally, medical software, Data security in healthcare involves protecting sensitive
such as DICOM and PACS, may lack proper input validation, patient information from unauthorized access, disclosure, and
transmit data in cleartext, and use poor cryptographic theft. The Health Insurance Portability and Accountability Act
algorithms, making them susceptible to unauthorized access and (HIPAA) sets the standard for protecting patient data, requiring
data modification. encryption of electronic Protected Health Information (ePHI),
unique user identification, and audit trails to monitor access and
A. Smart Infusion Pumps: usage of PHI. Encryption is a critical technology for securing
These devices connect to hospital internal networks via Wi- data during transfer, use, and storage, ensuring that data is
Fi or Ethernet and transmit status, alerts, and alarms to central unreadable to unauthorized individuals. Additionally, the
monitoring/control stations, as well as transfer data to Electronic adoption of secure communication protocols, such as those
Health Records (EHR). outlined by DICOM for medical data transfer, is essential for
maintaining the confidentiality and integrity of patient
B. MRI Machines: information.
MRI machines may be connected to the hospital's internal
network, and scans can be encoded and sent to Picture Archiving B. Network Security
and Communication System (PACS) software via Digital Network security in the healthcare sector involves protecting
Imaging and Communications in Medicine (DICOM). PACS the infrastructure that supports the transmission and storage of
images may be stored locally and made available on web-based medical data. This includes securing wireless networks,
EHR, potentially allowing unauthorized access to clinicians on implementing firewalls, and using virtual private networks
network devices, including computers. (VPNs) to encrypt data in transit. The Cybersecurity and
Infrastructure Security Agency (CISA) provides resources and
C. Pacemakers: best practices for strengthening network defenses and mitigating
Pacemakers and other cardiac implantable electronic devices cyber threats. Healthcare organizations must also ensure that
(CIEDs) have evolved to include wireless connectivity for their network security measures comply with HIPAA
monitoring and programming. This connectivity, while regulations and other relevant standards.
beneficial for patient care, introduces vulnerabilities.
Cyberattacks could potentially lead to device malfunction or C. Device Security
unauthorized access to patient data, posing significant risks to Device security focuses on protecting medical devices and
patient health mobile devices used in healthcare settings from cyber threats.
This includes implementing strong authentication mechanisms,
D. IoT Devices: encrypting data stored on devices, and regularly updating device
Many IoT devices in healthcare lack robust security controls, software to address security vulnerabilities. The increasing use
making them susceptible to unauthorized access and data of Internet of Medical Things (IoMT) devices introduces
breaches. This includes issues with data encryption, cleartext additional security challenges, requiring healthcare
data transmission, and insecure storage of passwords. organizations to adopt comprehensive security measures to
protect these devices from hacking and unauthorized access
E. Third-Party Vendors:
Devices and software provided by third-party vendors can V. ATTACK CONSEQUENCES
introduce vulnerabilities into healthcare networks, offering a The consequences of a Cyber attack on medical technology
backdoor for cyberattacks. can be severe and wide-ranging, affecting patients, healthcare
F. Medical Software: organizations, and medical device manufacturers.
Software like DICOM and PACS may lack proper input • Compromised patient safety: Cyber attacks on
validation and use insecure communication protocols, medical devices, such as pacemakers, smart infusion
increasing the risk of unauthorized access and data pumps, or MRI machines, can lead to disruption,
manipulation. degradation, or destruction of these devices, potentially
endangering patient health and even lives.
G. Radio Frequency (RF) Interference:
• Loss of sensitive data: Hackers may steal or expose
RF interference can disrupt device communication, leading sensitive patient data, including personal information,
to data loss or misinterpretation, which can have direct treatment records, and financial statements, leading to
implications on patient care. privacy breaches and potential identity theft.
H. 5G Connectivity: • Financial and legal penalties: Healthcare
The adoption of 5G technology in healthcare introduces new organizations may face significant fines, legal
vulnerabilities through expanded attack surfaces and potential consequences, and sanctions for failing to secure patient
supply chain risks. data properly and comply with regulations like HIPAA.
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• Reputational damage: Cyber attacks can erode patient • Disruption of Healthcare Services: MRI machines are
trust and damage the reputation of healthcare crucial for diagnosing and monitoring various
organizations and medical device manufacturers, which conditions. A Cyber attack could disable these
can be difficult to recover from. machines, causing delays in diagnosis and treatment. In
critical situations, even small delays can have severe
• Operational disruptions: Cyber incidents can cause consequences for patient health.
prolonged IT or production failures, paralyzing critical
healthcare services and threatening the existence of • Ransomware Attacks: MRI machines, like other
affected organizations. medical devices, are vulnerable to ransomware attacks.
Such attacks could block access to the machines or
• Hindered innovation: The persistent threat of Cyber encrypt the images, demanding a ransom to restore
attacks may limit the adoption of new technologies and access. This not only disrupts healthcare services but
slow down innovation in the healthcare sector also puts patient data at risk.
A. Smart Infusion Pumps • Exposure of Sensitive Data: MRI machines are
The consequences of a Cyber attack on smart infusion pumps connected to hospital networks, making them potential
can be severe and potentially life-threatening. Smart infusion entry points for attackers to access and steal sensitive
pumps are network-connected devices that deliver medications patient data, including personal and health information.
and fluids to patients, and they are commonly used in hospitals This breach of privacy can have legal and financial
and clinics. According to a study by Palo Alto Networks' Unit implications for healthcare providers.
42 threat research service, 75% of infusion pumps have • Operational and Financial Impact: Recovering from
cybersecurity flaws, putting them at increased risk of being a Cyber attack on MRI machines can be costly and time-
compromised by hackers consuming. Healthcare providers may need to replace or
These cybersecurity flaws can lead to various consequences, repair compromised devices, and face potential legal
including: penalties and loss of trust from patients.

• Unauthorized access: Hackers can gain unauthorized • Regulatory Challenges: Strict regulations make it
access to infusion pumps, potentially allowing them to difficult to conduct basic updates on medical PCs
change how the pump delivers intravenous medications. connected to MRI machines, complicating efforts to
This can result in patients receiving incorrect dosages, protect against Cyber attacks. The slow development
which can be harmful or even fatal. process of medical imaging devices also leaves them
vulnerable to evolving cyber threats
• Interception of unencrypted communications: Some
infusion pumps transmit unencrypted communications, C. Pacemakers
which can be intercepted by hackers. This can lead to The consequences of a Cyber attack on pacemakers can be
the exposure of sensitive patient data, such as medical severe and potentially life-threatening. Cybersecurity
records and personal information. vulnerabilities in pacemakers were first exposed by hackers in
2011, and since then, various security flaws have been
• Exploitation of known vulnerabilities: Infusion
discovered. In 2017, the US Food and Drug Administration
pumps may have known security gaps, such as leaving
usernames and passwords unchanged from the device's (FDA) recalled an implantable pacemaker due to concerns that
default factory settings. These vulnerabilities can be it could be hacked
easily exploited by hackers, potentially putting patients Potential consequences of a on pacemakers include:
at risk or exposing private data.
• Direct Threat to Patient Life: can lead to life-
• Disruption of services: disrupt healthcare services, threatening situations. Attackers could potentially take
leading to software outages, loss of access to health control of the device, altering pacing functions or
records, and inability to provide appropriate care. In delivering inappropriate electrical shocks, which could
extreme cases, healthcare facilities may be forced to result in severe health complications or even death.
divert patients to other medical centers or cancel
surgeries. • Battery Drainage: Certain types of attacks, such as
those involving the continuous sending of commands to
B. MIR Machines the pacemaker, could lead to rapid battery depletion.
The consequences of a Cyber attack on MRI machines are This would necessitate an early surgical intervention to
multifaceted and can significantly impact patient safety, data replace the device, posing additional health risks to the
integrity, and healthcare operations. patient.
• Patient Safety Risks: Cyber attacks can lead to the • Unauthorized Access to Personal and Medical Data:
manipulation of MRI images, potentially resulting in Pacemakers can store and transmit data regarding
incorrect diagnoses. For instance, attackers could alter patient health and device performance. Cyber attacks
images to either remove a tumor or erroneously add one, could compromise the confidentiality of this data,
leading to misdiagnosis and inappropriate treatment, leading to privacy breaches and potential misuse of
which could be fatal. personal information.
• Loss of Confidence in Medical Devices: Widespread
knowledge of vulnerabilities and successful attacks
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could erode public trust in pacemakers and other device providers, and supply chain vendors. These
medical devices. This loss of confidence could deter consequences include:
patients from opting for potentially life-saving
treatments • Data Breach: Third-party vendors often have access to
sensitive data. If a third-party vendor is hacked, this data
D. Medical IoTs could be compromised, leading to unauthorized access
Cyber attacks on IoT medical devices can have severe to patient information and financial data.
consequences for patient care, including loss of life. The primary • Malware Infections: If a third-party vendor's system is
target for cyber attackers are Internet of Things (IoT) and infected with malware, it could spread to your
Internet of Medical Things (IoMT) devices, which were the root organization's system through the vendor.
cause for 21% of all ransomware attacks in the healthcare
industry. The top-10 bedside devices that pose the greatest • Ransomware Attacks: Many ransomware attacks
security risks include infusion pumps, VoIP devices, ultrasound occur through third-party vendors. If these vendors lack
machines, patient monitors, and medicine dispensers. robust security and cyber defense measures, they can
become an entry point for ransomware attacks.
• Patient Safety Risks: can directly threaten patient lives
by compromising the functionality of medical IoT • Distributed Denial of Services (DDoS) Attacks: Your
devices such as pacemakers, insulin pumps, and organization could be targeted by DDoS attacks through
ventilators. For example, attackers could alter device third-party vendor systems.
settings or functionality, leading to inappropriate • Compliance Failures: Third-party vendors may not
treatment or device failure. always comply with the same regulations as the
• Data Breaches: IoT medical devices often collect and organizations they work with. This could lead to
transmit sensitive patient data. Cyber attacks can lead to compliance failures for the organizations.
unauthorized access to this data, resulting in privacy • Reputation Damage: If a third-party vendor is hacked,
violations, identity theft, and potential misuse of it could damage the reputation of the organizations they
personal health information. work with.
• Operational Disruptions: can disrupt healthcare • Impact on Medical Devices: Cyber attacks on third-
operations by disabling medical devices, leading to party vendors can potentially affect medical devices
delays in diagnosis, treatment, and care delivery. This such as CT and MRI machines, which are commonly
can have cascading effects on patient flow and hospital connected to hospital networks. Vulnerabilities in
capacity. outdated firmware can be exploited by cyber attackers,
• Financial Costs: The aftermath of a can impose disrupting digital patient records and potentially
significant financial burdens on healthcare jeopardizing patients' health
organizations, including costs associated with device F. Medical Software
replacement or repair, data breach response, increased
insurance premiums, and potential legal liabilities. The consequences of a cyber attack on medical software are
significant and multifaceted, impacting not only the healthcare
• Loss of Trust: can erode trust between patients and organizations but also the patients they serve. The consequences
healthcare providers. Patients may become hesitant to of a cyber attack on medical software extend beyond immediate
use certain medical devices or share their data, fearing financial losses, posing serious risks to patient safety, data
privacy breaches and questioning the reliability of their integrity, and the overall effectiveness of healthcare delivery. It
care. underscores the importance of prioritizing cybersecurity
• Regulatory and Legal Implications: Healthcare measures to protect sensitive health information and ensure the
organizations may face regulatory penalties for failing continuity and quality of care
to protect patient data and ensure the security of medical • Data Breaches: can lead to unauthorized access to
devices. Legal actions could also arise from affected sensitive patient data, including personal and financial
patients or regulatory bodies. information, medical records, and treatment histories.
• National Security Threats: In the context of defense This compromises patient privacy and can result in
and military operations, compromised IoT devices could identity theft and financial fraud.
reveal sensitive information, posing national security • Financial and Legal Penalties: Healthcare
risks. Third-Party Vendors organizations may face substantial financial losses due
E. Third-party vendors to fines and legal penalties for failing to protect patient
data adequately. The costs associated with responding to
Cyber attacks on third-party vendors in the medical sector a breach, such as notification expenses and credit
can have severe consequences for both the healthcare monitoring services for affected individuals
organizations and the patients they serve. These attacks pose one
of the biggest challenges on the healthcare cyber-risk landscape, • Patient Safety Concerns: can disrupt healthcare
with hospitals and health systems at increasing risk of services and compromise patient safety. For example,
cyberattacks on third parties such as business associates, medical tampering with medical records or diagnostic software
could lead to incorrect diagnoses, inappropriate
treatments, or delays in care.
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• Damage to Patient Trust and Reputation: erode trust healthcare system as a whole, potentially leading to a
between patients and healthcare providers. Patients may reluctance to use such devices or seek medical care.
lose confidence in an organization's ability to protect
their data and provide safe care, damaging the H. 5G Connectivity
organization's reputation and potentially leading to a The consequences on 5G connectivity in the medical field
loss of business. can be substantial, given the critical role of 5G in enhancing
communication and data transfer within healthcare systems:
• Loss of Productivity: can disrupt healthcare operations,
leading to delays in procedures and tests, longer patient • Increased Attack Surfaces: The expansion of 5G
stays, and overall reduced efficiency. This can strain networks increases the number of potential entry points
healthcare resources and negatively impact patient care. for cyber attackers, making it more challenging to secure
the network against unauthorized access and data
• Increased Mortality Rates: In some cases, cyber breaches.
attacks have been linked to increased patient mortality
rates. Delays in procedures, tests, and the provision of • Vulnerabilities in IoT Devices: medical devices are
care due to cyber incidents can have dire consequences part of the Internet of Medical Things (IoMT) and rely
for patient outcomes. on 5G for connectivity. These devices may have
inherent security weaknesses that can be exploited,
• Compromised Value-Based Models: can undermine leading to compromised patient data and device
the efforts of healthcare organizations to deliver value- functionality.
based care by compromising the quality and integrity of
data, which is crucial for making informed decisions • GPRS Tunneling Protocol Risks: The use of GPRS
about patient care. tunneling protocols in 5G networks can introduce
security vulnerabilities, potentially allowing attackers to
• Limited Innovation: Persistent and large-scale cyber intercept and manipulate transmitted data.
attacks can stifle innovation within the healthcare sector.
Concerns about cybersecurity may deter organizations • Legacy Network Connections: 5G networks connected
from adopting new technologies that could improve to legacy systems may inherit existing vulnerabilities,
patient care and operational efficiency. providing cyber attackers with opportunities to exploit
these weaknesses and gain access to sensitive medical
G. Radio Frequency (RF) Interference medical data and systems.
The consequences on Radio Frequency (RF) Interference in
the medical field can be severe, as it can compromise the • Increased Bandwidth Challenges: The higher
functionality and security of medical devices that rely on RF bandwidth of 5G networks can strain current security
communication. monitoring capabilities, making it more difficult to
detect and respond to threats in real-time.
• Interference with Device Functionality: can disrupt
the normal operation of medical devices, potentially • Network Function Virtualization: The reliance on
leading to incorrect readings or malfunctions. This can software and virtualization in 5G networks introduces
have serious consequences for patient care, especially in new security challenges, as each virtual component
critical situations where accurate measurements and needs to be monitored and secured to prevent potential
device performance are essential. breaches.

• Data Breaches: RF interference can potentially be • IMSI Encryption Weaknesses: Weaknesses in IMSI
exploited to gain unauthorized access to sensitive patient encryption can lead to vulnerabilities in subscriber
data transmitted through RF communication channels. identity confidentiality, potentially allowing man-in-
This can lead to data breaches, exposing personal and the-middle attacks and unauthorized tracking of devices.
medical information, and potentially compromising • Botnet and DDoS Attacks: The increased number of
patient privacy. connected devices in a 5G network can be leveraged by
• Device Tampering: could potentially manipulate RF attackers to create botnets or launch distributed denial-
signals to send unauthorized commands to medical of-service (DDoS) attacks, which can disrupt medical
devices, such as pacemakers or insulin pumps, services and data availability.
potentially causing harm to patients. This can include • Disruption of Critical Healthcare Services: Cyber
altering device settings, administering incorrect attacks on 5G networks can disrupt the communication
dosages, or even shutting down devices entirely. between medical devices and healthcare providers,
• Denial of Service: can cause devices to become leading to delays in critical care and potentially
unresponsive or malfunction, leading to a denial of endangering patient lives.
service. This can disrupt patient care and potentially put • Regulatory and Compliance Implications: Healthcare
patients at risk, especially in situations where immediate organizations may face regulatory scrutiny and penalties
medical attention is required. if they fail to protect patient data and ensure the security
• Loss of Trust: Successful attacks on RF interference of their 5G-enabled medical devices and services
can erode public trust in medical devices and the