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HIPAA Covered Entities Urged to Address Spectre and Meltdown Chip Vulnerabilities

The Office for Civil Rights has sent an email update on the Spectre and Meltdown chip vulnerabilities, urging HIPAA-covered entities to mitigate the vulnerabilities as part of their risk management processes. The failure to address the computer chip flaws could place the confidentiality, integrity, and availability of protected health information at risk.

HIPAA-covered entities have been advised to read the latest updates on the Spectre and Meltdown chip vulnerabilities issued by the Healthcare Cybersecurity and Communications Integration Center (HCCIC).

What are Spectre and Meltdown?

Spectre and Meltdown are computer chip vulnerabilities present in virtually all computer processors manufactured in the past 10 years. The vulnerabilities could potentially be exploited by malicious actors to bypass data access protections and obtain sensitive data, including passwords and protected health information.

Meltdown is an attack that exploits a hardware vulnerability (CVE-2017-5754) by tricking the CPU into speculatively loading data marked as unreadable or “privileged,” allowing side-channel exfiltration. Spectre is an attack involving two vulnerabilities (CVE-2017- 5753, CVE-2017-5715) in the speculative execution features of CPUs. The first vulnerability is exploited to trick the CPU into mispredicting a branch of code of the attacker’s choosing, with the second used to trick the CPU into speculatively loading the memory allocated to another application on the system. The Meltdown and Spectre chip vulnerabilities can be exploited to gain access to sensitive data, including passwords, cryptographic keys used to protect PII, PHI, or PCI information handled by an application’s database.

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Meltdown and Spectre affect computers running on Windows, Mac, Linux and other operating systems. Eradicating the vulnerabilities means replacing chips on all vulnerable devices; however, operating system vendors have been developing patches that will prevent the vulnerabilities from being exploited. Updates have also been made to web browsers to prevent web-based exploitation of the vulnerabilities.

Following the disclosure of the vulnerabilities, HCCIC alerted healthcare organizations about the risk of attack, with the vulnerabilities categorized as a medium threat since local access is generally required to exploit the flaws. However, potentially the flaws can be exploited remotely if users visit a specially crafted website. Browsers are susceptible due to improper checks on JavaScript code, which could lead to information disclosure of browser data.

Mitigating the Threat of Spectre and Meltdown Attacks

Patching operating systems and browsers will mitigate the vulnerabilities, but there may be a cost. The patches can affect system performance, slowing computers by 5-30%. Such a reduction would be noticeable when running high demand computer applications.

There have also been several compatibility issues with anti-virus software and other programs. It is therefore essential for patches to be thoroughly tested before implementation, especially on high value assets and systems containing PII and PHI.

Due to the compatibility issues, Microsoft is only releasing updates for computers that are running anti-virus software that has been confirmed as compatible with the patch. If anti-virus software is not updated, computers will remain vulnerable as the update will not take place. Most anti-virus software companies have now updated their programs, but not all. Kevin Beaumont is maintaining a list of the patch status of AV software.

Web browsers must also be updated to the latest versions. Microsoft has updated Internet Explorer 11 and Microsoft Edge, and Firefox (57.0.4) and Safari (11.0.2) include the update. Google Chrome has also been patched. Healthcare organizations should ensure they are running the latest versions of browsers on all devices to prevent data leakage and operating systems should be patches as soon as possible. One of the main challenges for healthcare organizations is identifying all vulnerable devices – including computers, medical devices and accessory medical equipment – and ensuring they are fully patched.

The vulnerabilities also affect cloud service providers, as their servers also contain computer chips. There could be leakage of PII and PHI from cloud environments if patches have not been applied.

Amazon AWS and Azure have already been patched to protect against Meltdown and Spectre. Healthcare organizations using other managed cloud service providers or private cloud instances should check that they have been patched and are protected against Meltdown and Spectre.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.