
Fed-Up Hospitals Defy Windows Patching Rules 705
bingbong writes "According to Network World: 'Amid growing worries that Windows-based medical systems will
endanger patients if Microsoft-issued
security patches are not applied, hospitals
are rebelling against restrictions from device manufacturers that have
delayed or prevented such updates. Device makers such as GE Medical Systems,
Philips Medical Systems and Agfa say it typically takes months to test Microsoft patches because they could break the medical systems to which they're applied. In some instances, vendors won't authorize patch updates at all.' This is the typical patch vs. crash problem. Unfortunately, the stakes here could be human lives."
Stop playing solitaire on my dialysis machine (Score:5, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
I'm a rabid Linux user, but if I were designing equipment that held human lives in its anthropomorphic hands, I'd build it as an entirely atomic OS built from Linux or a BSD variant. And communications would be data-only, over a serial port. No network.
In high school, a nurse from St Mary's (here in Grand Rapids, MI) was showing us screenshots of their radiation therapy machine. I recognized CDE...she didn't know what version of UNIX it ran, though.
Re:Stop playing solitaire on my dialysis machine (Score:5, Informative)
Uh, no. Do you work in the health care industry? I do as a software developer for a vendor. Don't throw the blame on us. We actually changed to Windows off of other systems because hospitals started putting PCs with Windows into their various departments. The backend for the software I work on actually runs in Unix, and we have hospitals that are thinking of going to NT only, which means we have to try to port our code to it or loose that customer.
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
um, no. ALL of the blame rests on the software developer. If you all weren't so goddamn lazy and quick to grab dollars at the expense of careful design and reliable architecture, you wouldn't be using windows at all.
The backend for the software I work on actually runs in Unix, and we have hospitals that are thinking of going to NT only [...]
When you get back to 1997, would you call me and tell me to invest in eBay
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
I am a clinical doctor who programs in a couple of dozen languages and environments and follow the advancement in software solutions closely. I have been involved with clinical informatics only recently for the past couple of years though. Allow me to explain you some of the realities of the current health industry software. I admit I haven't sat down and structured the text well but I tried to put in as many issues as I could think of the moment.
The doctors want Windows or Macs. They want a familiar set up compared to what they use at home. It is very difficult to get doctors learn a completely different paradigm. There have been documented cases where nearly all the doctors in certain institutions rose up in arms because the developers thought they knew better and tried to force a solution onto them.
Most of the current set ups are almost always heterogeneous. We buy software from multiple vendors and bridge them together. This is because there are no completely integrated solutions as yet. GE and a few others are trying to close this gap but it is a VERY difficult one. Hospital information needs are not standard as your usual business information needs. The data processing here is often very simple but the volume and complexity of the data is overwhelming. It is not simple as Customers and Invoices. Clinical Medicine deals a lot with relatively abstract data with complex relationships. Most doctors know these relationships intuitively but there isn't enough published literature for a software developer to draw from. Clinical software is extremely expensive to build since the requirements are hard to establish. A lot of iterations are needed to fit the software to a given practice (This never gets completed usually and people settle for close enough).
Doctors themselves understand their needs best. A few doctors, while they don't hold CS degrees, practice design patterns or do EJB, do quite well to put together MS Access databases to solve their problems where professional software developers have not yet tread. Many times, they distribute these to their colleagues freely (Open Source if you will). Few even sell them. They may not be the best designed tools but they work. Mac's FileMaker and Linux's Total Rekall? don't exactly come close. Windows tools also have a larger number of books available to learn from.
Platform and tool costs are trivial, developer costs are not. A study in Human Computer Interactions is very essential here. Rich user interfaces are always preferred. Non-windows platforms don't have sufficiently advanced RAD tools. I really wanted Kylix to succeed. But I don't see any momentum behind it anymore. Veteran's Affairs Hospitals have built a remarkably physician friendly system. They are rightly proud of their constantly iterative development. They used Delphi but now that the system is stable (for user experience stand point) they are looking for other platforms. They looked at
The loss of work hours because the software does not fit the workflow at a given hospital is far far greater than losses due to worms and viruses.
The software should be as intuitive to use as possible. Should not require reading manuals. Hospitals always look whether the given software will slow the physician down in any way because physician time is very expensive and they rather have them seeing patients and generating revenue.
There is a case for cross-platform tools at the moment too. It is a case of mobility. Most doctors like to be able to review a patient's case online and advice on the phone when necessary. Many vendors provide web pages and applets for this but they often end up very unergonomic. But since the need is often information retrieval rather than data entry, they are accepted in the absence of the better alt
Separation of Concerns considered harmful ;-) (Score:3, Interesting)
Personally, I don't think the issue
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
I work for a GPO [greyhouse.com]. It's my job to write contracts for health care companies. It's a staggeringly boring occupation, but I do get to spend a lot of time thinking about what would happen if someone died because of a failure in a piece of equipment bought through one of my contracts.*
I see a lot of EULA-style documents. You might be surprised how many software companies have simply taken the EULA from Windows98 and adopted it as their own license agreement. You might also be surprised how many suppliers are willing to offer code escrow or source code access to customers. I've certainly seen some things I never would have expected.
But you know what surprises me the most? That some vendors don't seem to care that their slipshod implementation could result in harm to a patient. For example, I recently spoke with a sales rep from a large point-of-care software vendor. He was very very excited to tell me all about the features his web-enabled software offered, like giving me REALTIME! ACCESS! TO! PATIENT! DIAGNOSTICS! but when I asked him about security, his answer was "well, that's the customer's responsibility." The base functionality required for this app is to take a bunch of data from a handheld device over serial port, dump it into a networked database, and then provide reports from that database into a web frontend for multiple users, with a user administration tool tacked on as an afterthought. What did his application run on? IIS, and it requires IE on the client desktop. Do they SSL-encrypt traffic on the network? Of course not. Do they send patient name and ID number in cleartext along with their REALTIME!!! test results? Well, the data wouldn't be much good if you don't know who it belongs to, now would it?
tinfoil-hat concerns aside, healthcare organizations are now required to comply with HIPAA [hhs.gov], and if they fail to do so, people can go to jail [electroniclaim.com]. If the blood lab at one of my customers' hospitals buys this software, and someone is able to plug a laptop into their network and intercept data sent by their crappy IIS application, that's a clear HIPAA breach - but who is responsible for it? It's my job to make sure my customers aren't going to federal prison as a result of a poorly informed software purchase... you can bet that they're not buying the software.
see, you assume that the customer is always right. In fact, the customer is often wrong, either because they are ignorant, or because they are receiving some kind of incentive (read: bribe) from at least one vendor in order to influence their decisions. When you use Windows in healthcare, the "customer is always right" attitude could land your customer in federal prison.
*(what happens? Somebody gets sued. Usually, the dead patient's family sues the doctor and/or the hospital, and potentially the vendor, and also potentially my company. If the contract is written well, the vendor is obligated to step in and indemnify the doctor, our customer, and us against any claims. The funny thing is that vendors running on windows are NEVER NEVER NEVER willing to volunteer this indemnification- I always have to fight for it, and sometimes we just can't get it. If there's an alternative vendor who will indemnify, they usually end up winning the business, because this is such an important concern for the health care providers...)
Customers demanding Windows-based solutions (Score:3, Informative)
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
Or go bankrupt because we have no customers, because we don't use Windows. Besides, if our software crashes on one particular workstation (or all for that matter), I don't think anyone will die.
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
There are a ton of good OSes out there for specialty applications and, surprise!, most of them don't involve Linux! Linux is not the be-all and end-all of OSes.
For human-life-critical applications, you should be using something that is demonstrably proven.
Re:Stop playing solitaire on my dialysis machine (Score:3, Interesting)
This whole thing reminds me of when I worked for a small engineering firm that was developing a new device for the blood product industry. They wanted to migrate away from the tried and trust analog systems to digit. The CPUs available at the time were 8080A, 6800 and COPS. They decided to hire two "experts" and use the COPS devices.
The "experts" developed a system that met the decided functionality. But, regardless of what they
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
This happened to me in a hospital:
I was admitted for severe breathing difficulties and chest pain. This put me on the heart attack route. Turned out to be a rare form of asthma. While I set in a bed on oxygen, I looked up to watch my heart monitor flat-line. The crash cart crew runs in with all the resucitation equipment and my heart monitor starts beating again. They give me weird looks and examine me up an down to see that I'm doing great on the oxygen. This happens a second time. About 10 minutes later the hospital IS staff show up and examine it, and he says, "Aha, yours is set on the network to show the guy next door."
He leaves and I hear the crash cart go whizzing by my door.
Networked critical care systems are a bad idea--except to report a central monitoring station. Windows is an even worse idea. Why this kind of crap is tolerated is beyond me.
ShawnComment removed (Score:5, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
Another example, is the IV pumps, most of these run windows2k, But, I've worked on a couple that run CE a small problem here, can do one of multiple things...increase drug flow, decrease drug flow, or stop drug flow, none of these are good...oh we gave him
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
This was posted to
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
Re:Stop playing solitaire on my dialysis machine (Score:4, Insightful)
If it crashes, how do you know if the radiation dose was administered or not? Was it the whole dose? was it just part of the dose? Did the machine even turn off?
Those are awfully important questions for the doctors and radiation techs. Even moreso for the cancer patient that has to go through a battery of tests to determine the effect of a software glitch.
Re:Stop playing solitaire on my dialysis machine (Score:5, Informative)
So, yes, these machines -- and, specifically, radiation therapy machines that crash -- can kill.
Re:Stop playing solitaire on my dialysis machine (Score:3, Informative)
There is always an operator operating these machines, hence if the control machine (running win2k) was to go crazy, I hope the operator would shut down the actual radiation machine.
What you are describing is something else: The machine would act normally, but would deliver the wrong dosage.
These are different problems.
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:4, Insightful)
Very honestly, most of these machines couldn't "kill omeone".
Hmm, a pain pump that doesn't correctly meter the morphine could easily kill someone.
I mean, if the radiation therapy machine crashes, nobody dies.
Wow, you mean if the control computer crashes leaving the shutter to the Cobalt source open nobody could die? How about gamma knife overexposing the brain stem, cooking the brain stem couldn't possibly kill someone. How about a faulty homing cycle where the radiation head homes to the patient table, even if a patient is there.
Do me a favor, don't work on human critical systems.
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:4, Insightful)
What do you expect the operator to see? Radiation is invisible; you could easily not tell if the machine was still spitting out radiation or not. You can also overload on radiation quickly; by the time the operator notices what's going on, it may be too late.
Just as importantly, there should always be multiple lines of protection. Trusting the operator to handle the problems when the machine screws up is a bad thing; the operator may have stepped out for a smoke break, be thinking about her golf game, or have a stroke. It may be one in a million, but with half a million people needing four or five sessions every year, that's several needless deaths a year.
Re:Stop playing solitaire on my dialysis machine (Score:3, Funny)
Re:Stop playing solitaire on my dialysis machine (Score:4, Funny)
Have you ever used a phone modem ? Not one of those new ADSL things or Cable modems, but the kind that works just like any phone ?
No ? Well, listen now, newbie. When I was young we used those phone modems - we called them just modems, because there was no other kind available - to connect to the Internet and BBS's. We used Web browsers and e-mail programs and Usenet News readers (what's Usenet ? I'll tell you when you've started growing beard, for that's not a story for gentle newbie ears), and all the data went over the modem. And - here comes the important part - guess where we plugged those modems in our computers ? To serial ports.
So, newbie, now you know - Web browsers work perfectly well over serial ports, as long as you have the IP protocol configured properly for that - oh, did I confuse you with big words ? I'm sorry, newbie, I didn't realize that you're still this wet behind the ears. Off you go now, to play with other little wannabe trolls.
What was that ? You asked what a BBS is ? Well... It's a little like Slashdot, but it has smarter trolls. Sigh... The glory days... I remember fighting all those trolls, and they weren't these pitifull GNAA degenerates, but big, strong and fast with sharp wits. Yes, I remember what it was like to fight just one step from defeat... The troll and me, circling each other, searching for weakness, and then that terrible wit would slash at me and my own would turn the attack aside, and then the battle was in full swing... These days all I do is drink Pepsi and splat ACs like you, who don't even show me their name... In the old days trolls didn't hide behind namelessness, but came forward, proud of being what they were... Not these Anonymous Cowards, but opponents you could actually respect, who made you feel more alive than ever before, who made your blood boil in your veins as you rose to the challenge, and who fought to the bitter end and not just hit and run like the pathetic trollings of these days... Ah, the feeling as forum after forum was set aflame by the troll horde, and how we would fight a desperate war to subdue them...
Where did the glory days go ? When did I start needing 85 Hz refresh rate to be comfortable ? I used to stare at 60 Hz for 12 hours straight ! And when did my fingers start slowing ? When did my feet start to complain after 6 hours of sitting down ? When did my ears start demanding an mp3 player and Soundblaster Live ? I used to be fine with Cubic Player and ripped Star Control 2 tunes - where was even a time when I was fine with the gentle sound of the PC inbuilt speaker ! Why... How... When did I get old ?
Re:Stop playing solitaire on my dialysis machine (Score:4, Interesting)
Re:Stop playing solitaire on my dialysis machine (Score:3, Interesting)
That's fine with me too. The potted plants aren't human lives.
If you kill the plants through your cost-saving measures nobody is left without a mother, father, sister, brother, friend, or spouse. Nobody cares about the plants all that much. But human lives are different. So to hell with the plants, fine with me--but I sure as hell care about the patients.
By comparing the two, you are implying
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
Health care is
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
Re: (Score:3, Interesting)
Re:Stop playing solitaire on my dialysis machine (Score:4, Informative)
I heard of a hospital that bought some Systemax PCs (I'm still nursing the same model). These POS PCs had a tendancy to have a network failure every few weeks that required unplugging the power cable and the network cable to bring the PC back onto the network.
After this was realized, the hospital went nuts, and demanded (and got) new PCs. But this is the kind of crap hospitals, just like everyone else, have to put up with.
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
One thing of interest in that article is how the Microsoft exec specifically states the EULA of the SP and not the original EULA. This would be fine as long as the SP EULA states that it replaces completely the original EULA the user has been operating under and I don't know that it doesn't.
I do know of quite a few people who refuse to upgrade to WinXP because of the EULA and the fact that Microsoft can legally update anything on the OS without the user/admin/etc knowing should be cause to exclude them from any financial, healthcare, public service
Sure seems like all of these businesses would be on the high road to replace MS Windows ASAP with something they can have more control over...
LoB
Re:Stop playing solitaire on my dialysis machine (Score:5, Informative)
Dude, you have no idea what an unverified binary does. You don't. Period. End of story.
I'm all for cutting through bullshit, but don't provide your own. Go read a book or take a class on basic security before you spout off.
Re:Stop playing solitaire on my dialysis machine (Score:5, Informative)
to quote:
The text of the Microsoft EULA from Windows XP Service Pack 1 and 2000 Service Pack 3 reveals the offending material:
By using these features, you explicitly authorize Microsoft or its designated agent to access and utilize the necessary information for updating purposes. Microsoft may use this information solely to improve our products or to provide customized services or technologies to you. Microsoft may disclose this information to others, but not in a form that personally identifies you.
The OS Product or OS Components contain components that enable and facilitate the use of certain Internet-based services. You acknowledge and agree that Microsoft may automatically check the version of the OS Product and/or its components that you are utilizing and may provide upgrades or fixes to the OS Product that will be automatically downloaded to your computer.
In short, this agreement gives Microsoft permission to scan your hard drive for information, "fix" security holes or other bugs via updates to your system, and while the company is there, it would effectively have access to other data on the system, which is where the conflict comes in. Better yet, the company can even let "designated agents" do this, an even more nebulous term that leaves Windows users with even less control over who is accessing their system, and what they might do when there. All of this occurs without the user's permission.
Remember, these are the same people who faked a presentation in front of a Federal Justice and told him over and over it was fact....
IMHO, the EULA parts that I've seen are so vague Microsoft could collect anything they want without worrying about legal action against them. After all, they are masters of vague verbiage in license agreements, are they not?
LoB
Comment removed (Score:4, Insightful)
Re:Stop playing solitaire on my dialysis machine (Score:5, Insightful)
Sounds like a tech-challenged reporter reporting wide-eyed about crashing "medical devices" which she doesn't really understand.
get back to native inline machine code, dammit (Score:3, Insightful)
bas
Re:Stop playing solitaire on my dialysis machine (Score:5, Interesting)
Hospital hardware surely does run embedded systems. However, most parts of the hospital are probably kiosks running a web-based app that controls bed management, scheduling, the financial parts, etc.
They are running windows for the same reason they are using IBM Websphere for the app server instead of Apache Tomcat: liability. What happens when a patient dies because of a server crash? Who do you blame? Oh, we'll blame Microsoft or IBM for our own bugs. You don't have that luxury if you're using Tomcat and Linux. Yes, it's dirty, sleazy and nasty, but I have no control over it.
Re:Stop playing solitaire on my dialysis machine (Score:3)
Oh, boy, are you in for a suprise! Have you ever read a EULA? Microsoft and IBM would probably piss their pants laughing if you try to pin a liability suit on them.
You are trying to make a case that commercial software is more "credible" than OSS software, but you are leaving out the fact that you and your peers are the ones making the liable choices, not any of your vendors. So, a server crashes due to a Windows QA problem? Tough, you chose Windows. The same goes for OSS or any sof
Re:Stop playing solitaire on my dialysis machine (Score:3, Insightful)
If the case went to court, yes. But there is a lot more to it than that. The hospital wouldn't win in court, but the vendor would get annihilated in the marketplace by a saavy customer.
When your using free software, and you threaten to not only not buy any more, but tell your friends not to either, it doesn't really make your problem better
Re:Stop with the security through obscurity crap (Score:5, Insightful)
The reason it the smaller the OS the less you have to test it. The whole KISS thing. Keep it simple stupid.
On a standalone ebedded system you do not need support for TrueType fonts, every printer and USB device known to man, or even video playback. On an Embeded device you often only need a few functions but those functions have to work. If you have ever programmed under windows you will find all sorts of APIs just do not work or do not work the way they are documented. Windows programers just program around these issues. You should always use the smallest OS that you can get away with for the device you are using. Linux is a good option for very flexable embedded devices. I would tend to stay clear of X and use nano-x myself.
There are many off the shelf ebeded OSs the most popular I can think of is QNX. For life critcal systems I would go for QNX over windows any day.
Re:Stop with the security through obscurity crap (Score:3, Informative)
Sure, you can modify the Linux kernel. But if you do, you don't have a million man-hours on your modifications.
The distinction about "off the shelf" is between that and "roll your own". Off the shelf would include vxWorks, Green Hills, and pDos and OS-9 (if they are still
Re:If it doesn't *SAVE* Dollars... (Score:3, Interesting)
1. The uninsured who are clogging up the system and sticking us with the bill.
2. Increased litigation costs as doctors have to pay higher malpractice insurance, they up their prices so they can stay profitable.
3. Large numbers of the eldery who need expensive treatments (such as hip replacements) end up pulling more money out of the system then they contribute (thus our premiums go up)
4. Every increasingly complicated legistation that forces
Why do they need patching? (Score:5, Insightful)
Re:Why do they need patching? (Score:5, Informative)
Because the inside of the hospital network is so insecure, I've actually set up my own firewall around my test and development machines. One solution would be to totally cut off the hospital from the internet, but that wouldn't be very practical and would piss off a lot of doctors to boot!
Re:Why do they need patching? (Score:3, Interesting)
Seems to be the only solution that makes sense though. Fuck the doctors, they can surf pr0n at home! Seriously, why does the whole hospital network need to be left attached to the public Internet? Have a few stand-alone surf-stations available in the building so they can go look up stuff they need to. Though really, if my doctor *has* to go check somethin
Re:Why do they need patching? (Score:4, Insightful)
Uhhh.... Do you think that all doctors know absolutely everything about the human body? Don't you think that they need references, too? And don't you think that maybe, just maybe, it's much easier to have up-to-date online references than book references? Why do you assume that the only thing that hospitals need internet for is surfing? You might as well stay home - your doctor looks up information online.
Maybe they also have billing systems that interact directly with insurance providers so that people don't have to use typewriters and carbon copies anymore. Jesus, there's more to the internet than porn and email. Deal with it.
Re:Why do they need patching? (Score:3, Informative)
Looking stuff up online is a fairly recent practice. Has it saved lives, or encouraged a lazy attitude towards diagnosis? I guess time will tell. Before that, they got by, and at the same time didn't have to worry about the issues raised by this article. Just because something has a big "PROGRESS" label on it, doesn't mean it's a good thing for anyone.
Re:Why do they need patching? (Score:3, Insightful)
You want a doctor that never reads medical journals, consults with colleagues, participates in research studies,...?
All that stuff is likely to be an integral part of any good doctor's daily job (including doing research to help diagnose you; you don't really want a doctor who make every single diagnosis based on memory alone).
--b.
Re:Why do they need patching? (Score:5, Insightful)
Who said they're on the internet? Consider the following scenario:
The Hospital PCs are connected to a primary server that backs up all data and managed the PCs.
The Primary Server has a leased line or occasional dial-up to transfer data to a state-wide backup and update site.
The backup and update site has firewalled internet access for a VPN to GE, and troubleshooting purposes.
GE communicates with customers via internet email. One clerk in a backroom opens an attachment with an RPC worm. Within a half-hour the entire chain is compromised.
Any question on why having a monosystem Windows network is a bad thing? Even ONE Unix server in there would help break the chain.
Re:Why do they need patching? (Score:3, Interesting)
so? (Score:5, Funny)
FDA? (Score:5, Insightful)
OK.... We now have the Food and Drug Administration in charge of computer security?
Remember Therac-25 (Score:5, Informative)
I.e. while one can build a simple manometer [komar.org] the reality is that blood pressure devices used today probably have all sorts of interdependancies that can cause a ripple effect, so one should be pretty darn careful before just applying patches licky-split ... in a work discussion earlier today, we talked about how one of the recent Microsoft security patches broke one of our applications.
Re:FDA? (Score:5, Interesting)
Why is this a problem? (Score:3, Insightful)
Re:Why is this a problem? (Score:3, Insightful)
You are assuming that the devices are in static locations. Many of the devices are portable. Doctors drag them into their office and plug them into the network. It is the same network that they plug their personal laptop into. It is the same laptop that they take home and surf the ne
Why in the hell... (Score:5, Interesting)
The norm is that these devices may need to connect *out* to something else, but don't necessarily need any inbound connections, so a hardware firewall, or even a host-based software firewall, would work perfectly in most instances; those that do need externally initiated inbound communication can *still* set up the necessary rules to allow such communication to take place. And yes, it is just this simple. (I did RTFA, and noted that some vendors actually recommend this, but that, startlingly, "there have been several instances in which viruses originated from medical instruments straight from the vendors"!)
Re:Why in the hell... (Score:5, Insightful)
How is a firewall going to stop an insider from exploiting the network? Does working in a hospital magically transform a person into a paragon of morality?
Re:Why in the hell... (Score:3, Informative)
Re:Why in the hell... (Score:5, Funny)
Viruses from medical equipment? Haven't they heard of autoclaving? Sounds like a negligence lawsuit waiting to happen...
Re:Why in the hell... (Score:5, Informative)
You missed the point... (Score:3, Informative)
The whole point is that a hardware firewall mitigates the need to patch for those reasons, and leaves the OS in a state that is supported by the vendors for use with the specialized equipment and software.
Two words: (Score:2)
I would much rather have my life staked on a Linux based embeded system than the current crop of MS systems mentioned above.
The real trick is pushing the vendors of the deviceds to move to an open(read: solid) OS platform.
Network (Score:5, Interesting)
Doesn't have to be a issue (Score:5, Insightful)
Re:Doesn't have to be a issue (Score:3, Insightful)
You need networking to be efficient. The problem is, it seems the medical manufacturers and Hospitals skimped on building a systematic network security infrastructure around these critical devices.
Can't say I'd blame Microsoft this time around. (Score:5, Insightful)
I would get laughed out of court if I tried to blame a critical problem with a report I wrote on my secretary, and the same should happen with these companies if somebody's loved one dies from their irresponsibility.
Re:Can't say I'd blame Microsoft this time around. (Score:3, Funny)
Step 1: Issue EULA stating yoru products are not suitable for mission-critical app
Re:Can't say I'd blame Microsoft this time around. (Score:3, Interesting)
Many non-obvious apps can be critical (Score:4, Insightful)
But there are a lot of applications that are not themselves critical, but could play a part. I work for a company that does materials management software for hospitals. This stuff is tweaked for efficiency, and hospitals rely on it. It runs on Windows only. Doesn't sound quite like the importance of a pacemaker, right? Well let's say the hospital gets hit by a virus. Yes, it happens, even with firewalls. Now their materials system is fubar, and they are used to it having the right supplies on hand at the right times. If it is low on something, it reorders it automatically. Now they are screwed, and they don't have something that they really need. Someone could die.
Hospitals have to operate on razor thin margins, and they can't stock millions upon millions of dollars of everything. They look to lower their on-hands inventory as much as possible.
There is all kinds of software in the hospitals that can go horribly wrong, not just the obvious stuff.
If it ain't broke, why fix it? (Score:3, Insightful)
Survery says... Beeep! Beeep! Beeep!
What "security" or other risk with a turnkey standalone system? I'd rather risk the remote chance of someone breaking into my room to run CAT-5 to my vitals monitor rather than a BSOD (possible REAL death in this case) because Service Pack x broke some obscure function and failed to alarm the nurse when my heart stopped.
Do the morons at the hospitals run Windows Update on the defibrillators?
The manufacturers have tested and retested and regression tested everything that goes into those medical devices (or they say, anyway), so why deviate from a known good combination without a compelling reason?
GE Medical Systems (Score:5, Informative)
It makes sense to me, GEMS and the Hospitals aren't going to risk $500,000 to $2,000,000 machines because of Microsoft's poor track record. Not to mention, a bug in the software can bring down the system for hours, until someone can come in and fix the problem. My Dad has problems all the time with doctors breathing down his neck. Most the time they have a full schedule, and when a x-ray tube blows it can take up to 4 or 5 hours to replace. Not including shipping from Wisconsin or France.
Re:GE Medical Systems (Score:5, Informative)
It's quite a quandry. If you don't patch the 'doze boxes, (and if you don't have a firewall...) it's possible that someone could infect that system. The problem is, GE (and obviously the other device manufacturers) test the hell out of that specific OS build and patch set. When Windows Update breaks things (which happens more than never), the system is now in a state which GE didn't test, and may in fact break the functionality of the scanner. At this point, the FE has no choice but to re-load the PC from the GE-supplied media(which doesn't have the latest patch that the hospital just installed).
The solution? It's pretty simple, stop using Windows in critical situations. I was trying to make that point 10 through 5 years ago there, and was involved in some of the very first Linux tests, prototypes, and production implementations there. The current generation of scanners is mostly linux/intel based, although there is still a lot of SGI/Irix at the top-end where heavy image processing is done. The fix for this problem, is to avoid this problem, and that's really the only sensible approach.
So, yes, they do have 'doze systems embedded in some of these scanners, but it's getting better. The hospital gets to choose between complying with HIPPA and patching the systems, or installing an unsupported patch which might break the scanner. Not a good place to be in, but then again, people shouldn't be reading their email or surfing the web from the MRI scanner's console, and the hospital _should_ have a firewall blocking the slammer/whichever ports.
There is no simple solution (Score:5, Informative)
You don't seriously believe that Microsoft gives anyone advance notice of what the patch is going to break, do you? Have you seen the ambiguous and undetailed language that goes with the WinXP SP2 patch? There's nothing actionable in there, certainly nothing testable. Until GE gets it and tests it, and authorizes it for the build, it's an astonishingly risky thing to install it.
21cfr11 mandates that only the tested configuration can be used, and if the hospital choses to violate that federal statute, they are not just at risk of screwing up their scanner, but they're technically in violation of federal statute.
I'm not defending Microsoft here, nor am I saying it's smart to have Windows in scanners, but it's there (less now than 5 years ago, but still there). The penalty for using it is that it's quite likely that some piece of malware _will_ find its way into the scanner. They're more vulnerable if they don't patch, they are going into an unsupported (and unsupportable) configuration if they do patch. The only answer is to not use Windows, but until all the 'doze-based scanners are history, they're stuck with it.
Re:GE Medical Systems (Score:4, Interesting)
Then you probably know who I am if you look at my initials. I left there in early 2002. OK, so let's take the MR scanner. ECG input comes from patient through the SCM. Gets displayed on a...anybody? Anybody? PC running Windows. Just one example, but I could dredge up more if you'd like. If Bill E. hasn't retired again, he could fill you in on the history you don't know. Rob J. could undoubtedly do the same, or Steve C., or John Z, or J. Eric S.
Maybe current production has (finnally) phased out the 'doze box, but to say "has never contained" is demonstrably false.
Prescription for disaster (Score:3, Interesting)
Of course administrative computers used for record-keeping do run M$ mostly (somebody should point out to the HMO's how much money they'd save with Linux! They'd be onto it in a shot). But the "patients lives on the line" threat there is not as great as the having faulty code controlling a laser in a brain surgeons hands.
I suppose that M$ must be developing a real RTOS for use in medical machinery. They would have managed to get in some OS variant into some non-critical systems. And they will probably penetrate the critical medical systems market at some point in time.
That would be a bad time to visit a hospital.
Why aren't these devices on an isolated network? (Score:3, Insightful)
This is not so much a Windows problem as opposed to a lazy network admin's problem.
Isolate those damn machines!!! Don't have network ports just opened everywhere! Come on, this is why network admins get paid the big bucks!
Any medical IT staffers out there? (Score:4, Interesting)
But even then wouldn't such systems be running separate from the public Internet? If so, on top of that wouldn't they be secure enough so that executives with their laptops can't just plug in and hose things up? With even entry-level expertise IT staff should be able to separate these boxes onto some sort of a VLAN that would secure them by default. What are the IT folks' take on this who are working front line in the medical arena?
yes... (Score:5, Informative)
The article mentions one thing that needs to be emphasized, which is where the FDA guy states that they're not going back to the dark ages where systems don't talk to anything else. For years, every device was on its own proprietary network (if it was on a network at all), and talked to itself and absolutely nothing else. This was bad.
In only the last couple of years (because medical IT is very behind the rest of the IT industry in a lot of ways) these devices have moved rapidly to using commodity protocols and network infrastructures, driven by hospitals' needs to do all of this more cheaply, and not have a lot of chaos.
Also, they want to provide some value add on top of the monitoring systems. For instance, it's nice to be standing by the patient's bed and see the monitoring data. It's even better to be able to export that data to another system so that it's more useful, or display it on a website so MDs can see it. All of this requires networking capability, and Microsoft (like it or not) is considered a leader in the field for server software, and has a large division [microsoft.com] providing solutions to healthcare.
Overall, the more advanced features you want a clinical system to provide, the more that system needs to integrate with other systems. Companies have given up reinventing the wheel on this every time, and are basing what they do on standard software and protocols. Microsoft is one of those. We try to avoid it whenever possible, however in most instances the decision for one product over another is based on clinical value, and not IT preference.
What devices? (Score:4, Interesting)
Chicken Little (Score:3, Insightful)
Pshaw, what a pant load. Here's a more rational look at this.
1: Chances are, your life won't be at stake. Any doctor or nurse worth their salt should be able to keep you alive without a computer. It's not like it's sitting in the room beside you, monitoring you. At least, not one running Microsoft
2: Any System Administrator worth his/her salt never, ever, ever puts a patch on a critical system without first testing, testing, testing on another system.
3: Also, any System Administrator with half a brain puts some type of firewall in place between the world and critical systems.
If the above three conditions are not true then the failure has occured in more important places then Microsoft or the Software Provider.
And BTW, Linux is not the solution here. Sure the vendor might be able to put together a fix faster with open source but there would still be some lag time; assuming the software vendor chose to make a fix at all and not take the same attitude they are taking with Microsoft.
I work in a top hospital, and we're not patching. (Score:4, Informative)
Our CIO, who's pretty well respected among his peers, asked us last week on deployment schedules for this. We pushed back and said, if we deploy now, we'll run into a host of issues. Over the weekend we did some cursory testing against most of our Patient care apps (a lot are web based) such as Cerner Millennium and GE's CentricityWeb. We're far ahead in the CPOE game for healthcare, so our devices are used for input of labs and orders.
Most of the biomed equipment we have doesn't run Windows. Personally, if you do your environment right, then you shouldn't have to worry about viruses and stability.
Healthcare doesn't function like the rest of the business world. It's a completely different animal.
Security AND Stability (Score:5, Informative)
An old colleague of mine got funding to start his own reasearch group, meaning he got his own MRI scanner. He asked me to consult on some software that would extract the data from the console of a Siemens scanner (at the time, the console was based on an OLD version SunOS, whose native compilers did not even conform to standard ANSI C) and send it directly to another computer running software that we use for data analysis. The dialect of C was a little strange, but within a week, I was able to get the software together, and my colleague was able to do the type of experiments he wanted to. And his scanner hummed along. This was back in 2001.
Fast-forward to the present. His console has since been "upgraded" to Windows XP system, and in the times I've spoken to him, he's had nothing but bad things to say about the stability of the "upgraded" system. And it's not that he had a choice, as support for his previous system was phased out. So now patients, doctors and reasearchers in his group are at the mercy of the moods of an XP system. And mind you - this system is not even on a publicly accessible network. It is on its own dedicated, private network, and its stability still can't be maintained, even by the support staff of the scanner manufacturer.
When it comes down to it, Windows still does not have the stability (never mind the security issues to cut it in really "mission-critical" situations). Maybe in cases where you need your e-commerce site up, running, and handling 1000s of transaction per second. But NOT when peoples' lives are involved.
Everyone's asking why aren't they firewalled... (Score:5, Insightful)
Pretty soon, the internal network's either too busy generating random traffic to do anything else-- and even if the Big Iron of the business, the dialysis machines and heart-lung devices and all those wonderful things that better damned well not break work fine, you've still got the terminal the nurse sits in front of that keeps track of when to issue you your shot that keeps you alive spending half its time rebooting because it's got Sasser.
This is not a problem a firewall can solve, and it's pretty darned big: You can't go throwing software around willy-nilly to solve this problem (even though the real problem is that the users _are_ throwing software around willy-nilly), so you can't just go "oooh! A next-day patch from Microsoft, let's hope their two hours worth of QA before it walked out the door was good enough!".
-JDF
Fed. Regulations Cause This (Score:5, Interesting)
Case in point is the drug study setup. Setting up data entry screens and processes can take up to 6 months for a given trial, and that trial may only run 3 months for the study metrics. If any of these processes are documented incorrectly, and entire trial can be dropped and the drug denied.
This, in the hospital realm, is all about CYA. If a piece of equipment is not certified to this extent, the hospital can be held more liable for patient injuries if said equipment falters.
Really?! (Score:4, Interesting)
All computer systems involved in patient care (and paper tracking as well) are forced to go through governmental processes for design, documentation and testing
So, if the hospital installs an uncertified piece of software on the machine, then they would be at risk if death or injury occurs, not the vendor.
If someone was injured by an unpatched machine, the hospital could pass liability back to the manufacturer - after all, they were in full compliance with the federally tested machine configuration. In which case, the manufacturer would be held liable for any injuries.
But it doesn't stop there. The manufacturer could easily and convincingly claim that Microsoft overstated the reliability of their operating systems, and the failure was due to Microsoft's code. Convincing a jury that a Windows crash caused the injury would be a trivial exercise for even the most inexperienced attorney; almost everyone has had some experience with a Blue Screen of Death.
Now comes the interesting part. Yes, the manufacturer may have agreed to the EULA, and may not be able to sue Microsoft. The patient, however, did not agree to the EULA, and having been damaged by Microsoft's code, could easily convince a jury, that in spite of the EULA, because Microsoft knew that their code was being used in medical devices failed to show due diligence to protect the user. Microsoft can't weasel their way out of this one, because the EULA doesn't apply to the patient. And, unlike the software liability cases, a medical malpractice case could easily charge the defendant with millions, or even billions of dollars in punitive damages.
Coming soon... (Score:5, Funny)
Soon to be made into a movie starring Uma Thurman.
It's called "Bill Kills".
Just one of the many enourmous problems (Score:4, Insightful)
Knowing what I know there is no way in hell I will ever go to a hospital unless I'm already dead. Cause they'll kill you just sitting in the waiting area.
Sorry Mam, your husband has blue sceened (Score:3, Funny)
human lives depending on Windows? (Score:3)
Are there really systems that human lives depend directly on that are running Windows?
If my life ever depends on some software, I want the operating systems and all the other software to be mathematically proven to be correct and I want multiple backups/failsafes present. I don't want it to be some VB app running on Windows because it's quicker and easier to develop.
Comment removed (Score:3, Funny)
The DILEMMA of Configuration Management (Score:3, Insightful)
- controlling the Configuration of equipment, in order to ensure consistent behavior.
Unfortunately, Configuration Management often does not take into account the fact that when you put a system on a network, it becomes part of a larger system, and unless you manage the entire network of systems, then you cannot really control your conditions, nor can you ensure consistent behavior.
This needs to be taken into account as a basic "sky is blue" assumption of Configuration Management.
Sadly, it is not.
Off The Shelf OS's v. Industrial OS's (Score:3, Insightful)
The temptation is way to great for the bean counters and greedy sales typs to switch the robust hardware and OS for the commodity type and save a bundle up front.
Consider a $500 PC and an $2500 industrial PC. If you let the bean counter do the math he will tell you about the 3ghz P4, GeForce 4 100 gig hdd v. the P3 20 gig with an average video card.
Then you explain that the OS's have the same disparity in cost and he starts to get confused
I have said many times before that we have Windows not because it was best but because it was cheapest. Same with the clone PC. MS got to be the default OS because it was generaly 50% of what the other OS's were.
Now when it comes to saving lives the cost should not matter, however, it is still a business. And there are still bean counters and greedy sales people who get to make some very powerful decisions.
Bad idea anyway (Score:3, Insightful)
Why in the world are they using a desktop operating system of any kind on medical equipment?
I wouldn't care how stable it was, that doesn't belong in that market.. Embedded systems that are dedicated to the need are what should be used...
Vicious Circle (Score:3, Insightful)
Even the few vendors I've seen who have balls enough to release a Linux version of their software are tied to specific distributions, specific kernels, etc.
Oh come on! (Score:4, Insightful)
I know everyone on Slashdot would LOVE to blame the OS, but really... the fault is not with the OS as much as it is the networking admins, and even more likely, the administration for not providing the NAs with the support they need to make a properly secure network.
Re:I don't understand (Score:3, Insightful)
The problem is using an operating system that was meant for th
Re:Grrr! There are other OSs other than Windows (Score:3, Insightful)
They are.
The ultrasound machine that they use on you isn't running windows.
The computer hooked up to it, which handles the image analysis, display, and archiving, however, probably is.