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Advisory (ICSMA-16-089-01)

CareFusion Pyxis SupplyStation System Vulnerabilities

Original release date: March 29, 2016 | Last revised: March 23, 2017

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OVERVIEW

Independent researchers Billy Rios and Mike Ahmadi in collaboration with CareFusion have identified numerous third-party software vulnerabilities in end-of-life versions of CareFusion’s Pyxis SupplyStation system. The Pyxis SupplyStation was obtained through a third-party that resells decommissioned systems from healthcare systems, and the vulnerabilities were found using an automated software composition analysis tool. Because the affected versions are at end‑of-life, a patch will not be provided; however, CareFusion has provided compensating measures to help reduce the risk of exploitation for the affected versions of the Pyxis SupplyStation systems.

These vulnerabilities could be exploited remotely.

Exploits that target these vulnerabilities are known to be publicly available.

AFFECTED PRODUCTS

The following Pyxis SupplyStation system software versions are affected:

  • Pyxis SupplyStation system, Version 8.0 Server 2003/XP;
  • Pyxis SupplyStation system, Version 8.1.3 Server 2003/XP;
  • Pyxis SupplyStation system, Version 9.0 Server 2003/XP;
  • Pyxis SupplyStation system, Version 9.1 Server 2003/XP;
  • Pyxis SupplyStation system, Version 9.2 Server 2003/XP; and
  • Pyxis SupplyStation system, Version 9.3 Server 2003/XP.

CareFusion has reported that Version 9.3, Version 9.4, and Version 10.0 of the Pyxis SupplyStation systems that operate on Server 2008/Server 2012/Windows 7 do not contain the reported vulnerabilities.

IMPACT

Exploitation of these vulnerabilities may allow a remote attacker to compromise the Pyxis SupplyStation system. The SupplyStation system is designed to maintain critical functionality and provide access to supplies in “fail-safe mode” in the event that the cabinet is rendered inoperable. Manual keys can be used to access the cabinet if it is rendered inoperable.

Impact to individual organizations depends on many factors that are unique to each organization. NCCIC/ICS-CERT recommends that organizations evaluate the impact of these vulnerabilities based on their operational environment and specific clinical usage.

BACKGROUND

CareFusion is a subsidiary of Becton, Dickinson and Company (BD), which is a US-based company that maintains offices in multiple countries around the world.

The affected products, Pyxis SupplyStation systems, are automated supply cabinets used to dispense medical supplies that can document usage in real-time. The Pyxis SupplyStation systems include automated devices that may be deployed using a variety of functional configurations. The Pyxis SupplyStation systems have an architecture that typically includes a network of units, or workstations, located in various patient care areas throughout a facility and managed by the Pyxis SupplyCenter server, which links to the facility’s existing information systems.

CareFusion products are deployed across the Healthcare and Public Health sector.

VULNERABILITY CHARACTERIZATION

VULNERABILITY OVERVIEW

VULNERABLE THIRD-PARTY SOFTWARE VERSIONS

Version 8.1.3 of the Pyxis SupplyStation system, last updated around April 2010, was tested and determined to contain 1,418 vulnerabilities that are present in 7 different third-party vendor software packages, spread across 86 different files. The breakdown of the 1,418 vulnerabilities by CVSS score is as follows:

  • 715 vulnerabilities were identified as having a CVSS base score of 7.0-10.0,
  • 606 vulnerabilities were identified as having a CVSS base score of 4.0-6.9, and
  • 97 vulnerabilities were identified as having a CVSS base score of 0-3.9.

Third-party software components for these legacy versions of the Pyxis SupplyStation are:

  • BMC Appsight 5.7,
  • SAP Crystal Reports 8.5,
  • Flexera Software Installshield,
  • Microsoft Windows XP,
  • Sybase SQL Anywhere 9,
  • Symantec Antivirus 9, and
  • Symantec pcAnywhere 10.5.

VULNERABILITY DETAILS

EXPLOITABILITY

These vulnerabilities could be exploited remotely.

EXISTENCE OF EXPLOIT

Exploits that target these vulnerabilities are publicly available.

DIFFICULTY

An attacker with low skill would be able to exploit many of these vulnerabilities.

MITIGATION

CareFusion has confirmed that the identified vulnerabilities are present in the Pyxis SupplyStation systems that operate on Server 2003/Windows XP, which are at end-of-life, are no longer supported. As a result of the identified vulnerabilities, CareFusion has started reissuing targeted customer communications, advising customers of end-of-life versions with an upgrade path. For customers not pursuing the remediation path of upgrading devices, CareFusion has provided compensating measures to help reduce the risk of exploitation. CareFusion recommends that customers using older versions of the Pyxis SupplyStation system that operate on these legacy operating systems should apply the following compensating measures. Specifically, users should:

  • Isolate affected products from the Internet and untrusted systems; however, if additional connectivity is required, use a VPN solution.
  • When remote access is required, use secure methods, such as Virtual Private Networks (VPNs), recognizing that VPNs may have vulnerabilities and should be updated to the most current version available. Also recognize that VPN is only as secure as the connected devices.
  • Monitor and log all network traffic attempting to reach the affected products for suspicious activity.
  • Close all unused ports on affected products.
  • Locate medical devices and remote devices behind firewalls, and isolate them from the business network.
  • Work with local team to ensure all Microsoft patching and ESET virus definitions are up to date. A Security Module for automated WSUS patching and virus definition management is provided to all accounts. SupplyStations Version 8 and Version 9 have been upgraded to ESET.
  • If pcAnywhere is used and has not been upgraded to Version 12.5 Service Pack 4, contact CareFusion’s Customer Support to schedule an upgrade or to have it removed. Contact information for CareFusion’s Customer Support is available at the following:

http://www.carefusion.com/customer-support/technical-support.

  • Use the extended password feature configured for strong passwords, enable the password history tracking feature, and set user passwords to expire according to site policy.

ICS-CERT reminds organizations to perform proper impact analysis and risk assessment prior to deploying defensive measures.

ICS-CERT also provides a section for recommended security practices on the ICS-CERT web page at: http://ics-cert.us-cert.gov/content/recommended-practices.

Additional mitigation guidance and recommended practices are publicly available in the ICS‑CERT Technical Information Paper, ICS-TIP-12-146-01B--Targeted Cyber Intrusion Detection and Mitigation Strategies, that is available for download from the ICS-CERT web site (http://ics-cert.us-cert.gov/).

Organizations observing any suspected malicious activity should follow their established internal procedures and report their findings to ICS-CERT for tracking and correlation against other incidents.


Contact Information

For any questions related to this report, please contact ICS-CERT at:

Email: ics-cert@hq.dhs.gov
Toll Free: 1-877-776-7585
International Callers: (208) 526-0900

For industrial control systems security information and incident reporting: http://ics-cert.us-cert.gov

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