Analysis of Legacy Software in Medical Devices

Introduction

This paper set out to give an analysis of two research papers by Laštovička-Medin (2020) and Trevor et al.(2020).

Exposure to particulate matter can be harmful to people's health. There have been several studies by scientists to help people monitor their exposure to these particulates. Often the coronavirus is labeled as a particulate matter, hence the need to control its presence. An experimental study was conducted by Laštovička-Medin (2020) to demonstrate how to visualize coronavirus by interacting with it using an Arduino-designed prototyping air pollution demonstration tool. The emphasis of this study is on how an existing air pollution demonstration prototype tool can be simulated to help people track and monitor air pollution particulate matter, like coronavirus. Of major concern is the inability of the prototype tool to measure accurately

Healthcare institutions are the main target for cyber attackers as confidential patient identity information is valuable and can be used for medical fraud. This confidential information can be accessed by attackers exploiting vulnerabilities on medical devices that rely on legacy software. Most medical devices running on legacy software cannot receive patch releases and replacing them is very expensive, so reducing risks associated with the medical device is more rational and cheaper. The objective of this research done by Tervoot et al. (2020) is to provide information on solutions that can be used on this medical device to reduce risks caused by legacy software. However, the paper did not treat the technical part of proferred solutions of solutions in more detail.

Summary

• Summary: Visualizing “Coronavirus”: Engaging with Invisible Threats through Prototyping Air Pollution Demonstration Tool with Arduino

Due to the mortality rate caused by air pollution, Laštovička-Medin (2020) set out to create a prototype of air pollution control method. The prototype demonstration tool was designed prior to the coronavirus pandemic but was adopted by the University of Montenegro after the outbreak to help people monitor and control the coronavirus and other airborne particulate matter. The University of Montenegro approach was undertaken with a view to keep the young people involved and out of the depression caused by the virus.

The purpose of Laštovička-Medin’s study was to design a tool that can people can engage with to visualize particulate matters.

The prototype tool was developed using a light emission LED device, MQ2 a gas sensor to detect hazardous gas emissions, the Arduino fan module with a propeller to simulate an alarm and a temperature sensor to detect changes in temperature. The final outcome was a prototype device that can monitor air pollution to a certain degree but can still be improved further.

• Summary: Solutions for Mitigating Cybersecurity Risks caused by legacy software in medical devices: A scoping review

The authors, Tervoot et al.(2020) set out to find literature studies that address solutions that to mitigate security vulnerabilities caused by legacy software in medical devices.

They used a scoping review and after further selections using a “pearl method”, 849 studies were initially found and eventually dropped to 18 relevant studies which address risks caused by legacy software and provide solutions options to address the risks. These studies cover solutions on intrusion detection, tunneling wireless legacy protocol, indiscriminate jamming, and secure remote maintenance.

The findings of the studies include mobile proxying of Bluetooth messages, behavioral anomaly-based recognition, and physical signal authentications.

These solutions vary on the type of medical devices relying on legacy software. For healthcare institutions’ that follow these solutions, the security of their medical devices using legacy software will be improved.

Analysis of Visualizing “Coronavirus”: Engaging with Invisible Threats through Prototyping Air Pollution Demonstration Tool with Arduino

There is a need to design an air pollution control tool to help people visualize the threats of particulate air pollution and how to monitor and control it. Several studies have established air pollution to be the leading cause of premature deaths( Lelieveld et al., 2020; Ritchie & Roser, 2019; Barrett, 2020). This suggests that by being able to visualize air pollution, the rate of premature deaths can be minimized. Finn and Fallon (2017) have promoted environmental health literacy, believing that this would increase awareness about the risk of air pollution and provide guidelines to minimize risk exposure. about how to reduce risk perception for individuals. This proves that environmental factors such as air pollution can lead to premature deaths and such, it is necessary to have tools that will help in mitigating the risks associated with air pollution. This argument is convincing because due to the high adverse health effect caused by air pollution, there is a need to further protect oneself against air pollution. Hence, the need to design a tool that can effectively help people become more aware of the risk. This evidence is compelling because, due to the high adverse health effects caused by air pollution, there is a need for protection from it. Therefore, it is important to design a tool to make people more conscious of the risk.

As an experimental study, Laštovička-Medin’s paper argues that there is no conclusive answer as to whether coronavirus is an airborne disease or a transmissible disease but still went ahead to identify and apply it as an airborne particulate matter using the air pollution demonstration tool. Based on trends and other studies, several scientists classify the coronavirus as being an airborne disease and appealed to the relevant health body to acknowledge it as airborne. (Morawska & Cao, 2020, Wilson et al., 2020). Contini and Costabile (2020) also asserts that being exposed to air pollution can increase the chances of getting infected with the coronavirus. The argument of coronavirus being an airborne disease is a complex and ongoing discussion. However, WHO (2020) who is the dictating health body points out that there is sufficient evidence to prove that the primary way people get infected by COVID-19 is majorly through direct or indirect contact with infected people and not through airborne. While WHO hasn’t completely ruled out the virus as an airborne disease, this study inaccurately presents it as one. Overall, this argument suffers a drawback as there is still inconclusive evidence from different health bodies and studies about Coronavirus being an airborne disease.

In the design principle of the prototype tool, Laštovička-Medin (2020) stated he used an LED for the prototype tool but claims using a Laser LED would have been better. This argument differs from Galanis and Dasgupta (2020) who contend that LED is more useful to monitor the presence of pollutants in small sizes of airborne particulates. This evidence suggests that using LED can be an effective approach as major threats of airborne particulates lies in the medium and small sizes.

In designing a prototype tool, use an LED instead.

Strength and Weaknesses

The final designed prototype tool is consistent with the aim of the paper as it was designed to monitor and control the rise of air pollution.

However, the research failed to explain why the prototype tool can’t measure air pollution accurately. This is a major weakness as it can lead to limitations which will result in errors in measurement which can cause unreliability in the detection of air pollution.

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Also, the author asserted a drawback in his design principle was not using Laser LEDs but using LEDs. However, there was no logical discussions as to why LEDs were used instead of Laser LEDs.

Analysis of Solutions for mitigating cybersecurity Risks caused by legacy software in medical devices: A scoping review

Trevor et al.(2020) adopted a scoping review with PRISMA guidelines to answer their research questions “what solutions, other than full replacement, address security issues caused by legacy software in medical devices?”. The scoping review method was proposed by Askey and O’Malley(2005) who assert that using a scoping review is a precursor to any systematic review. The scoping review was used to find relevant studies that cover solutions to mitigate risk of medical devices relying on legacy software. Medical devices that rely on this legacy software are mostly at risk because they connect to each other and as such, solutions to fix them will go a long way.

While this proposal provides an overview to the research question, it failed to provide a technical analysis of these solutions such as Jagannathan and Sorini (2016) in their published paper on “Self-authenticating in medical devices: An approach to include cybersecurity in legacy medical device”. This study would have been more interesting if it had highlighted and included a technical analysis of the solutions found.

A scoping review with PRISMA guidelines was adopted to answer the research question “what solutions, other than full replacement, address security issues caused by legacy software in medical devices?”. The scoping review method was proposed by Askey and O’Malley(2005) who assert that it is relevant to find a variety of different literature studies and also used as a precursor to any systematic review. The research paper being While the scoping review method found studies that focus on solutions, a disadvantage of using it in this method was that the systematic review approach would have found studies that address these solutions and also propose a technical analysis of found solutions. According to Moher et al., (2015), scoping review provides an overview to a question rather than providing the main answer. This suggests that a more system

The scoping review used in this research paper focused more on giving a narrative review with little or no information on the technical analysis of

However, a scoping review allows for a more general question and exploration of the related literature, rather than focusing on providing answers to a more limited question (Moher et al., 2015).

(Insert diagram – Table 1)

One of the solutions found as seen in Table 1 was adding a security system to mitigate risks on medical devices that are legacy compliant. Medical devices relying on legacy software should have an additional security system such as an intrusion detection system to alert healthcare personnel and patients of any suspicious activity. There is a need for medical devices to have an additional wireless monitoring system to be connected to the internet in order to ensure real-time patient tracking (Thamilarasu, Odesile & Hoang, 2020). Medical devices which rely on legacy software are vulnerable to attacks and need a further external security system such as an intrusion detection system to monitor patients. Barney(n.d.) also pointed out that most healthcare data breaches occur due to lack of security systems such as intrusion detection systems to detect suspicious activities.

Attacks on medical devices can cause life-threatening harm to patients and also result to the loss of patients’ healthcare data. These facts show that an external security monitoring system on a medical device relying on legacy software is necessary to protect patients' life and confidential data from cyber-attackers.

Securing communication in implantable medical devices is another solution to mitigate risk associated with these devices that rely on legacy software. According to Bu, Karpovsky and Kinsy (2020), having a secure protocol on implantable medical devices makes it easier for health practitioners to gain access to the devices in case of any suspicious activity or emergency. An implantable medical device is typically used to monitor a patient's vitals and also to increase the patient quality of life.

Most of these devices have a security vulnerability that cyber attackers try to exploit (Zheng et al., 2017). The implication of attackers been able to infiltrate these IMDS and eavesdrop on the communication between the implantable device and healthcare practitioners can lead to loss of patients’ data.

Strength and Weaknesses

Bidirectional citation is a selection process that used a smaller set of studies to select other studies. Trevor et al. (2020) adopted this selection process in their research paper. Although this methodology is a good approach to avoid time-wasting, a weakness associated with this methodology is that it can lead to limitations as the pearl method can lead to missing out on relevant studies not cited in the pearls. Examples of relevant studies that were missed are Jagannathan and Sorini (2016) in their published paper on “Self-authenticating in medical devices: An approach to include cybersecurity in legacy medical device”, Thamilarasu, Odesile and Hoang (2020) in their published paper on “an intrusion detection system for internet of medical things”. These missed relevant studies could have also been used as an approach to mitigate risk in medical devices hosted on a legacy software platform.

Similarities, Differences, and Overlap

Both research papers share a key feature in providing solutions or tools that can mitigate risks associated to health. However, the research paper by Laštovička-Medin (2020) adopted a systematic/experimental review approach while the research paper by Tervoot et al. (2020) adopted a scoping/narrative review. An overlap shared by these two research papers is that they both focus on the healthcare industry.

Conclusion

This critical paper evaluated Laštovička-Medin (2020) and Trevor et al. (2020) research papers.

The research paper by Laštovička-Medin (2020) highlights the importance of being able to monitor and control air pollution threats however the scope of this paper was limited in terms of why the prototype tool can’t measure accurately. Although the study is based on a prototype demonstration tool, there is room for improvement with better measures in the next phase of the production tool. Despite this limitation, the prototype tool could still track air quality, albeit not accurately, which was the main objective of the paper.

The research paper by Tervoot et al. (2020) set out to review solutions that mitigate the risk of medical devices relying on legacy software. The study identified 18 key solutions to address these risks and proffer key solutions to reduce it. A limitation of this research paper is that it fails to give a technical analysis of the solutions being reviewed and also missed out on other relevant studies due to the citation methodology used.

However, further studies of Tervoot et al.(2020) research paper needs to be carried out using a systematic review to illustrate the technical analysis of selected solutions that can mitigate the risk of medical devices relying on legacy software without outrightly replacing the device.