Cryptographic Attacks In Medical Devices

Cryptography is a critical aspect of cyber security, and ensuring that data is properly protected is vital, especially in sensitive industries, such as healthcare. No matter how many precautions are taken, it may still be possible for bad hackers to find a way to access sensitive information. Processes storing or moving this data need to account for this possibility and act accordingly to prevent dangerous access. Failure to properly encrypt sensitive data can be dangerous for user data and lead to regulatory problems in several different industries.

Key Takeaways

• Encrypt all sensitive medical device data.
• Use current, validated encryption standards always.
• Avoid in-house encryption implementations.
• Recognize encoding is not encryption.
• Guard against key leaks and weak keys.
• Ensure secure encryption configurations.

What Data Needs To Be Encrypted?

When in doubt, data is often better left encrypted. Even seemingly harmless information can allow attackers to mount more careful and targeted attacks that will access sensitive functionalities. Devices should be mapped and modeled to identify any areas where data is stored or transmitted. It is important to ensure that data is encrypted during transit and at rest and that the integrity of data is verified in new locations.

Medical devices can process a massive range of data. Depending on the functionality of the device, there can be very personal information that users would not want public. Information such as this requires extra special care. FDA regulations require that transmissions and data either be encrypted with the latest standards or have solid risk controls in place to explain the absence of encryption. This includes all sensitive information in the device, not just PHI.

How Can Cryptography Be Exploited?

Cryptographic attacks can be very complex and devastating if successful. Attackers able to compromise an encryption method will have unrestricted access to all current and future data if they maintain access to the device. Depending on where and what the data is, there are many different attacks that hackers can perform to extract plaintext information.

One far too common attack is the utilization of leaked keys. Many signature services have had certain algorithms broken and exposed in the past, and this information can be searched for on the public internet. When this happens with the use of public/private keys, attackers can not only strip out encrypted data but also send malicious, modified data that appears to be perfectly valid. Developers should be diligent to only use the latest encryption methods and protocols available.

It may also be possible for certain attacks to brute force the encryption method during transit and forge their own decryption keys. This can happen when encryption methods are not sufficiently complex and irreversible. Attacks like this will often be more successful on cryptographic implementations that were made in-house and contained major flaws in the mathematical operations used to generate encrypted data.

When poorly configured, it can often be possible to force protocols and web servers to downgrade to a known, weaker encryption method. This kind of attack can occur when servers are configured to fall back on a backup method that has known vulnerabilities. If this fall back can be directed by hackers, they can control the encryption method and greatly increase the odds of successful data extraction.

What Are Encryption Best Practices?

Developers should take care to use the latest standards and protocols in all areas of encryption. Luckily for defenders, modern encryption protocols do not have known vulnerabilities that allow for data decryption by unauthorized parties. This means that data can be considered secure as long as configurations are secure. It can be worth performing an analysis of encryption methods in use and searching for known vulnerabilities to screen out potential problems.

As part of this, it is rarely a good idea to use in-house encryption methods unless they are confirmed to be safe. Even small flaws can open just enough of a window for attackers to exploit and decrypt data. The same attacks can happen even with strong algorithms if secrets and signing keys are not sufficiently strong and can be brute forced. If an attacker is successful with this attack, they will be able to forge their own keys and produce malicious data. This opens up far more problems than the confidentiality concerns typically associated with cryptography.

A very important distinction that can be confused is the difference between encryption and encoding. Some implementations may confuse the two and encode data instead of encrypting it. While there are certainly use cases for data encoding, confidentiality is not one of them. Encoded data can be easily reversed into the original text, despite it often appearing to be encrypted in some fashion.

Cryptography can be difficult to properly secure. Consulting security experts can help spot weaknesses before they become dangerous. The team at Blue Goat keeps up with the latest practices in all areas of security, and cryptography is no exception. When a small mistake can be the difference between costly breaches and submission delays, it is worth getting it right the first time. Contact us to schedule a discovery session.

FAQs

What data in medical devices needs encryption?

All sensitive data, including Protected Health Information (PHI) and other confidential information, should be encrypted. The FDA's February 3, 2026 premarket cybersecurity guidance emphasizes encryption for data at rest and in transit.

How can encryption in medical devices be exploited?

Exploitations can occur through leaked encryption keys, brute-forcing weak algorithms, or by coercing systems to use outdated, vulnerable protocols. Poorly configured systems are particularly susceptible to these attacks.

What are common cryptographic attack types?

Common attacks include using leaked keys to decrypt data or forge malicious data, brute-forcing weak encryption methods, and downgrade attacks where adversaries force systems to use less secure protocols.

Why should in-house encryption be avoided?

In-house encryption methods often contain subtle flaws that attackers can exploit. It is safer to use well-vetted, industry-standard cryptographic algorithms and protocols, which have undergone extensive peer review and testing.

What is the difference between encryption and encoding?

Encryption is a method to secure data confidentiality, making it unreadable without a key. Encoding transforms data into another format for integrity or compatibility, but it does not conceal information and can be easily reversed.

Does the FDA require encryption for medical devices?

Yes, the FDA's February 3, 2026 premarket cybersecurity guidance highlights the importance of encryption for protecting sensitive data in medical devices, requiring solid risk controls if encryption is not used.

Related: Key Exchange in Medical Device Cybersecurity: TLS, PKI, and Keys

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