These LA Startups Are What Stand Between Hackers and Your Medical Devices

Surachet Jo/

Some of the most important cybersecurity work is happening in nondescript offices across the nation.

LOS ANGELES – The term cyber threat information sharing tends to evoke images from a techno spy thriller: banks of computer monitors manned by steely-eyed operators, wall-sized screens with flashing red dots on one side of the globe that send even redder arrows streaking toward targets on the other side.

For major threat sharing operations, such as the Homeland Security Department’s National Cybersecurity and Communications Integration Center or a joint facility that serves major financial institutions, that image may not be far off.

Those outfits collect and seamlessly, digitally share thousands of data points about phishing emails, ransomware campaigns and hackable software vulnerabilities in both consumer and specialized technologies.

For the average small- or medium-sized business that make up more than half the U.S. economy, however, those digital threat indicators look like so much gobbledygook.

That’s why some of the most consequential efforts in cyber threat sharing may be running out of nondescript office spaces across the country, each with a small staff working on one small corner of the nation’s larger cybersecurity challenge.

Tiny Pieces of the Cyber Threat Pie

Akilah Kamaria and Daniel Beard run two of those offices, known as Information Sharing and Analysis Organizations, or ISAOs. Both are based in the Los Angeles area and both focus on sharing threat information that’s pertinent to internet-connected medical devices, such as MRI machines, defibrillators, pacemakers and insulin pumps.

Beard focuses on helping medical device manufacturers build their devices more securely and patch them more efficiently when researchers spot new vulnerabilities in their products’ digital code.

Kamaria focuses on translating cyber threat information into plain English that doctors and other health care providers without technical backgrounds can understand when they’re making crucial decisions about patient care.

The fact that these two organizations can exist simultaneously, and within about an hour’s drive of each other, gets at something fundamental about ISAOs. As envisioned by the February, 2015 executive order that established them, ISAOs are meant to be loosely defined, to pop up where there’s a need and to morph when that need changes.

Unlike the Information Sharing and Analysis Centers, or ISACs, that served as a partial model for the ISAOs and that are based around critical infrastructure sectors such as financial services, energy and health care, ISAOs “may be organized on the basis of [industry] sector, sub-sector, region, or any other affinity, including in response to particular emerging threats or vulnerabilities,” according to the executive order.

They can also include public entities, private entities or a combination and can be organized as for profit or nonprofit enterprises.

Gregory White, a University of Texas-San Antonio computer science professor and executive director of the ISAO Standards Organization, has envisioned a world with thousands of larger and smaller ISAOS filling the landscape like a mosaic. He’s even, half-jokingly, suggested regional ISAOs for mariachi bands.

In other words, if you can build it—and find a way to pay for it—it can be an ISAO. If that means two LA-area ISAOs both serve the medical device community, then so be it.

There’s No Wrong Way to ISAO

When the Obama administration first developed the ISAO concept, officials envisioned them something like mini-ISACS, said Michael Daniel, who was President Barack Obama’s cybersecurity coordinator when the ISAO executive order came out.

Over time, Daniel said, his own vision of ISAOs has evolved and broadened. In addition to simply being smaller and differently organized, he said, ISAOs can also do a different sort of information sharing than ISACs, which tend to be highly sophisticated and, in the case of the most developed ones, such as the Financial Services ISAC, to share complex threat information automatically in specialized digital formats.

“There’s an implicit assumption that the standard ISAC model is what the FS-ISAC model does, trading technical-level threat intelligence at computer speed,” he said. “What we’re learning is that, for many if not most businesses that aren’t Fortune 500 companies, what may be more relevant is: ‘What are the cyber lessons for my business line? What do I need to understand to get better at cybersecurity given my business operations?’”

Connected medical devices are at the center of a growing panic about cyber vulnerabilities in the so-called internet of things.

Along with the industrial control systems that manage dams and power plants, it’s one of the few spaces where digital vulnerabilities could literally cost lives. The diabetic security researcher Jay Radcliffe, for example, demonstrated at a 2011 cybersecurity conference how his insulin pump could be hacked to deliver a fatal dose.

For the organizations that Kamaria and Beard work with, however, the sort of threat data that top cybersecurity companies share would be of very little use, they said. Even the information shared by the National Health ISAC, or NH-ISAC, which covers the health care sector, is usually too complex, they said.

“There are just so many things happening all at the same time and I’m reading all this [threat information] and going: ‘If I was a nurse or a doctor, it wouldn’t make any sense,’” Kamaria said. “How does this information sharing provide value to the person who most needs to understand it?”

Members, Money and Funding Models

Kamaria’s solution is a mobile app her staff is developing that sends plain English alerts to clinicians about newfound medical device vulnerabilities and patches, phishing emails and other digital dangers, including some from related fields that may be relevant to the medical device space.

Doctors and nurses will also be able to share curious things they encounter through the app, providing intelligence Kamaria’s staff can feed back to other members.

Kamaria’s plan is to fund the ISAO with subscription fees for the app.

By contrast, the medical device manufacturers that Beard works with are less concerned about the newest malware or phishing scam but are very concerned with ensuring their own devices are built as securely as possible, he said.

“Manufacturers don’t care that there’s a threat that’s active this very second,” he said. “They’re too busy building their devices. So, we help them with vulnerabilities and we help them with resources to increase the general cybersecurity hygiene of their devices.”

Beard is funding his ISAO, called MedISAO, with fees from member organizations. About 22 have joined so far, including Panasonic, Hitachi and Promenade Software, where Beard is a vice president and was a cofounder.

Beard built up most of the current members through his personal contacts in the medical device industry. Right now, they’re centered around Los Angeles and south to San Diego, he said, which makes it easy to meet informally with members as they try to implement new cyber protections and best practices.

Eventually, the ISAO might expand to other medical device industry hubs in San Francisco, Minneapolis-St. Paul and Boston, Beard said.

Or, separate medical device ISAOs may pop up in those areas that Beard’s organization can share information with, he said. In that case, MedISAO “will grow as much as it needs to,” he said.

Though Kamaria’s ISAO is currently called the SoCal ISAO, she also envisions a future in which clinicians far away from southern California may be interested in subscribing to the threat information in her app.

Those models—of one ISAO operating nationally for a particular niche or several regional ISAOs for the same niche—are just two of numerous models that might develop, Daniel, the former White House cybersecurity coordinator, said.

In other cases, ISAOs may evolve into a hub-and-spoke model with regional ISAOs organized around a central organization that helps filter threat information and cut down on duplicated labor, he said.

“From my view, this is a good example of how people saw the environment and picked up the ISAO idea and are working with it,” he said. “I think in many ways the original vision for ISAOs has had to grow and evolve as our understanding of the challenges have grown.”