Monday, July 26, 2010

Killed by Code: Software Transparency in Implantable Medical Devices


Software is an integral component of a range of devices that perform critical, lifesaving functions and basic daily tasks. As patients grow more reliant on computerized devices, the dependability of software is a life-or-death issue. The need to address software vulnerability is especially pressing for Implantable Medical Devices (IMDs), which are commonly used by millions of patients to treat chronic heart conditions, epilepsy, diabetes, obesity, and even depression.

The software on these devices performs life-sustaining functions such as cardiac pacing and defibrillation, drug delivery, and insulin administration. It is also responsible for monitoring, recording and storing private patient information, communicating wirelessly with other computers, and responding to changes in doctors’ orders.

The Food and Drug Administration (FDA) is responsible for evaluating the risks of new devices and monitoring the safety and efficacy of those currently on market. However, the agency is unlikely to scrutinize the software operating on devices during any phase of the regulatory process unless a model that has already been surgically implanted repeatedly malfunctions or is recalled.

The FDA has issued 23 recalls of defective devices during the first half of 2010, all of which are categorized as “Class I,” meaning there is “reasonable probability that use of these products will cause serious adverse health consequences or death.” At least six of the recalls were likely caused by software defects.1 Physio-Control, Inc., a wholly owned subsidiary of Medtronic and the manufacturer of one defibrillator that was probably recalled due to software-related failures, admitted in a press release that it had received reports of similar failures from patients “over the eight year life of the product,” including one “unconfirmed adverse patient event.”2

Despite the crucial importance of these devices and the absence of comprehensive federal oversight, medical device software is considered the exclusive property of its manufacturers, meaning neither patients nor their doctors are permitted to access their IMD’s source code or test its security.


We at the Software Freedom Law Center (SFLC) propose an unexplored solution to the software liability issues that are increasingly pressing as the population of IMD-users grows--requiring medical device manufacturers to make IMD source-code publicly auditable. As a non-profit legal services organization for Free and Open Source (FOSS) software developers, part of the SFLC’s mission is to promote the use of open, auditable source code5 in all computerized technology. This paper demonstrates why increased transparency in the field of medical device software is in the public’s interest. It unifies various research into the privacy and security risks of medical device software and the benefits of published systems over closed, proprietary alternatives. Our intention is to demonstrate that auditable medical device software would mitigate the privacy and security risks in IMDs by reducing the occurrence of source code bugs and the potential for malicious device hacking in the long-term. Although there is no way to eliminate software vulnerabilities entirely, this paper demonstrates that free and open source medical device software would improve the safety of patients with IMDs, increase the accountability of device manufacturers, and address some of the legal and regulatory constraints of the current regime.

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