Outdated TLS/SSL in Healthcare: The Open Ransomware Risk

When it comes to healthcare, the focus is often on patient safety and privacy. But what if the very systems designed to protect sensitive data are putting it at risk?  

A recent report from Bitsight reveals a startling figure: 76% of healthcare organizations are vulnerable to ransomware attacks due to outdated or mismanaged TLS/SSL configurations.  

Healthcare providers store massive amounts of personal health data. Therefore, weak security practices, such as outdated TLS versions or expired certificates, can lead to significant threats, including data breaches, operational disruptions, and ransomware incidents.

While healthcare cybersecurity is often discussed regarding firewall protection or access management, the importance of TLS/SSL—the encryption protocols that secure data in transit—is often overlooked.  

Yet, these protocols are the first defense against malicious interception and data theft.  

Healthcare organizations often juggle hundreds or even thousands of TLS/SSL certificates, each identifying an internet-connected device or service. Without a comprehensive framework to manage these configurations, a healthcare network can quickly become a patchwork of vulnerabilities.

In this blog, we’ll explain why TLS/SSL vulnerabilities are so prevalent in healthcare. We’ll also share the staggering consequences of outdated configurations, our findings in the Japanese and Bangladeshi healthcare sectors, and a step-by-step approach to improving TLS/SSL management in healthcare.

Why TLS/SSL Matters More Than Ever in Healthcare

In healthcare, data security isn’t just about compliance but protecting lives and sensitive information.  

TLS (Transport Layer Security) and its predecessor, SSL (Secure Sockets Layer), are protocols designed to secure data as it moves between systems. From transmitting patient records to securing communications between medical devices and databases, TLS/SSL plays a critical role in safeguarding healthcare data.

The Complexity of Healthcare IT

Healthcare organizations are uniquely vulnerable to TLS/SSL risks because of the sheer volume of internet-connected devices and applications they manage.  

Each device — from patient monitoring systems to administrative software — often requires its own TLS/SSL certificate to verify and secure its connection. This decentralized environment creates fertile ground for expired or misconfigured certificates, leading to significant vulnerabilities that attackers can exploit.

Maintaining a secure and up-to-date TLS/SSL infrastructure in this landscape is tough. This often results in ad hoc, department-based management.  

Without a centralized, organization-wide strategy, even well-meaning IT teams can miss critical details, inadvertently exposing systems to risk.

The Cost of Outdated TLS/SSL Configurations

TLS/SSL certificates are foundational to secure data exchanges in healthcare, ensuring sensitive information like patient records and treatment details are encrypted and shielded from unauthorized access.  

However, when these configurations are outdated or insecure, they open pathways for cybercriminals to infiltrate networks, intercept sensitive data, and, increasingly, deploy ransomware attacks.

Common Vulnerabilities in Outdated TLS Versions

Older TLS versions, like TLS 1.0 and 1.1, were groundbreaking when first introduced. But as cyber threats evolved, so did the flaws in these protocols.  

Today, TLS 1.0 and 1.1 are widely considered insecure and vulnerable to attacks like:

• BEAST (Browser Exploit Against SSL/TLS): Allows attackers to decrypt sensitive data, exploiting a weakness in the protocol’s encryption method.

• POODLE (Padding Oracle On Downgraded Legacy Encryption): Allows an attacker to downgrade TLS connections to older, more vulnerable SSL protocols, compromising the security of supposedly encrypted data.

These vulnerabilities allow attackers to intercept, read, and potentially alter transmitted data, including patient information, administrative data, and sensitive financial records. The continued use of these protocols is akin to leaving hospital doors unlocked.

Real-World Consequences for Healthcare Providers

The risks associated with outdated TLS/SSL configurations extend beyond theoretical attacks — they translate into real, devastating consequences. Ransomware has become the most prominent threat, with attackers targeting vulnerable healthcare networks to hold critical data hostage.  

For healthcare providers, a successful ransomware attack means:

• Operational Downtime: Hospitals and clinics rely on uninterrupted access to patient records, medical histories, and real-time data. A ransomware-induced shutdown can stall or halt vital services, risking patient care and even lives.

• Financial Costs: The financial burden of a ransomware attack is multifaceted, ranging from direct ransom payments to the cost of system repairs and recovery and potential fines for data breaches.

• Reputation Damage: Patients trust healthcare providers with their most sensitive information. A high-profile data breach can severely damage public trust, impacting the organization’s reputation and bottom line for years.

The Impact of Poor TLS/SSL Configurations

According to Bitsight’s research, healthcare organizations that lack robust TLS/SSL configuration practices are four times more likely to experience ransomware attacks.  

Only 25% of healthcare entities currently earn an “A” grade in TLS/SSL management, with a concerning 33% scoring in the “D” or “F” range. For organizations with lower grades, the likelihood of a ransomware incident skyrockets. In a field where downtime can mean the difference between life and death, this is a risk the healthcare sector cannot afford.

As threats escalate, organizations that have not prioritized TLS/SSL management may find themselves in a reactive — rather than preventive — stance.

To understand the real-world impact of poor TLS/SSL management, Pipeline conducted an in-depth investigation using Censys, a powerful platform for tracking internet-connected assets and identifying potential security risks.  

Our focus was on healthcare providers in Japan and Bangladesh, two regions where healthcare systems are rapidly modernizing yet often lack robust cybersecurity frameworks.  

The findings reveal a concerning reality: outdated TLS/SSL protocols and weak certificate configurations are alarmingly prevalent, leaving these critical sectors vulnerable to cyber threats, including ransomware attacks.

The Situation in Japanese Healthcare

Using Censys, we queried Japanese healthcare organizations specifically for instances of weak or expired TLS/SSL certificates. The results were sobering. Our search identified 1,838 unique instances of healthcare-related systems using outdated or insecure TLS versions such as TLS 1.0, TLS 1.1, and even misconfigured TLS 1.2.

We used the query, ((services.tls.version_selected: {TLSv1_0, TLSv1_1, TLSv1_2}) and location.country="Japan" and (healthcare)).  

This targeted systems specifically within the healthcare sector in Japan and revealed there vulnerable setups.  

Numerous servers in these healthcare systems were also running outdated versions of FreeBSD and using SSH configurations that are highly susceptible to attacks.  

These deprecated protocols and operating systems create security gaps that adversaries can exploit, particularly in ransomware scenarios where attackers seek easy entry points. These vulnerabilities mean attackers can intercept, manipulate, or lock down patient and operational data for Japan's healthcare providers.  

Bangladesh: A Comparative Snapshot

Curious to see how these risks translated to another region, we turned our focus to healthcare providers in Bangladesh.  

We used the same Censys query, ((services.tls.version_selected: {TLSv1_0, TLSv1_1, TLSv1_2}) and location.country="Bangladesh" and (healthcare)).  

Then, we found similarly concerning results: outdated TLS configurations were widespread among Bangladeshi healthcare entities, with numerous servers using insecure versions of TLS.

Although Bangladesh’s healthcare infrastructure is not as extensive as Japan’s, the lack of robust TLS/SSL protocols represents a major risk as these systems scale and interact with international healthcare networks.  

Outdated encryption protocols in Bangladeshi healthcare mean patient information, including diagnostic data and medical histories, remains exposed to potential interception, compromising both privacy and security.

The Broader Implications of Inconsistent TLS/SSL Management in APAC

Our findings in Japan and Bangladesh point to a larger issue within APAC’s healthcare sector.  

Across these countries, inconsistent or ad hoc management of TLS/SSL certificates has led to outdated encryption protocols that leave entire organizations vulnerable. Given the interconnected nature of modern healthcare, a weak link in TLS/SSL security can have widespread implications.

In Japan, where patient data is highly digitized, and healthcare systems are heavily utilized, even one compromised certificate could lead to a cascade of security breaches.  

Bangladesh's risks are equally severe. These vulnerabilities create fertile ground for ransomware attacks and data breaches as the healthcare sector continues its digital transformation.

Through our work with Censys, we have gained visibility into these overlooked threats, providing healthcare providers in APAC with actionable insights to begin mitigating these risks.

Challenges in TLS/SSL Management for Healthcare

Healthcare organizations, especially in regions like Japan and Bangladesh, face significant challenges in managing TLS/SSL configurations due to fragmented IT systems, limited cybersecurity resources, and a high volume of certificates.

Decentralized Systems

Many healthcare networks operate with fragmented IT management, where departments independently handle TLS/SSL certificates.  

This decentralization leads to inconsistent security, making it easy for outdated or expired certificates to go unnoticed.

High Volume, Low Oversight

Healthcare providers often manage thousands of certificates across devices, substantially burdening IT teams. Without centralized tracking, certificates can slip through the cracks, exposing systems.

Limited Resources and Skill Gaps

Budget and resource constraints and a shortage of cybersecurity expertise hinder healthcare providers from implementing robust TLS/SSL management practices.  

As a result, many rely on outdated protocols, increasing security risks.

Manual Processes

TLS/SSL management often involves manual, ad hoc processes, especially in regions with fewer automated tools. Manual renewals and tracking are prone to errors, leading to expired certificates and potential vulnerabilities.

In Japan, where healthcare systems are complex, manual management of certificates across departments only increases the likelihood of mistakes. Similar risks arise in Bangladesh, where reliance on manual systems is common, leaving healthcare data vulnerable to compromise.

How utilising ASM in Healthcare Data Using Censys can improvise TLS/SSL Management

At Pipeline, we leverage Censys to help healthcare organizations across the APAC region. We empower them to address TLS/SSL vulnerabilities and protect against ransomware and other cyber threats, as part of Attack Surface Management scanning strategy.

Here’s how:

• Comprehensive TLS Inventory: Pipeline uses Censys to automate TLS/SSL discovery, creating a centralized inventory that tracks device certificate status. This ensures healthcare providers maintain complete visibility and can address issues before they become risks.

• Certificate Management Awareness: Through Censys, Pipeline enables healthcare providers to find out outdated TLS, understand its risk and take due action towards updating them, reducing the chance of expired certificates that could lead to security lapses.

• Real-Time Monitoring and Alerts: Pipeline configures Censys for continuous monitoring, providing real-time alerts on weak cipher suites and outdated protocols like TLS 1.0 and ensuring actionable steps towards securing the internet facing assets. This quick response system prevents minor issues from escalating into serious vulnerabilities.

• Advanced Reporting and Analytics: Censys’ analytics help Pipeline provide healthcare providers with insights into TLS/SSL health. By identifying weaknesses, we offer actionable recommendations to enhance security.

• Centralized Management Interface: Pipeline sets up a user-friendly Censys interface, enabling healthcare IT teams to monitor and update not only certificates, but other emerging threats like CVEs discovery and proactive threat hinting -  simplifying TLS/SSL management is just one of the many.  

• Migration to Modern Protocols or ensure patch updates: Pipeline guides healthcare providers in upgrading to TLS 1.3, the latest secure standard, identifying and addressing outdated versions through Censys for a more secure, resilient network.