Some places, the 'code' is merely a tool for businesses or other organizations to avoid liability. "We met all the standards, we shouldn't be accountable."

If the brakes go out on your care, and you smash into a building, even though it was recently serviced to whatever 'standards' are you liable? Yes. And then it will be up to you to pursue the manufacturer of the car, who will claim they met all standards, so they're not liable. See how it works?

I would need to give you a very deep dive into how europa and germany especially handle this so you can understand it ... I often forget how different the way people think about regulations is in the USA. On the surface: There is a joint initiative of the Federal Office of Civil Protection and Disaster Assistance (BBK) and the Federal Office for Information Security (BSI) which work with domain experts to define the abstract standards for critical infrastructure. There are more specialized sets where the German Hospital Federation (DKGeV) has more influence in how to make it happen for hospitals in particular. The whole regulation is set up to focus on continuous improvement, risk management, escalation processes, investigation of breaches and the like. It is related to ISO27001, but goes beyond that.

Maybe comparing it to MilSpec makes it understandable to citizens of the USA: we want our hospitals IT infrastructure to be like the navy wants its warships: made out of steel, with redundant systems and sane compartmentalization so it can withstand most attacks. And we are willing to invest billions of tax money to get our existing hospitals up to these standards, because many are like viking longboats: they stay afloat and cure disease, but they are not protected against torpedoes. A hospital looses most of its infrastructure to a some ransomware? There is an investigation by the supervisory body into the technical and organizational details of the specific security incident and they really don't care about certifications printed by some private company that claims to have audited the hospital. The expected result is a "how this hospital intents to prevent this type of incident in the future" document. These standards are not about certifications of industry sector mediocrity waved around to shift blame and win liability cases in court. Also I don't think liability cases work that way over here, but i am not a lawyer.

> Some places, the 'code' is merely a tool for businesses or other organizations to avoid liability.

And that's important. You have to have some place to draw the line between "we did nothing and we're all out of ideas" and "what do you mean you didn't write your own operating system from scratch and hire fifteen security experts to continuously analyze it for un-patched zero-day exploits?"

That's where industry standard "best practices" come in. Once some sort of standard is issued (by regulation) or accepted (by industry), it becomes the thing that a Reasonable Person does. Meeting that standard is then usually sufficient to avoid charges of (or additional liability for) negligence.

> If the brakes go out on your car, and you smash into a building

In this case, you're liable because you carry strict liability for your actions as a driver. However, proof that you've kept the car in working order would be sufficient to escape any criminal charges (dangerous operation of a vehicle, for example)

So did the hospital violate it?

They got dozens of servers with patient data hacked and encrypted and had to shutdown their intensive care and reroute patients elsewhere.

What do you think?

I don't think there is a single hospital that completely fulfills those standards. The bar is very high and the umbrella organization of hospitals says there must be millions per hospital invested to reach the requirements.

In unrelated news: a new law was passed today, after years of preparation, that includes a 4.3 billion euro investment of tax money into hospital IT systems.

> They got dozens of servers with patient data hacked and encrypted and had to shutdown their intensive care and reroute patients elsewhere.

> What do you think?

I don't understand why this apparently seems so obvious to you. I think I would need more information about the attack, the hospital's preparations for such an attack, and the legal and industry-standard security expectations for such a hospital.

The simple fact that an attack took down a hospital's computer systems is not sufficient to conclude that the hospital was negligent in its security. Surely a sufficiently sophisticated actor (e.g. a state) could take down the computers at most hospitals if they chose to.

I did not say that the hospital was negligent

> What do you think?

I think you can follow all the laws and still get hacked, so I don't think the fact that they got hacked tells us much about whether they were following the rules

> They got dozens of servers with patient data hacked and encrypted and had to shutdown their intensive care and reroute patients elsewhere.

Wouldn't simply using a cloud-based B2B service with something like Chrome OS / Cloudready instead of Windows solve the entire problem?

If that wouldn't work for data privacy or network availability reasons, it could be an open-source self-hosted server application, accessible locally only through a REST API.

And the server security? Just use something like self-updating RHEL CoreOS with a bunch of isolated containers, which greatly limits the entire attack surface.

> I don't think there is a single hospital that completely fulfills those standards.

Why can't a single technical solution be designed and supported for all state-owned hospitals in Germany?

The problem is not in any particular stack. It’s system design overall. All your mentioned alternatives could just as easily fail if not properly secured.

> The problem is not in any particular stack. It’s system design overall.

Are you aware that unlike Windows, Chromium OS has been designed from the ground up with security in mind[1]? And that it can run on almost any hardware[2]?

> All your mentioned alternatives could just as easily fail if not properly secured.

Software has to be designed and chosen with security in mind from the beginning.

If a hospital is running Windows Server instead of automatically-updating, minimal Container Linux[3], it has a much larger attack vector space.

These two factors alone (a proper client OS, and a proper server OS) can reduce the probability of a successful ransomware attack to almost zero.

[1] https://www.chromium.org/chromium-os/chromiumos-design-docs/...

[2] https://get.neverware.com/healthcare/

[3] https://getfedora.org/en/coreos

What about credentials? Access? Administration? DDOS attacks?

I think you can’t tell the attack space from a glance like that. And there’s ways to properly lock down Windows installations too, patched or not. Careful systems design and planning is key, regardless of exact components.

> What about credentials? Access? Administration?

That has been a solved problem, at least in Chromium OS[1]. Even hardware-based two-factor authentication can be required for all users by a click of a button.

> DDOS attacks?

If it's self-hosted by a hospital locally, most parts of the system should not be available on an open network. If it's not self-hosted locally, the largest European hosting provider, OVH, can survive a 1.1 Tbps DDoS attack[2].

> Careful systems design and planning is key, regardless of exact components.

If the solution is not designed around up-to-date technical components, it can fail regardless of careful planning.

[1] https://support.google.com/chrome/a/answer/1289314?hl=en

[2] https://arstechnica.com/information-technology/2016/09/botne...

You list technical solutions, but I'm talking about organisational failure. What about using too simple password, posting passwords on some semi-public forum, using the same password for several people, using the same account for several people and so on.

In large organisations, the problems are always found in the organisation itself, seldom in whatever tech stack is used. That they used unpatched Windows installations is not the disease, it's a symptom of the disease.

You can enthusiastically treat the symptoms and improve the condition of the patient, but unless you go to the root causes, the patient will find new ways to be ill and you can 't be there to band-aid everything, all the time.

1: I have far too few information to even speculate on how to improve this particular hospitals infrastructure.

2: because Germany is federal-social-democratic, not stalinist.

> because Germany is federal-social-democratic, not stalinist

Ah, "federal" is the right answer here. In many smaller EU countries, there is a single central social-democratic government, which can just fund an open-source solution for all regions to use.

well we can fund an OSS, but i have this feeling you underestimate the complexity of all possible hospitals.

I probably do. In any case, I would design a fundamental core system with an open API for extensions, that could be developed and maintained by third-parties, based on additional requirements by each hospital.