Attachment 4 MDERA.pdf

PDF 376 KB Posted

Attached to
Patient Monitoring System Federal contract opportunity
Solicitation number
FA558720Q1029
Issued by
Department of the Air Force United States Air Forces in Europe - Air Forces Africa

About this file

This document contains a Medical Device and Equipment Risk Assessment (MDERA) questionnaire for a Patient Monitoring System solicitation. The questionnaire requests technical details about medical devices and equipment to ascertain compliance with federal cybersecurity standards. It covers system identification, architecture, technical specifications, data processing capabilities, and risk assessment. Vendors must provide details of all hardware, software, operating systems, applications, accounts, vulnerabilities, wireless capabilities, and data encryption used. They must also describe how electronic protected health information is received, processed, stored, transmitted and displayed. The questionnaire aims to identify technical characteristics and the effort required for a Risk Management Framework assessment prior to procurement.

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FA558720Q1029 Amendment 00003.pdf PDF
Amendment 00002.pdf PDF
Attachment I-Statement of Work 21 AUG 2020.pdf PDF
FA558720Q1029 Amendment 00001.pdf PDF
Solicitation FA558720Q1029.pdf PDF
Attachment 3 DHA Cybersecurity-RMF Requirements (3-25-19).pdf PDF
Attachment 2 Pricing Sheet.xlsx XLSX spreadsheet
Attachment 1a ATO and ATC Sheeet.docx DOCX document
Attachment 1 Statement of Work.pdf PDF

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CYBERLOG MDERA VER 4.0 PAGE 1 OF 15

UNCLASSIFIED//FOR OFFICIAL USE ONLY WHEN COMPLETED

DEFENSE HEALTH AGENCY (DHA)

MEDLOG CYBER Logistics Center of Excellence

693 Neiman Street Ft. Detrick, Maryland 21702

Medical Device and Equipment Risk Assessment

MDERA

Version 4.0

To ascertain security compliance that is in agreement with United States Federal Government (USFG), Department of Defense (DoD), and Defense Health Agency (DHA) policies and directives, the DHA Cyber Logistics Center of Excellence (CyberLOG) requires the vendor complete the following Medical Device Equipment Readiness Assessment Questionnaire (MDERA).

All Medical Systems/Devices are required to meet DoD cybersecurity and National Institute of Standards and Technology (NIST) standards. The information provided below will be used as a pre-procurement selection tool used to support all stakeholders working to achieve a Risk Management Framework (RMF) Authorization. Failure to disclose all required information, or misrepresentation of the proposed system’s capabilities, will result in the system being ineligible for purchase, or result in a breach of contract and cancellation of contract if discovered after award.

The information provided below which includes data processing capabilities, current security posture, and level of compliance with the cybersecurity principles of Confidentiality, Integrity, and Availability will be used to identify the technical characteristics of the Medical System/Device and determine the level of effort and potential actions required prior to and during an RMF Assessment process, from a cybersecurity standpoint.

CYBERLOG MDERA VER 4.0 PAGE 2 OF 15

Revision History

Date Section/Item Comments Author 22-Jan-19 Full Document Initial draft. Andrew McGraw

28-Mar-19 Full Document Removal of technical requirements not required during the RFI phase.

Andrew McGaw

6-Jan-20 Full Document

Addition of Section 3: Data Processing Capabilities.

Clarified and enhanced questions in Section 2.

Andrew McGraw

CYBERLOG MDERA VER 4.0 PAGE 3 OF 15

READ BEFORE PROCEEDING:

THIS SECTION OF THE CYBERLOG MEDICAL DEVICE AND EQUIPMENT RISK ASSESSMENT (MDERA) QUESTIONNAIRE IS TO BE COMPLETED BY THE COMMERCIAL VENDOR IN ITS ENTIRETY AS PART OF THE MEDICAL DEVICE/SYSTEM REQUEST FOR INFORMATION (RFI) PROCESS. THEREFORE, ALL INFORMATION FIELDS MUST BE ADDRESSED. REFERENCES TO EXTERNAL

DOCUMENTS OR PRODUCT LITERATURE ARE NOT ACCEPTABLE.

ONCE COMPLETED, SUBMIT THE MDERA TO THE DESIGNATED POINT OF CONTACT (POC).

COMPLETION OF THIS QUESTIONNAIRE IS APPLICABLE TO REGULATED MEDICAL SYSTEMS/DEVICES AS WELL AS NON-

REGULATED MEDICAL SYSTEMS/DEVICES THAT OPERATE IN A HEALTHCARE SETTING.

CYBERLOG MDERA VER 4.0 PAGE 4 OF 15

P R I M A R Y V E N D O R P O I N T O F C O N T A C T ( P O C ) I N F O R M A T I O N ( V e n d o r A c c o u n t M a n a g e r )

Name:

Job Title:

Company:

Business Address:

E-Mail Address:

Phone Number:

Web page Address:

POC Signature and Date:

(Signature indicates acceptance that all provided information is accurate, and that no information has been omitted.)

If Digital Signature is not possible, print and sign this page only. Attach scanned copy to the document.

DATE:

V E N D O R T E C H N I C A L P O I N T O F C O N T A C T ( P O C ) I N F O R M A T I O N ( T e c h n i c a l P O C R e s p o n s i b l e f o r c o n d u c t i n g R M F A c t i v i t i e s )

Name:

Job Title:

Company:

Business Address:

E-Mail Address:

Phone Number:

Web page Address:

Technical POC Signature and Date:

(Signature indicates acceptance that all provided information is accurate, and that no information has been omitted.)

If Digital Signature is not possible, print and sign this page only. Attach scanned copy to the document.

DATE:

CYBERLOG MDERA VER 4.0 PAGE 5 OF 15

Section 1: System Identification

M E D I C A L D E V I C E A N D E Q U I P M E N T I D E N T I F I C A T I O N – T e c h n i c a l a n d R e g u l a t o r y

1.0 Medical Device/Equipment Title/Version:

Provide the naming convention for the medical device/equipment and primary application version.

1.1 Medical Device Description:

Provide a brief technical description of the medical device’s/equipment intended use/capability. If applicable, the FDA 510K Summary Description should be used for accuracy.

1.2 Medical Device/Equipment Model:

List all devices/equipment and versions covered under this review (eg. family of systems)

1.3 Product Suite/Family of Products

Indicate whether the medical device/equipment is marketed by any other model, brand names, trademark, or product suite/family. (eg. Resellers)

1.4 Medical Device/Equipment Category: Recommend use of

ECRI Institute’s Universal Medical Device Nomenclature System (UMDNS).

1.5 Primary Software Application Release/EOL Date: Provide

the software release and expected End of Life (EOL) dates of the Primary Software Application. Also, indicate whether Extended Support for the Primary Software Application is provided by the manufacturer. See DHA CyberLOG Cybersecurity Acquisition Language

Release Date: EOL Date:

1.6 Food and Drug Administration (FDA 510K)/other

Regulatory Certification, or Premarket Authorization identifier, if applicable: Provide the number associated with the medical device/equipment, if applicable.

1.7 Department of Defense (DoD)/Defense Health Agency

(DHA) Authorization: State whether the proposed medical device/equipment has been or is currently undergoing the DoD/DHA Risk Management Framework (RMF) Authorization process, and the corresponding eMASS record identifier. State the originating office conducting the RMF efforts, as well as the Authorization Termination Date (ATD).

ATD:

1.8 Baseline physical testing location: Indicate whether an

instance of the MDE installed at the manufacturer’s facility is available for RMF Assessment. If such a system is available, provide complete street address.

1.9 Intended Mode of Operation:

Select the intended mode of operation of the medical device/equipment.

Standalone – Operates in complete isolation and thus does not require the use of networking protocols.

Peer to Peer – Operates in complete isolation but requires the use of networking protocols.

Client/Server – Operates as a distributed application that partitions task or workloads between the service requester (client) and the service provider (server) through the use of networking protocols.

Web-based – Operates as a distributed application that requires the use of a browser to access the primary application. There is no client software installed on the client workstation.

https://www.ecri.org/

CYBERLOG MDERA VER 4.0 PAGE 6 OF 15

M E D I C A L D E V I C E A N D E Q U I P M E N T I D E N T I F I C A T I O N – T e c h n i c a l a n d R e g u l a t o r y

Host-based – Operates as a passive subsystem which requires connection a host computer to produce information. It may require the use of networking protocols.

Cloud-based – Operates within a cloud-service environment

Government Cloud Service Provider (eg. DISA, SPAWAR)

Commercial Cloud Service Provider (eg. Amazon Web Service)

1.10 Intended Method of Implementation:

Select the intended method of implementation of the proposed medical device/equipment.

System comprises Hardware + Software + Firmware (traditional configuration)

System is Software Only in a Physical Environment (requires hardware provided by the GOV)

System is Software Only in a Virtual Environment (requires virtual environment)

Virtual Environment must be provided by the Government

Government must provide all Operating System/Database/Application Virtual Servers.

Virtual Environment provided by the Vendor

1.11 Interfaces

Describe how the device connects to the network, or the intended mode for communications.

CONNECTION TYPE:

Serial over RS-232 RJ-45 Networked Serial to RJ-45 Connection 802.11 Wireless Other (Specify Connection Type Below)

1.12 Connected Systems

Describe the types of systems this will connect to, or communicate with. (i.e. PACS, Networked patient monitors, Stand Alone, EHR, etc.)

CYBERLOG MDERA VER 4.0 PAGE 7 OF 15

Section 2: Technical Information

2.0 SYSTEM HARDWARE/FIRMWARE

List all components required for the operation and clinical functionality of the device, to include all servers, workstations, routers, switches, etc.

SYSTEM CONFIGURATION MUST BE DESCRIBED IN ITS ENTIRETY. FAILURE TO DISCLOSE ALL INFORMATION MAY CAUSE A

BREACH OF CONTRACT.

Component Purpose Comments

2.1 OPERATING SYSTEMS

For each Component Listed in Section 2.0, List the Operating System (OS): Make sure to identify all instances regardless of platform (i.e. server, client, peer, standalone, and portable peripheral end point device), End of Life (EOL) date and intended operational environment (i.e., physical, virtual)

EACH COMPONENT FROM SECTION 2.0 MUST BE LISTED. FAILURE TO DISCLOSE ALL INFORMATION MAY CAUSE A BREACH OF

CONTRACT.

Component Operating System Service Pack Level End of Life Date Extended Support Virtualized

2.2 INSTALLED APPLICATIONS

For each Component Listed in Section 2.0, List the Applications required for the System to operate/meet clinical requirements.

Make sure to identify all instances regardless of platform (i.e. server, client, peer, standalone, and portable peripheral end point device), End of Life (EOL) date and why the software is required.

EACH COMPONENT FROM SECTION 2.1 MUST BE LISTED. FAILURE TO DISCLOSE ALL INFORMATION MAY CAUSE A BREACH OF

CONTRACT.

Component Application Version End of Life Date Purpose

CYBERLOG MDERA VER 4.0 PAGE 8 OF 15

2.3 Individually Identifiable User Accounts:

For each Component Listed in Section 2.0, describe the account types that are required for the system to operate. Are individual accounts for clinicians required for the application.

EACH COMPONENT FROM SECTION 2.1 MUST BE LISTED. FAILURE TO DISCLOSE ALL INFORMATION MAY CAUSE A BREACH OF

CONTRACT.

Describe how accounts are created (site setup accounts, vs vendor default) List all account types in the table below:

Component Account Type Admin Account? Application, OS, or DB?

Authentication Method (PKI, UN/PWD, etc.)

Purpose

S Y ST E M AR CH I T E CT U R E D R A W I N G :

2.4 Medical Device Architecture Diagram: Provide a block diagram depicting all subsystems and components of the proposed medical system/device as configured in your proposal. Include connection specifications such as: Ethernet Connection, Wireless Connection or Bluetooth Connection. You may include an embedded Microsoft Visio diagram with your submission.

CYBERLOG MDERA VER 4.0 PAGE 9 OF 15

S Y ST E M AR CH I T E CT U R E D R A W I N G :

2.5: MIGRATION PATH

For any application, or Operating System listed above, with less than 24 months of support/extended support, describe the migration plan, or upgrade path to maintain compliance.

CYBERLOG MDERA VER 4.0 PAGE 10 OF 15

2.6 END POINT PROTECTION - ANTI-VIRUS / HOST BASED SECURITY SYSTEM (HBSS) / HOST-BASED INTRUSION PREVENTION

SYSTEM (HIPS)

a. Provide a summary describing if 3rd party/Government Furnished applications can be installed on the proposed medical device/equipment. (i.e.

Antivirus, HBSS, monitoring agents (SPLUNK, TANIUM, etc.)

b. If validation is required prior to installation, describe the validation process.

c. If the system does not support these applications, does the system utilize a native White Listing program (or other technology) to effectively mitigate the vulnerabilities associated with not supporting End Point Protection?

a.

b.

c.

Anti-virus/Anti-malware recommended best practices (if available) *List items which must be excluded from scanning below.

YES

NO

Antivirus/Antimalware Heuristics scanning supported?

Does the system provide notification of malware detection in the device user interface or through other mechanism (describe below)?

Does the system automatically update malicious code protection mechanisms? (If no, describe below how malicious code protection mechanisms are updated)

2.7 – VULNERABILITY SCANNING POLICY

Indicate limitations for the ability to run vulnerability scans (i.e. Nessus/ACAS scans) against the device.

MDE can be scanned in a test/vendor lab environment only.

No scanning capability at all (Serial/no networking capability)

MDE can be scanned in a live environment

Provide a summary describing if Network Vulnerability scans can be run against the device while in a live environment, and any limitations to the ability to scan the device in real time. (i.e. restrictions on running scans while conducting a study, system must be “de-hardened” and coordinated with the vendor prior to scanning, etc.).

If the MDE cannot be scanned in a live environment, but can be scanned in a vendor test lab, describe in detail the limitations to scanning within the live environment. (Impact to patient safety, etc.)

Are admin account passwords made available to the local IT departments to facilitate Fully Credentialed Scans?

YES

NO

2.8 - VULNERABILITY MANAGEMENT/PATCHING POLICY

CYBERLOG MDERA VER 4.0 PAGE 11 OF 15

Provide a summary describing the plan for providing validated software updates and patches throughout the life cycle of the medical device/equipment. Include timeframes to approve patches, if critical OS patches can be installed without vendor permission. The summary should describe how the security patch is validated and then installed (e.g. remote installation by the vendor or distribution by the vendor for biomedical personnel at the healthcare organization to install.) The vendor should also specify the frequency of product updates.

2.9 REMOTE ACCESS

The software that provides the remote access capability must be included in the Application Inventory. Examples of remote desktop software applications are Microsoft Remote Desktop (MSRDP) and Secure Shell (SSH) Yes No

Can the medical device be serviced remotely (i.e., through the use of a secure point to point encrypted network connection)

Can the device be configured to require the local use to accept or initiate remote access?

Does the device provide an explicit indication of use to users physically present at collaborative computing devices?

Does the device require unrestricted access to the Internet in order to provide remote access?

2 . 1 0 W I R E LES S C A P A B I L I T I E S

( I E E E 8 0 2 . 1 1 )

State whether the medical system/device employs any form of wireless communication, either standards-based and/or proprietary to facilitate the transmission/reception of data between system components and/or other systems? Yes No

Does the system employ wireless communication?

Wireless Mode of Operation ad hoc? (eg. Device connects internally to another wireless system component)

Wireless Mode of Operation infrastructure? (eg. Device connects to a LAN Environment)

Wireless Authentication Method (eg. PKI, User-name/Password, Token)

Wireless Encryption Method (eg. AES-256

CCMP)

I E E E 8 0 2 . 1 5 B L U E T O O T H ( W i r e l e s s P e r s o n a l A r e a N e t w o r k – W P A N )

Use FIPS 140-2 validated cryptographic modules for data in transit, including digital voice communications.

Bluetooth Discovery Mode Turned Off by default.

W I R E L E S S – O t h e r

(Describe any other wireless capabilities, i.e. Ultrawide band, Zigbee, etc.)

Wireless Technology Range (ft.)

(indoor/outdoor) Throughput (Mbps) Purpose

CYBERLOG MDERA VER 4.0 PAGE 12 OF 15

2.11 – MASS STORAGE

Provide a summary describing if the use of USB Thumb Drives/External Hard Drives is required for the operation of the system. Are drives required for use by the operator, or administrative in nature? Please detail what information is stored on the drives, how information on the drives is protected, and alternatives to using the drives.

CYBERLOG MDERA VER 4.0 PAGE 13 OF 15

Section 3: Data Processing Capabilities S Y S T E M I D E N T I F I C A T I O N – D a t a P r o c e s s i n g , E l e c t r o n i c P r o t e c t e d H e a l t h I n f o r m a t i o n / R M F A u t h o r i z a t i o n

3.0 Data Processing Capabilities:

Does the proposed medical device/equipment perform any of the following data processing functions? (check all that apply)

Receive Process Store Transmit Display

3.1 Electronic Protected Health Information/Personally

Identifiable Information (ePHI/PII):

(as defined by HIPAA Security Rule, 45 CFR Part 164) Indicate whether the proposed medical device acquires, processes, stores, displays/routes ePHI.

Yes No

3.2 Non ePHI/PII information

Define any data processed that is not ePHI/PII information.

3.3 Electronic Protected Health Information/Personally

Identifiable Information (ePHI/PII) Elements: (as defined by HIPAA Security Rule, 45 CFR Part 164) Identify each and all applicable ePHI elements.

Address

Dates of Birth, Admission, Discharge, Death, and all ages over 89 [and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older]

Social Security Number

Telephone numbers

Fax number

E-Mail address

Medical Record Number

Health Plan beneficiary number

Account number

Certificate/License number

Any vehicle or other device serial number

Device identifier or serial numbers

Web Uniform Resource Locator (URL)

IP address

Finger or voice prints

Photographic/Radiographic images

Test Results

Physiologic data with identifying characteristics

Biometric data

Personal Financial Data

Any other unique identifying number, characteristic, or code.

3.4 DoD Information Persistence/Electronic Protected Health

Information/Personally Identifiable Information (ePHI/PII) storage method:

Describe the persistence of the DoD Information processed/stored/transmitted on or by the system.

Permanently Temporarily

Describe the method in which data is removed from the MDE, and amount of time for data storage. (i.e., First in First Out, removed upon system reset, manually removed, etc.)

3.5 Data Input Method

Describe the data input method. Distinguish between manual versus "prescribed" (automated/programmed) data input methods.

3.6 Data Workflow

Indicate what data elements enter the MDE, and what data elements leave the MDE. Indicate how data is processed and, or changed by the MDE.

CYBERLOG MDERA VER 4.0 PAGE 14 OF 15

S Y S T E M I D E N T I F I C A T I O N – D a t a P r o c e s s i n g , E l e c t r o n i c P r o t e c t e d H e a l t h I n f o r m a t i o n / R M F A u t h o r i z a t i o n

3.7 Data At Rest Encryption Capabilities

Describe any capability to encrypt data at rest. Include Encryption method and key strength (i.e. Bitlocker, AES-256)

3.8 Data in Transit Encryption Capabilities

Describe any capability to encrypt DoD Information/ePHI/PII while in transit. Include Encryption method and key strength (i.e. AES-256)

CYBERLOG MDERA VER 4.0 PAGE 15 OF 15

V E N D O R : D O N O T C O M P L E T E A N Y T H I N G B E Y O N D T H I S P O I N T

I D E N T I F I C A T I O N I N F O R M A T I O N

RFO/Contract Number:

ACN:

CE POC:

Contracting POC:

Assigned CyberLOG Container

(based on answers in Sections 2.6-2.8)

End Point Protection:

Yes (1) No (0)

Scanning:

Yes (1) No (0)

Patching:

Yes (1) No (0)

Assigned Container:

(000 – 111)

Comments ISSO will need to review and provide justification for findings within the MDERA.

Need to cover how information was gathered/verified, etc.

2.678

MDERA Reviewed By:

Name: Digital Signature Date

PRIMARY VENDOR POINT OF CONTACT (POC) INFORMATION (Vendor Account Manager)
VENDOR TECHNICAL POINT OF CONTACT (POC) INFORMATION (Technical POC Responsible for conducting RMF Activities)
MEDICAL DEVICE AND EQUIPMENT IDENTIFICATION – Technical and Regulatory
SYSTEM ARCHITECTURE DRAWING:
2.10 WIRELESS CAPABILITIES
(IEEE 802.11)
IEEE 802.15 BLUETOOTH (Wireless Personal Area Network – WPAN)
WIRELESS – Other
SYSTEM IDENTIFICATION – Data Processing, Electronic Protected Health Information/RMF Authorization
VENDOR: DO NOT COMPLETE ANYTHING BEYOND THIS POINT
IDENTIFICATION INFORMATION
Name:
Job Title:
Company:
Business Address:
EMail Address:
Phone Number:
Web page Address:
DATE:
Name_2:
Job Title_2:
Company_2:
Business Address_2:
EMail Address_2:
Phone Number_2:
Web page Address_2:
DATE_2:
10 Medical DeviceEquipment TitleVersion Provide the naming convention for the medical deviceequipment and primary application version:
11 Medical Device Description Provide a brief technical description of the medical devicesequipment intended usecapability If applicable the FDA 510K Summary Description should be used for accuracy:
12 Medical DeviceEquipment Model List all devicesequipment and versions covered under this review eg family of systems:
13 Product SuiteFamily of Products Indicate whether the medical deviceequipment is marketed by any other model brand names trademark or product suitefamily eg Resellers:
14 Medical DeviceEquipment Category Recommend use of ECRI Institutes Universal Medical Device Nomenclature System UMDNS:
Release Date:
EOL Date:
16 Food and Drug Administration FDA 510Kother Regulatory Certification or Premarket Authorization identifier if applicable Provide the number associated with the medical deviceequipment if applicable:
17 Department of Defense DoDDefense Health Agency DHA Authorization State whether the proposed medical deviceequipment has been or is currently undergoing the DoDDHA Risk Management Framework RMF Authorization process and the corresponding eMASS record identifier State the originating office conducting the RMF efforts as well as the Authorization Termination Date ATD:
ATD:
18 Baseline physical testing location Indicate whether an instance of the MDE installed at the manufacturers facility is available for RMF Assessment If such a system is available provide complete street address:
Standalone Operates in complete isolation and thus does not require the use of networking: Off
Peer to Peer Operates in complete isolation but requires the use of networking protocols: Off
ClientServer Operates as a distributed application that partitions task or workloads between the: Off
Webbased Operates as a distributed application that requires the use of a browser to access the: Off
Hostbased Operates as a passive subsystem which requires connection a host computer to: Off
Cloudbased Operates within a cloudservice environment: Off
Government Cloud Service Provider eg DISA SPAWAR: Off
Commercial Cloud Service Provider eg Amazon Web Service: Off
System comprises Hardware Software Firmware traditional configuration: Off
System is Software Only in a Physical Environment requires hardware provided by the GOV: Off
System is Software Only in a Virtual Environment requires virtual environment: Off
Virtual Environment must be provided by the Government: Off
Virtual Environment provided by the Vendor: Off
Government must provide all Operating SystemDatabaseApplication Virtual: Off
Serial over RS232: Off
RJ45 Networked: Off
Serial to RJ45 Connection: Off
80211 Wireless: Off
Other Specify Connection Type Below: Off
CONNECTION TYPE Serial over RS232 RJ45 Networked Serial to RJ45 Connection 80211 Wireless Other Specify Connection Type Below112 Connected Systems Describe the types of systems this will connect to or communicate with ie PACS Networked patient monitors Stand Alone EHR etc:
ComponentRow1:
PurposeRow1:
CommentsRow1:
ComponentRow2:
PurposeRow2:
CommentsRow2:
ComponentRow3:
PurposeRow3:
CommentsRow3:
ComponentRow4:
PurposeRow4:
CommentsRow4:
ComponentRow5:
PurposeRow5:
CommentsRow5:
ComponentRow6:
PurposeRow6:
CommentsRow6:
ComponentRow1_2:
Operating SystemRow1:
Service Pack LevelRow1:
End of Life DateRow1:
Extended SupportRow1:
VirtualizedRow1:
ComponentRow2_2:
Operating SystemRow2:
Service Pack LevelRow2:
End of Life DateRow2:
Extended SupportRow2:
VirtualizedRow2:
ComponentRow3_2:
Operating SystemRow3:
Service Pack LevelRow3:
End of Life DateRow3:
Extended SupportRow3:
VirtualizedRow3:
ComponentRow4_2:
Operating SystemRow4:
Service Pack LevelRow4:
End of Life DateRow4:
Extended SupportRow4:
VirtualizedRow4:
ComponentRow5_2:
Operating SystemRow5:
Service Pack LevelRow5:
End of Life DateRow5:
Extended SupportRow5:
VirtualizedRow5:
ComponentRow6_2:
Operating SystemRow6:
Service Pack LevelRow6:
End of Life DateRow6:
Extended SupportRow6:
VirtualizedRow6:
ComponentRow1_3:
ApplicationRow1:
VersionRow1:
End of Life DateRow1_2:
PurposeRow1_2:
ComponentRow2_3:
ApplicationRow2:
VersionRow2:
End of Life DateRow2_2:
PurposeRow2_2:
ComponentRow3_3:
ApplicationRow3:
VersionRow3:
End of Life DateRow3_2:
PurposeRow3_2:
ComponentRow4_3:
ApplicationRow4:
VersionRow4:
End of Life DateRow4_2:
PurposeRow4_2:
Describe how accounts are created site setup accounts vs vendor default List all account types in the table below:
ComponentRow1_4:
Account TypeRow1:
Admin AccountRow1:
Application OS or DBRow1:
Authentication Method PKI UNPWD etcRow1:
PurposeRow1_3:
ComponentRow2_4:
Account TypeRow2:
Admin AccountRow2:
Application OS or DBRow2:
Authentication Method PKI UNPWD etcRow2:
PurposeRow2_3:
ComponentRow3_4:
Account TypeRow3:
Admin AccountRow3:
Application OS or DBRow3:
Authentication Method PKI UNPWD etcRow3:
PurposeRow3_3:
ComponentRow4_4:
Account TypeRow4:
Admin AccountRow4:
Application OS or DBRow4:
Authentication Method PKI UNPWD etcRow4:
PurposeRow4_3:
For any application or Operating System listed above with less than 24 months of supportextended support describe the migration plan or upgrade path to maintain complianceRow1:
a b c:
Indicate limitations for the ability to run vulnerability scans ie NessusACAS scans against the device:
MDE can be scanned in a testvendor lab environment only:
No scanning capability at all Serialno networking capability:
MDE can be scanned in a live environment:
Provide a summary describing if Network Vulnerability scans can be run against the device while in a live environment and any limitations to the ability to scan the device in real time ie restrictions on running scans while conducting a study system must be dehardened and coordinated with the vendor prior to scanning etc If the MDE cannot be scanned in a live environment but can be scanned in a vendor test lab describe in detail the limitations to scanning within the live environment Impact to patient safety etcRow1:
Provide a summary describing the plan for providing validated software updates and patches throughout the life cycle of the medical deviceequipment Include timeframes to approve patches if critical OS patches can be installed without vendor permission The summary should describe how the security patch is validated and then installed eg remote installation by the vendor or distribution by the vendor for biomedical personnel at the healthcare organization to install The vendor should also specify the frequency of product updatesRow1:
Wireless Authentication Method eg PKI UsernamePassword Token:
Wireless Encryption Method eg AES256 CCMP:
Wireless TechnologyRow1:
Range ft indooroutdoorRow1:
Throughput MbpsRow1:
PurposeRow1_4:
Wireless TechnologyRow2:
Range ft indooroutdoorRow2:
Throughput MbpsRow2:
PurposeRow2_4:
Provide a summary describing if the use of USB Thumb DrivesExternal Hard Drives is required for the operation of the system Are drives required for use by the operator or administrative in nature Please detail what information is stored on the drives how information on the drives is protected and alternatives to using the drivesRow1:
Receive: Off
Process: Off
Store: Off
Transmit: Off
Display: Off
undefined_3: Off
Yes No32 Non ePHIPII information Define any data processed that is not ePHIPII information:
Address: Off
Dates of Birth Admission Discharge Death and all ages over 89 and all elements of dates: Off
Social Security Number: Off
Telephone numbers: Off
Fax number: Off
EMail address: Off
Medical Record Number: Off
Health Plan beneficiary number: Off
Account number: Off
CertificateLicense number: Off
Any vehicle or other device serial number: Off
Device identifier or serial numbers: Off
Web Uniform Resource Locator URL: Off
IP address: Off
Finger or voice prints: Off
PhotographicRadiographic images: Off
Test Results: Off
Physiologic data with identifying characteristics: Off
Biometric data: Off
Personal Financial Data: Off
Any other unique identifying number characteristic or code: Off
Permanently: Off
Temporarily: Off
35 Data Input Method Describe the data input method Distinguish between manual versus prescribed automatedprogrammed data input methods:
36 Data Workflow Indicate what data elements enter the MDE and what data elements leave the MDE Indicate how data is processed and or changed by the MDE:
37 Data At Rest Encryption Capabilities Describe any capability to encrypt data at rest Include Encryption method and key strength ie Bitlocker AES256:
38 Data in Transit Encryption Capabilities Describe any capability to encrypt DoD InformationePHIPII while in transit Include Encryption method and key strength ie AES256:
RFOContract Number:
ACN:
CE POC:
Contracting POC:
Yes 1: Off
No 0: Off
Yes 1_2: Off
No 0_2: Off
Yes 1_3: Off
No 0_3: Off
Assigned Container 000 111:
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Date_2:
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Text12:
Attach:
Text14:
Text15:
Check Box16: Off
Check Box17: Off
Check Box18: Off
Check Box19: Off
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Check Box21: Off
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Check Box23: Off
Check Box24: Off
Check Box25: Off
Check Box26: Off
Check Box27: Off
Check Box28: Off
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Check Box32: Off
Check Box33: Off
Check Box34: Off
Check Box35: Off
Check Box36: Off
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Check Box38: Off
Check Box39: Off
Check Box40: Off
Check Box41: Off
Check Box42: Off
Check Box43: Off

File details come from the government source that posted it. Updated .