CVE-2018-17181 in OpenEMR
Summary
by MITRE
An issue was discovered in OpenEMR before 5.0.1 Patch 7. SQL Injection exists in the SaveAudit function in /portal/lib/paylib.php and the portalAudit function in /portal/lib/appsql.class.php.
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Analysis
by VulDB Data Team • 09/21/2023
The vulnerability identified as CVE-2018-17181 represents a critical SQL injection flaw affecting OpenEMR versions prior to 5.0.1 Patch 7. This vulnerability resides within the patient portal functionality of the electronic medical records system, specifically in two key files that handle audit logging and payment processing operations. The flaw allows attackers to manipulate database queries through malicious input parameters, potentially compromising the integrity and confidentiality of sensitive patient health information stored within the system. The affected functions SaveAudit in /portal/lib/paylib.php and portalAudit in /portal/lib/appsql.class.php demonstrate a classic lack of proper input validation and parameterization in database operations, creating an attack surface that could be exploited by malicious actors to execute arbitrary SQL commands.
The technical exploitation of this vulnerability occurs through improper sanitization of user-supplied data within the audit logging functions. When users interact with the patient portal payment processing features or audit trail functionalities, the application fails to properly escape or parameterize input values before incorporating them into SQL queries. This design flaw directly maps to CWE-89 which categorizes SQL injection vulnerabilities as a result of inadequate input validation and improper use of database APIs. Attackers can craft malicious payloads that manipulate the SQL execution flow, potentially gaining unauthorized access to the underlying database, extracting confidential patient records, modifying audit logs to cover malicious activities, or even escalating privileges within the database environment. The vulnerability affects the core data integrity mechanisms of the system, particularly when audit trails are being maintained for financial transactions and user activities.
The operational impact of this vulnerability extends beyond simple data theft to encompass complete system compromise and regulatory compliance violations. Healthcare organizations utilizing affected OpenEMR versions face significant risk of data breaches that could expose Protected Health Information (PHI) in violation of HIPAA regulations and other healthcare data protection mandates. The audit logging functionality, which is meant to provide security monitoring and compliance tracking, becomes compromised when attackers can manipulate these very logs to hide their activities. This creates a dangerous situation where security monitoring systems become ineffective, as malicious actors can alter or delete audit records to avoid detection. The vulnerability also poses risks to business continuity and patient care, as attackers could potentially disrupt payment processing workflows or manipulate patient data access controls through database manipulation.
Mitigation strategies for CVE-2018-17181 require immediate implementation of the vendor-provided patch version 5.0.1 Patch 7 which addresses the SQL injection vulnerabilities through proper input validation and parameterized database queries. Organizations should implement comprehensive input sanitization measures that enforce strict data type validation and escape special characters in all user-supplied inputs before database processing. The remediation process must include code review of the affected files to ensure proper implementation of prepared statements and parameterized queries as recommended by the OWASP Top Ten and NIST guidelines for secure coding practices. Network segmentation and database access controls should be enhanced to limit the potential impact of successful exploitation, while implementing comprehensive monitoring solutions to detect anomalous database access patterns that could indicate attempted exploitation of the vulnerability. Additionally, regular security assessments and penetration testing should be conducted to identify and remediate similar vulnerabilities in other system components, following ATT&CK framework mappings for database attack patterns and ensuring compliance with healthcare security standards.