Authenticated Patient Record Creation and Enumeration in OpenEMR

Executive Summary

This vulnerability affects OpenEMR versions before 8.5.0. It allows any authenticated user, even with minimal privileges, to create new patient records with protected health information (PHI) or enumerate all patients in the system. The issue occurs because certain endpoints like new_comprehensive_save.php, new_search_popup.php, and patient_select.php lack proper authorization checks by not calling AclMain::aclCheckCore().

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Detection Guidance

Check OpenEMR versions prior to 8.5.0 for unauthorized patient record creation or enumeration attempts. Monitor POST requests to endpoints like new_comprehensive_save.php, new_patient_save.php, new_search_popup.php, and patient_select.php. Look for unusual activity such as creation of patients with PHI or queries returning multiple patient records without proper authorization.

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Impact Analysis

Attackers can exploit this to create unauthorized patient records containing sensitive data like names, SSNs, DOBs, and insurance details. They can also leak existing patient information by searching or enumerating records without proper access controls.

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Compliance Impact

This vulnerability likely violates compliance with regulations like HIPAA and GDPR due to unauthorized access and exposure of protected health information (PHI). It enables data breaches, unauthorized record creation, and potential leakage of sensitive patient data, all of which are critical compliance violations.

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Mitigation Strategies

Upgrade OpenEMR to version 8.5.0 or later to apply the necessary authorization checks. Ensure AclMain::aclCheckCore() is implemented in all affected endpoints. Review and restrict user permissions to minimize potential abuse. Monitor logs for suspicious activity related to patient record creation or enumeration.

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