📄 Description (English)
OpenEMR is a free and open source electronic health records and medical practice management application. Prior to version 8.0.0.3, an authenticated user with access to the Carecoordination module can upload a crafted CCDA document containing `<xi:include href="file:///etc/passwd" parse="text"/>` to read arbitrary files from the server. Version 8.0.0.3 patches the issue.
🤖 AI Executive Summary
OpenEMR versions prior to 8.0.0.3 contain an XML External Entity (XXE) injection vulnerability in the Carecoordination module that allows authenticated users to read arbitrary files from the server via crafted CCDA documents. This high-severity vulnerability (CVSS 7.7) poses significant risk to healthcare organizations in Saudi Arabia that rely on OpenEMR for patient records management. Immediate patching to version 8.0.0.3 or later is critical to prevent unauthorized access to sensitive medical and system data.
📄 Description (Arabic)
🤖 AI Intelligence Analysis Analyzed: Apr 29, 2026 20:34
🇸🇦 Saudi Arabia Impact Assessment
Healthcare sector organizations in Saudi Arabia using OpenEMR are at highest risk, including private hospitals, clinics, and medical centers. The vulnerability directly threatens patient confidentiality and data protection compliance under SAMA's healthcare cybersecurity requirements. Government health facilities under MOH and private healthcare providers are exposed to unauthorized access to sensitive patient records (PHI), system configuration files, and potentially database credentials. The vulnerability could enable attackers to access /etc/passwd, configuration files containing database credentials, and other sensitive system information, leading to broader system compromise and regulatory violations under Saudi healthcare data protection laws.
🏢 Affected Saudi Sectors
Healthcare
Government Health Services
Private Medical Centers
Hospitals and Clinics
Telemedicine Providers
🎯 MITRE ATT&CK Techniques
T1190 - Exploit Public-Facing Application (XXE injection via CCDA upload)
T1005 - Data from Local System (reading /etc/passwd and other local files)
T1552.001 - Unsecured Credentials (potential access to database credentials in config files)
T1083 - File and Directory Discovery (arbitrary file read capability)
T1040 - Traffic Capture or Replay (potential interception of sensitive data)
⚖️ Saudi Risk Score (AI)
8.2
/ 10.0
🔧 Remediation Steps (English)
IMMEDIATE ACTIONS:
1. Identify all OpenEMR instances in your healthcare environment and verify current versions
2. Restrict access to the Carecoordination module to only essential personnel pending patching
3. Review access logs for suspicious CCDA document uploads in the past 90 days
4. Monitor for indicators of compromise (IOCs) related to /etc/passwd access attempts
PATCHING GUIDANCE:
1. Upgrade OpenEMR to version 8.0.0.3 or later immediately
2. Test patches in a non-production environment first to ensure compatibility with existing workflows
3. Coordinate patching with healthcare operations to minimize disruption to patient care
4. Verify patch application by confirming version number in system settings
COMPENSATING CONTROLS (if immediate patching not possible):
1. Disable the Carecoordination module entirely until patching is completed
2. Implement strict input validation and file upload restrictions at the application level
3. Configure Web Application Firewall (WAF) rules to block XXE payloads containing 'xi:include' and 'file://' patterns
4. Restrict file system permissions to limit what files the OpenEMR application user can access
5. Implement network segmentation to isolate OpenEMR servers from sensitive systems
DETECTION RULES:
1. Monitor application logs for CCDA uploads containing 'xi:include' or 'file://' strings
2. Alert on any attempts to access /etc/passwd or other sensitive system files through OpenEMR processes
3. Track unusual file read operations from the OpenEMR application user account
4. Monitor for XML parsing errors or XXE-related exceptions in application logs
5. Implement SIEM rules to detect multiple failed authentication attempts followed by file access attempts
🔧 خطوات المعالجة (العربية)
الإجراءات الفورية:
1. تحديد جميع مثيلات OpenEMR في بيئة الرعاية الصحية والتحقق من الإصدارات الحالية
2. تقييد الوصول إلى وحدة Carecoordination للموظفين الأساسيين فقط في انتظار التحديث
3. مراجعة سجلات الوصول للتحميلات المريبة لوثائق CCDA في آخر 90 يوماً
4. مراقبة مؤشرات الاختراق المتعلقة بمحاولات الوصول إلى /etc/passwd
إرشادات التصحيح:
1. ترقية OpenEMR إلى الإصدار 8.0.0.3 أو أحدث فوراً
2. اختبار التصحيحات في بيئة غير إنتاجية أولاً للتأكد من التوافق مع سير العمل الحالي
3. تنسيق التصحيح مع عمليات الرعاية الصحية لتقليل التأثير على رعاية المرضى
4. التحقق من تطبيق التصحيح بتأكيد رقم الإصدار في إعدادات النظام
الضوابط البديلة (إذا لم يكن التصحيح الفوري ممكناً):
1. تعطيل وحدة Carecoordination بالكامل حتى اكتمال التصحيح
2. تنفيذ التحقق الصارم من المدخلات وتقييد تحميل الملفات على مستوى التطبيق
3. تكوين قواعد جدار حماية تطبيقات الويب (WAF) لحظر حمولات XXE التي تحتوي على 'xi:include' و 'file://'
4. تقييد أذونات نظام الملفات لتحديد الملفات التي يمكن لمستخدم تطبيق OpenEMR الوصول إليها
5. تنفيذ تقسيم الشبكة لعزل خوادم OpenEMR عن الأنظمة الحساسة
قواعد الكشف:
1. مراقبة سجلات التطبيق لتحميلات CCDA التي تحتوي على سلاسل 'xi:include' أو 'file://'
2. التنبيه على أي محاولات للوصول إلى /etc/passwd أو ملفات نظام حساسة أخرى من خلال عمليات OpenEMR
3. تتبع عمليات قراءة الملفات غير العادية من حساب مستخدم تطبيق OpenEMR
4. مراقبة أخطاء تحليل XML أو الاستثناءات المتعلقة بـ XXE في سجلات التطبيق
5. تنفيذ قواعد SIEM للكشف عن محاولات مصادقة متعددة فاشلة متبوعة بمحاولات الوصول إلى الملفات
📋 Regulatory Compliance Mapping
🟢 NCA ECC 2024
ECC 2024 A.5.1.1 - Access Control Policies (authentication and authorization for Carecoordination module)
ECC 2024 A.8.2.1 - User Access Management (restrict module access to authorized personnel)
ECC 2024 A.12.2.1 - Change Management (patch management procedures)
ECC 2024 A.14.2.1 - Secure Development (input validation and XXE prevention)
🔵 SAMA CSF
SAMA CSF ID.AM-2 - Asset Management (inventory OpenEMR instances)
SAMA CSF PR.AC-1 - Access Control (restrict Carecoordination module access)
SAMA CSF PR.DS-1 - Data Security (protect patient health information from unauthorized access)
SAMA CSF DE.CM-1 - Detection and Analysis (monitor for XXE exploitation attempts)
🟡 ISO 27001:2022
ISO 27001:2022 A.5.3 - Segregation of duties (restrict Carecoordination access)
ISO 27001:2022 A.8.1 - User endpoint devices (secure file upload mechanisms)
ISO 27001:2022 A.12.6.1 - Management of technical vulnerabilities (patch management)
ISO 27001:2022 A.14.2.1 - Secure development policy (input validation and XXE prevention)
🟣 PCI DSS v4.0.1
PCI DSS 6.2 - Security patches and updates (apply patches promptly)
PCI DSS 6.5.1 - Injection flaws (XXE is a form of injection attack)
🔗 References & Sources 3
🔗
https://github.com/openemr/openemr/commit/67e1702c41cf486af0069bdafce19860e2cd9a11
security-advisories@github.com
Patch
🔗
https://github.com/openemr/openemr/releases/tag/v8_0_0_3
security-advisories@github.com
Product
🔗
https://github.com/openemr/openemr/security/advisories/GHSA-9757-3cfj-wc8q
security-advisories@github.com
Exploit
Mitigation
Vendor Advisory
📦 Affected Products / CPE 1 entries
open-emr:openemr