CVE-2025-31121
📋 TL;DR
OpenEMR versions before 7.0.3.1 contain a cross-site scripting vulnerability in the Patient Image feature. Attackers can inject malicious scripts via EXIF title metadata in uploaded images, which then execute when viewed by other users. This affects all OpenEMR installations using vulnerable versions.
💻 Affected Systems
- OpenEMR
📦 What is this software?
Openemr by Open Emr
⚠️ Risk & Real-World Impact
Worst Case
Attackers could steal healthcare provider credentials, access sensitive patient health records, or perform administrative actions on behalf of authenticated users.
Likely Case
Attackers could hijack user sessions, steal authentication cookies, or redirect users to malicious sites.
If Mitigated
With proper input validation and output encoding, the malicious scripts would be rendered harmless as text rather than executed.
🎯 Exploit Status
Exploitation requires an attacker to upload a malicious image with crafted EXIF metadata and have a victim view the image. Some level of access to upload images is needed.
🛠️ Fix & Mitigation
✅ Official Fix
Patch Version: 7.0.3.1
Vendor Advisory: https://github.com/openemr/openemr/security/advisories/GHSA-2w94-qmj6-3qxx
Restart Required: Yes
Instructions:
1. Backup your OpenEMR installation and database. 2. Download OpenEMR 7.0.3.1 from the official repository. 3. Replace the existing installation with the patched version. 4. Restart the web server service. 5. Verify the update was successful.
🔧 Temporary Workarounds
Disable Patient Image Upload
allTemporarily disable the Patient Image feature to prevent exploitation while planning an upgrade.
Modify OpenEMR configuration to disable image upload functionality
Implement WAF Rules
allConfigure web application firewall to block malicious script patterns in image metadata.
Add XSS detection rules to your WAF configuration
🧯 If You Can't Patch
- Implement strict content security policies (CSP) to prevent script execution from untrusted sources
- Apply input validation and output encoding at the application layer for all user-supplied image metadata
🔍 How to Verify
Check if Vulnerable:
Check OpenEMR version via admin interface or by examining the source code version files. If version is below 7.0.3.1, the system is vulnerable.Check Version:
Check the version.php file or use the OpenEMR admin dashboard to view current versionVerify Fix Applied:
After upgrading to 7.0.3.1, test by uploading an image with script tags in EXIF title and verify they are properly sanitized when displayed.📡 Detection & Monitoring
Log Indicators:
- Unusual image upload patterns
- Multiple failed upload attempts with special characters in filenames
- User sessions terminating unexpectedly after viewing images
Network Indicators:
- HTTP requests containing script tags in image metadata parameters
- Outbound connections to suspicious domains following image views
SIEM Query:
source="openemr_logs" AND ("image upload" OR "patient_image") AND ("<script>" OR "javascript:" OR "onerror=" OR "onload=")