An attacker with local access the to medical office computer can escalate his Windows user privileges to "NT AUTHORITY\SYSTEM" by exploiting a race condition in the Elefant Update Service during the repair or update process. When using the repair function, the service queries the server for a list of files and their hashes. In addition, instructions to execute binaries to finalize the repair process are included. The executables are executed as "NT AUTHORITY\SYSTEM" after they are copied over to the user writable installation folder (C:\Elefant1). This means that a user can overwrite either "PostESUUpdate.exe" or "Update_OpenJava.exe" in the time frame after the copy and before the execution of the final repair step. The overwritten executable is then executed as "NT AUTHORITY\SYSTEM".

An attacker with local access the to medical office computer can escalate his Windows user privileges to "NT AUTHORITY\SYSTEM" by exploiting a command injection vulnerability in the Elefant Update Service. The command injection can be exploited by communicating with the Elefant Update Service which is running as "SYSTEM" via Windows Named Pipes.The Elefant Software Updater (ESU) consists of two components. An ESU service which runs as "NT AUTHORITY\SYSTEM" and an ESU tray client which communicates with the service to update or repair the installation and is running with user permissions. The communication is implemented using named pipes. A crafted message of type "MessageType.SupportServiceInfos" can be sent to the local ESU service to inject commands, which are then executed as "NT AUTHORITY\SYSTEM".