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June 9, 2026

Healthcare’s OT Cybersecurity Gap: Why Hospitals Must Make the Same Security Investments as Regulated Critical Infrastructures

Healthcare organizations rely on OT and IoMT more than ever. Learn why OT cybersecurity expertise, visibility, and governance are critical to reducing operational risk and strengthening cyber resilience.
Inside the SOC
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Daniel Simonds
Director of Operational Technology
Written by
Joseph Williams
OT Specialist
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09
Jun 2026

Rethinking the healthcare attack surface

When most people think about Operational Technology (OT) cybersecurity, they think about oil & gas pipelines, utilities, manufacturing plants, or power grids. However, hospitals & healthcare systems have quickly become a point of focus in the OT cybersecurity community as they do employ a variety of OT in the form of IoMT (Internet of Medical Things) networked devices such as: infusion pumps, imaging systems, patient monitoring equipment, laboratory systems, and traditional industrial control systems (ICS) in the form of smart building management systems (BMS) and even on site power generation control systems. 

These healthcare environments are no longer just traditional IT ecosystems, they are cyber-physical environments where disruption can directly impact patient care, operational continuity, and ultimately patient safety.

The OT cybersecurity expertise gap in healthcare organizations

Our research in the OT cybersecurity space revealed a concerning trend. Many hospitals and healthcare networks lack dedicated OT cybersecurity teams, OT security full time employees (FTE) and even OT expertise in the form of OT security certifications when compared to other critical infrastructure sectors.

On the other hand, within industries such as energy and manufacturing, we encounter more mature OT security programs that employ full time employees  dedicated to OT cybersecurity with OT security certifications and expertise to secure industrial and operational environments and lead investment in OT security processes and technology.

When reviewing the top 20 U.S. Hospitals by market cap, given what is publicly available on LinkedIn, only one FTE with an OT cybersecurity certification was found. The certifications that were searched for include: GIAC GICSP, GIAC GRID, GIAC GCIP and all ISA/IEC 62443 certifications. When replicating this same search across the top 20 utility providers in the US, 73 FTEs with OT related certifications were identified. As a control group, we looked within financial services, an industry NOT expected to have OT systems worth investing in FTEs to protect. However, the top 20 US financial institutions had 18 FTEs with OT related certifications. 

What these findings reveal

Overall, the findings regarding healthcare investment in OT security FTEs are surprising given how operationally dependent modern healthcare has become on OT. So why aren't hospitals investing in OT security personnel at the rate of peer critical infrastructures? It could just be lack of awareness; however, there are other, more plausible reasons.  

Based on historical trends in cyber incidents within the healthcare space, one could speculate that there is significantly greater likelihood of being victim to an attack that  focuses on extortion or data theft rather than an attack on specific OT systems. The amount of ransomware events incurred in healthcare, that historically do not target OT systems, may divert attention and security investment to the parts of the attack surface most likely to be targeted by ransomware. Additionally, data theft is a relevant threat objective for hospitals given PHI, PCI and PII, and data theft does not traditionally align with attacks targeting OT.  

However, with focused investment to address data theft and with adversaries new capability to string together chains of vulnerabilities of different severity scores using advancements in AI, we could be entering a threat landscape where adversaries pivot their tactics to target exposed and under protected devices and systems like OT. For example, although not a patient records database, predominant IOMT protocols HL7 and DICOM are unencrypted plaintext protocols and unless encrypted it is very simple for adversaries, who are sniffing traffic, to identify protected health information (PHI) in these communication protocols.

Why OT cybersecurity expertise can be effective for healthcare organizations

The convergence of IT, OT, and IoMT is already here, and threat actors are increasingly aware of the operational vulnerabilities that come with it. Additionally, as AI solutions such as agentic or generative applications are adopted and deployed, the attack surface will continue to change as permissions, and new connections will exist to support AI efficiency. From a cybersecurity standpoint, the reality is that many healthcare organizations are still working to establish consistent visibility and governance across their enterprise-connected devices and systems as their attack surface is changing in real time.  As the healthcare sector remains a significant target for cyber-attacks, hospitals would be well advised to begin addressing their operational environments OT as a critical component of their attack surface and invest in securing them first with people, then process and technology. 

What can healthcare organizations do to secure their OT

Including OT in current cybersecurity processes such as red teaming and testing incident response plans that take OT into account alongside building dedicated OT security capabilities including improving OT network visibility, leveraging OT network anomaly detection, micro-segmentation, and secure remote access will become essential steps in strengthening healthcare resilience. 

However, before any of the above processes or investments in technology can be made, these healthcare organizations, like the other critical infrastructure sectors, need to invest in the people with the experience in OT security to lead, implement, manage and audit the investment in OT cybersecurity technology and processes.  In cases where headcount cannot be added, investment in OT security certifications, such as the ones listed in this article, and participation on OT security events focused on practitioner training for existing cybersecurity employees can move the needle in terms of bringing OT expertise to the existing team.  

In an industry where uptime and safety are as mission critical as they are for a power utility, OT cybersecurity FTEs can no longer be viewed as optional for healthcare organizations and must become part of the foundation of modern healthcare cybersecurity strategy. 

[related-resource]

Healthcare Threat Report

Analysis of healthcare cybersecurity across the UK, US, and Brazil, covering ransomware targeting, patient data exposure, and more.

Inside the SOC
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Daniel Simonds
Director of Operational Technology
Written by
Joseph Williams
OT Specialist

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September 17, 2026

The Problem of Re-defining Human Value in the Agentic Age

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Newsfeeds are constantly informing us about the rapid escalation of agentic AI systems. These systems move far beyond simple machine-based computations, and  the focused, defined and bounded assistance that most AI systems started out as.

The next evolution of AI will harness the agentic properties of orchestration, automation, and heightened value-chains in IT, taking on the burden of workflow management, not just workflow delivery.

In nearly all of these instances, promises are made such as ‘this will free up human time’ or ‘this will allow people to focus on higher-order strategy’. However that message is delivered, one thing is clear: in ceding the orchestration and management of work to increasingly sophisticated AI agents and agentic systems, human value will be elevated to a particular and specific layer: the ability to judge its outputs.  As AI takes on more tasks, humans should be able to focus on a higher level of governance; making sure the decisions that AI offers us are ethical, responsible and worthwhile.  

But there are two major problems with that approach.

This blog discusses the problem of how Agentic systems are re-shaping how we review information, where we fit in, and when we make decisions.  It also discusses the problem of how the increased flow of confident, generated information affects the way we make judgement.  This blog considers how human judgement needs to adapt, and how a behavioral defense approach – using techniques pioneered by Darktrace – can help us do that.

The challenge of knowing where human judgement belongs

As we confer more automated decision-making to agentic systems, it might look increasingly less like ‘granting permissions’, and more like ‘surrendering authority’.  

The judgement layer for AI-generated work is not a fixed boundary. We have become used to the idea of a ‘human in the loop’ (HITL) and, historically, relationships between humans and IT systems were reasonably clear and bounded.  Computer and software systems were programmed to carry out certain tasks or automated functions, and humans could control the gates and decision points where actions were undertaken. Even across highly complex computational workflows, human interaction was a controllable node within the process; we were able to configure and regulate. But in the agentic age, where that human interaction sits, and what it can influence shifts every time AI systems are granted autonomy.  

This leads us to the first problem: if humans are moving themselves (or are being moved) into the ‘judgement’ part of the value chain, exactly where and when do we exercise that judgement?  

Humans are no longer the sole shepherds of computer-based or software-controlled outputs.  We are at times at least one step further (and slower) behind the new agentic shepherds.  We might also be blind to what they are doing.  Not only might we be removed and blind to the actions of our AI shepherds, but with the challenge of unknown, unapproved AI systems operating beyond our control, humans might not even know that our work is being shepherded by an AI at all.  Simply put, with the advent of greater levels of autonomy and orchestration, humans are at risk of not even knowing where to apply our newly-extended powers of strategic judgement.

Shadow AI – the use of unapproved AI systems or processes – is a growing threat to the role of effective governance and oversight. Shadow AI isn't just the AI you can't see. Its the AI you already know about being used in an unapproved way. The ability to generate effective oversight of the AI systems you use (or that are used on your behalf) will be increasingly important to ensure that human judgement in the AI value chain is effective, and deliberately placed.

The problem of what makes good judgement

The second problem lies in how flawed human judgement can be.  Humans are historically, notoriously, and, sometimes dangerously, unreliable when it comes to exercising judgement.  Humans are prone to the worst kinds of bias, the seduction of malign influence, and the sometimes-overwhelming urge to succeed. AI has long had a known flaw of operating with sycophancy, providing outputs that tend to agree with or flatter the human user.  But as AI grows ever more effective, there is a risk of both hyper-enablement (where humans increasingly and knowingly enable AI despite potential harm), as well as the greater risk of suggestion. Both of these aspects could skew the newly-elevated input of human judgement.

Imagine a highly competent AI system that has just orchestrated and managed a dizzying array of processes and workflows.  The AI is designed to present the human decision-maker with recommendations; based on analysis, comparison and other programmed factors.  This is where the human judgement layer is enabled.  But what if that judgement is summarily diffused by an AI-based recommendation that emulates the decision, provides plausible but unattractive alternatives, then suggests (or, worse, directs) the human end-user to take a particular course of action.

The risk here is that you are given a recommendation, tailored to your preferences (which the AI has learned, or which you have divulged), and which appears to make perfect sense.  It appears to be a well-weighted recommendation, with sound arguments that tap into our inherent biases or inclinations so that a specific decision-path is followed. With the growth of agentic systems specifically designed to match user profiles (from Cowork agents to ‘digital twin’ models), the likelihood of agentic influence could badly skew human judgement or, at the least, devalue the proposition that humans are taking a higher-layer of strategic control over AI-based decisions.

If AI convincingly recommends something that may be problematic, it can be difficult to discern both accurate data, and the context required to make the right judgement.

Given the two problems described above, the job of exercising valuable human judgement in the agentic age can draw down to these two questions:

  • When should humans intervene in the agentic process?  
  • How can we make the best possible judgement calls?

What humans contribute that AI cannot

For all the flaws that make human judgement unreliable, people have the edge over even the most sophisticated and powerful AI systems when it comes to issues such as ethics and social context.  An AI system can, with startling granularity, rank the value of adopting a new business proposal: offering predictive metrics on costs, returns, market value, time-to-deliver operations, conformance with legal registers, etc.  But it can’t tell if the business proposal is ethically sound, or if the business venture will potentially affect groups outside of the analyzed proposal. It can’t tell you if the CEO has a ‘bad feeling’ about this effort.  It can’t tell you if this is the right thing to do.  

The ability to add social context, balance complex interpersonal dynamics, understand nuance, and to go beyond what seems economically reasonable is where human judgement can add value.  

Human judgement is difficult to encapsulate in metrics. And the way we train our development may need to adapt too. Rather than building up a gradual, experiential knowledge base, we should think about training the skill of judgement itself; especially for an agentic age.

How behavioral security strengthens AI governance

If this all feels like a vicious circle (‘I need AI help to make good judgements’ / ‘AI can twist what I need to judge’) it needn’t be. The key to this is having a defense-in-depth approach, with tools that can actually help.

This is precisely where behavioral security becomes important. The complex and nuanced way that humans exercise judgement is often rooted in our ability to recognize behavior that doesn't look right. We may not always be able to articulate it immediately, but we can often identify when an action, recommendation, or outcome feels inconsistent with the context around it. As AI systems take on more responsibility across the decision chain, preserving that ability to recognize meaningful deviations becomes increasingly important.

Darktrace’s / SECURE AI is designed to do exactly that. It applies behavioral security to AI ecosystems, helping organizations understand how people, AI tools, identities, and agents interact across the business. By learning the patterns of normal AI usage and surfacing activity that deviates from those patterns, it provides security teams with the context needed to investigate risk, understand unusual behavior, and make informed governance decisions. Rather than relying solely on predefined rules or assumptions, this behavioral understanding helps organizations distinguish between expected AI activity and behavior that warrants closer scrutiny.

This matters because we are already in an era of information overload. If humans are expected to elevate their value through strategic judgement, the ability to do this without being overwhelmed by data (good or bad) will be critical.  

We need the ability to discern when we're being misled by AI, and whether our judgement calls are being made on the basis of accurate, contextual information. Darktrace / SECURE AI provides that additional layer of defensive security for activity we cannot easily see. Whether it is suspected Shadow AI or skewed recommendations, the net result is a protected organization, where users can more effectively use AI to make positive judgements.

For those where that judgement is a critical skill (both individuals, as well as those working in security teams), improving our metacognition - the ability to understand information in a broader context - will supercharge the value of human judgement. When those judgements are grounded in context rather than assumptions we have better information to make sound decisions.

Conclusion

Human judgement is a skill that is honed over time and experience.  Darktrace’s / SECURE AI employs the same principles, but at machine-speed. Rather than influencing or directing, Darktrace / SECURE AI offers AI-enabled assurance; providing human-based judgement with the right context to make a balanced decision.  

What we judge can be valued by the legitimacy of its outputs. For AI, those outputs are valued on the speed and accuracy of the information provided.  Increasingly for humans, the value of our outputs will be based on the validity of our judgement, and how we justify our decisions in ways that engineer confidence.  

Humans often know more than we can express, while AI is prone to expressing more than it truly understands. Humans can bridge the context AI often fails to appreciate. When that judgement is supported by relevant, impartial AI systems, this is the future space where good AI governance will be exercised.

Discover Darktrace / SECURE AI.

[related-resource]

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About the author
Jason Lusted
AI Governance Advisor

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September 4, 2026

Darktrace Advances Incident Investigation and AI-Agent Security with OpenAI Daybreak Models

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Earlier this year, Darktrace joined OpenAI’s Daybreak Defense Network to explore how their cyber capabilities can be integrated within Darktrace products and services to transform how security teams move from signal to action.

At the heart of this work is Darktrace's behavioral understanding of customer environments and identification of complex security incidents, combined with OpenAI models that can add context to help explain why an incident matters and its potential impact on the business. By bringing these capabilities into defensive workflows security teams already use, the goal is to give defenders not just greater visibility, but the context and guidance they need to act with confidence.

Since joining the program, we've been working with OpenAI to explore how these capabilities can address specific security challenges for defenders.

The problem we're solving

Attackers continue to change how they operate, including by using AI to increase the speed and scale of some techniques. Security teams are already managing a large volume of alerts, and the question isn't just what's happening, but how it could affect the organization. Even when an incident is fully investigated and correlated, technical severity alone doesn't tell a security team how much it actually matters to the business. That same challenge extends to internal AI adoption. As organizations adopt more AI systems and agents, security teams need visibility into their behavior, access and activity, along with the broader business context needed to identify and investigate potential risk.

Darktrace's Adaptive AI™ builds a detailed, organization-specific picture of what's normal for each environment, and uses that picture to investigate threats and identify complex security activity across domains. OpenAI's models can build on Darktrace's correlated, technically prioritized incidents by adding context that can help defenders understand what may be at stake.

What we're building

Our work is focused on two areas: supporting security investigation and response, and helping defenders identify risky behavior across enterprise AI systems and agents.

The first aligns Darktrace's behavioral understanding with OpenAI models to support  security investigation and prioritization. Darktrace's Adaptive AI continuously learns the unique patterns of normal behavior within each customer it protects, creating a deep, organization-specific understanding of its digital estate. When unusual activity emerges, OpenAI's models can draw on that context to help analysts investigate the incident, understand its significance and assess potential business consequences — reducing the need to manually assemble context from fragmented signals.

Second, we are exploring how these capabilities can support AI-agent and runtime security through Darktrace / SECURE AI™. OpenAI’s Daybreak models can build on the detections and visibility Darktrace / SECURE AI provides, connecting signals across a customer's environment and help defenders identify potentially risky behavior involving AI systems and agents. Activity that might appear isolated can instead be connected with related signals, helping defenders investigate the broader context and determine appropriate remediation.

Darktrace brings deep cybersecurity expertise, an evolving understanding of each customer's environment, and AI-driven identification of threats across the digital estate. Through the Daybreak Defense Network, Darktrace is exploring how OpenAI models can augment those capabilities in defensive security workflows — supporting incident investigation and response and improving visibility into AI-agent and runtime risk.

These capabilities are still in development, and we're excited to continue building on this work.

To learn more about how Darktrace continues to innovate to meet today's most pressing security challenges, register for our upcoming launch broadcast here.

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