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.
.png)

%201.png)








