In today’s interconnected healthcare environments, the line between patient care and technology has blurred significantly. Behind every modern healthcare delivery organization (HDO) lies a complex ecosystem of operational technology (OT) that is integral to critical care functions and building management systems (BMS). But while these technologies introduce new levels of connectivity for healthcare providers, they also create challenges for IT and security teams as they try to maintain a balance between cyber resilience and uninterrupted patient care.
Further complicating this is the innate complexity of healthcare OT. Unlike the standardized world of enterprise IT, healthcare OT can include potentially dozens of disparate vendors for medical devices and hundreds of configurations to monitor and manage. To top things off, this complexity intersects with stringent regulatory requirements, as well as daily operations that include the possibility of life-threatening situations if a device is compromised.
With all this in mind, this guide explores the vital role of OT in healthcare environments and provides practical strategies for building resilience that protects critical systems and the lives of patients.
What is Operational Technology (OT) in Healthcare?
OT in healthcare encompasses the hardware and software systems that monitor and control physical devices and infrastructure that facilitate processes and patient care. Unlike traditional IT-centric systems that focus primarily on business functions, healthcare OT directly interacts with the physical world. More often than not, these interactions carry immediate implications for the quality of care and patient safety.
Examples of healthcare OT systems include medical devices, clinical engineering systems, building management systems, and laboratory equipment. All of these examples underscore the diversity and complexity of healthcare OT. A single hospital can often contain hundreds of devices across various clinical departments, each with their own configurations, firmware versions, and security profiles.
The Role of Operational Technology in Modern Care
In recent years, healthcare delivery has become less reliant on manual processes and more dependent on OT systems. Because of this transformation, the importance of OT resilience is now directly tied to patient safety. For example, monitoring systems continuously track patient vital signs and automatically alert clinical staff if any concerning changes occur, and data is logged in electronic health records. Diagnostic equipment captures and transmits detailed images and measurements that inform critical care decisions, and medication management systems such as smart infusion pumps help ensure each patient receives the right medication dosages.
Beyond affecting treatment itself, OT systems such as BMS control airflow in operating rooms and regulate temperature and humidity for patient comfort and equipment functionality. On top of that, HVAC and other environmental management via BMS systems directly impact how a hospital can contain possible infections, stability of pharmaceuticals, and the performance of life-saving equipment. With so many critical functions being directly tied to OT in healthcare environments, one security breach can have a potentially devastating cascading effect on nearly every facet of patient care.
OT in Healthcare Organizations is Increasingly Vulnerable
Complexity is the enemy of resilience in healthcare environments. The diversified ecosystem of devices and systems creates a broad attack surface that can be exploited by attackers—especially if devices are left undiscovered by security teams. That’s why it’s so important to conduct a thorough asset inventory of all devices across a healthcare organization. After all, if you can’t see it, you can’t protect it.
Much like industrial environments, programmable logic controllers (PLCs) play a key role in patient care and day-to-day operations in a hospital. An attack on one PLC could carry dire consequences, such as in the following scenarios:
HVAC and Refrigeration Equipment
A compromised PLC that controls airflow and/or temperature controls could result in spoiled lab cultures or medications that require strict refrigeration.
Elevators and Pneumatic Tubes
Transporting patients and critical surgical equipment throughout a hospital must be available 24/7. An attack on the OT governing those systems could halt the transport of emergency patients or blood samples between floors, creating a life-threatening situation.
Power and Power Backups
Attackers could target power management and related backups, preventing diesel generators from turning on during a blackout. An unreliable or damaged power supply could easily damage delicate diagnostic or surgical equipment.
In addition to these examples, legacy and outdated systems present another challenge. Most medical devices have operational lifespans of 10 to 15 years, and like other critical infrastructure, hospital networks were built with longevity and reliability in mind first. It’s therefore highly likely that several of the devices in hospital networks are running on outdated operating systems that contain unpatched vulnerabilities.
Building Resilient Healthcare Environments Through OT Security
To operationalize resilience in a healthcare environment, organizations must build systems that can withstand, adapt to, and recover from disruptions while maintaining a high standard of patient care. For the purposes of healthcare environments, resilience serves three key purposes:
Patient Safety
Ensuring critical-care systems are functioning reliably and accurately is tantamount to resilience. If these systems fail—or worse, suffer a security breach—it will endanger the lives of patients.
Operational Continuity
Even if these systems suffer an incident, it’s imperative to maintain healthcare delivery. Deploying compensating controls can be a good way to address weaknesses of specific security requirements and mitigate risks.
Regulatory Compliance
All of this must be done while staying in compliance with regulatory requirements issued by the FDA and HHS, among others.
As previously mentioned, a comprehensive asset inventory is a good starting point for achieving resilience in healthcare OT. But to truly align with these three key purposes, healthcare organizations need to implement a zero trust approach that relies on the principle of “never trust, always verify.” This approach requires continuous verification of every device that’s being used to log into the hospital network, and is particularly valuable in such environments that rely on so many life-saving devices that are managed by external vendors.
With the stakes this high, HDOs need a cybersecurity solution that defends the critical systems tied to patient safety. The Claroty Platform protects HDOs around the world with industry-leading asset discovery capabilities, and takes a zero trust approach to minimize the environment’s attack surface.
