Healthcare organizations have invested heavily in security controls across networks, endpoints, cloud environments and clinical systems. But with the growth of connected systems and AI within healthcare and the consequent widening of the threat landscape, organizations face tougher questions about who and what has access to critical systems and whether that access can be governed throughout its lifecycle.
For most, the answer is complicated. Today, a health system’s digital environment may include employees and clinicians, service accounts, APIs, third-party platforms, connected medical devices and, increasingly, AI systems and autonomous agents. Each can interact with sensitive data and critical systems and introduce access relationships that need to be understood, controlled and reviewed.
The challenge, therefore, is bringing those relationships into a governance model that can keep up with the environment.
healthcare’s digital environment is expanding.
Healthcare has always operated across a mix of systems that were difficult to secure through a single approach. Cloud applications, connected medical devices, remote access, third-party platforms and AI are adding new connections to an environment that already includes legacy technology and fragmented systems.
Third-party relationships are an important part of this picture. The American Hospital Association recommends that health systems maintain comprehensive inventories of third parties, understand dependencies beyond their immediate vendors and consider how a disruption at a technology partner could affect clinical operations.¹ Its guidance also calls for clear accountability and collaboration across procurement, legal, compliance, IT and cybersecurity.
the gap in identity programs.
Traditional identity programs were built around people: onboarding employees, assigning roles, granting access and removing it when someone leaves. Service accounts and other non-human identities exist in these programs too, but rarely with the same discipline.
However, non-human identities are becoming an increasingly important part of enterprise security. Service accounts, API credentials, machine accounts and connected devices can have persistent access to systems without behaving like traditional users. Connected medical devices can communicate with clinical systems while operating under long device lifecycles and vendor-specific constraints. Third parties can require access across organizational boundaries.
AI introduces another dimension. As healthcare organizations deploy AI applications and agents, security teams need to understand what those systems can access, what actions they can take and how those permissions are monitored. That makes AI governance part of the broader identity and access conversation.
That expands identity governance across four broad categories:
- Human identities: Clinicians, employees, contractors and administrators
- Non-human identities: Service accounts, APIs, machine accounts and application credentials
- Connected devices: IoMT and other systems operating within clinical environments
- AI systems: Applications and agents that may access information or perform actions
The objective is not to force these different technologies into one technical control. It is to establish consistent governance around access, ownership, lifecycle and risk.
visibility comes before control.
Healthcare organizations can’t govern access effectively when they lack a reliable view of what is connected to their environment. But this challenge is acute with connected medical equipment. Some run legacy operating systems. Others depend on manufacturers for software updates or security controls. Yet these devices may still communicate with systems containing sensitive information or support critical clinical workflows. The solution is broader than device discovery.
Security teams need to know what exists, but they also need to understand who owns each asset, how it connects to the environment, what access it requires and what should happen when that access is no longer necessary. Visibility becomes useful when it leads to ownership and enforceable controls. An inventory alone does not tell a security team whether access is appropriate. It provides the context needed to make that decision.
what stronger identity governance looks like in practice.
The challenge calls for more than managing individual accounts. Four areas can bring visibility, access, security operations and modernization into the same operating model.
1. establish visibility and ownership
Effective governance starts with a current view of human and non-human identities, connected devices, applications and third-party relationships. That view needs to include ownership and enough context to understand how each identity or asset connects to critical systems.
The AHA’s guidance on third-party risk emphasizes comprehensive inventories, clear accountability, ongoing assessment and consideration of dependencies beyond the immediate vendor.
The same principle applies across the broader technology environment. Security teams need to know who or what has access, why that access exists and where responsibility sits when something changes.
2. govern identities throughout their lifecycle
Access should reflect the full lifecycle of an identity, from provisioning through changes in role or responsibility to decommissioning. That includes workforce identities as well as service accounts, APIs, machine identities, IoMT and other non-human identities.
Role-based access, privileged access management, segregation of duties, just-in-time provisioning and continuous access certification can help reduce unnecessary or persistent access.
For emerging AI systems, the same lifecycle discipline is becoming increasingly relevant. As AI applications and agents gain access to data and enterprise systems, organizations need to understand what those systems can access, what actions they are authorized to perform and how that access is monitored over time.
3. link identity governance to threat detection
Identity governance becomes more valuable when identity signals inform the broader security operation. Changes in privileged access, anomalous identity activity or unexpected connections can provide useful context for threat detection, investigation and response.
Connecting identity governance with security operations can also support identity threat detection and response, giving analysts more information about the identities behind activity across complex environments.
The connection works in the other direction, too. Security events can provide context for access decisions and risk assessments. That makes identity governance part of a broader security operating model rather than a separate provisioning function.
4. build governance into modernization
Healthcare organizations often have to modernize around legacy platforms, clinical systems and medical devices that cannot be replaced or updated on conventional IT timelines.
Identity governance therefore needs to be part of the modernization strategy from the beginning. Phased migration, co-managed environments and platform-aware architecture can help organizations introduce modern cloud identity and security controls without disrupting clinical operations or requiring immediate rip-and-replace programs.
The same principle applies as healthcare organizations adopt new cloud services, connected devices and AI technologies. Governance built into the architecture makes it easier to understand access and risk as the environment changes.
regulation is reinforcing the fundamentals.
The regulatory direction is also placing greater emphasis on visibility, accountability and security controls.
The U.S. Department of Health and Human Services has proposed changes to the HIPAA Security Rule that would strengthen requirements around areas including technology asset inventories, network mapping, risk analysis, authentication, vulnerability management and incident response.
The proposal is not yet a final Security Rule, so healthcare organizations should distinguish between current requirements and proposed changes. The broader direction, however, reinforces the importance of knowing what is connected to the environment, understanding access and maintaining documented security controls.
Healthcare organizations are also managing expectations from business partners, vendors and cyber insurers, which can place additional requirements on security practices.
For security leaders, the practical question is how to build controls that remain effective as the environment changes and expectations increase.
keeping identity governance aligned with change.
Healthcare’s technology environment will continue to change. More systems will connect to one another. More work will move through cloud platforms and APIs. AI applications and agents will take on new roles.
The security model has to account for those changes as they happen. Identity governance gives healthcare organizations a way to connect people, machines, devices, applications and emerging technologies to the controls that govern their access. Done well, it provides security teams with better visibility into access and ownership, stronger control over the identity lifecycle and more context for managing risk across the clinical environment.
From HIPAA Security Rule programs and clinical environment security to OT/IoMT assessments, incident response and ransomware resilience, Randstad Digital helps healthcare organizations strengthen cybersecurity across complex clinical and technology environments.