Patient-Centric Incident Response in Healthcare: A New Approach: What You Need to Know

Introduction

Cyberattacks on healthcare are increasing in both frequency and severity, with the sector continuing to report more ransomware incidents than any other critical infrastructure. As threats grow more sophisticated, it’s clear that conventional cybersecurity methods are no longer sufficient—especially where the stakes involve not just systems and data, but human lives.

Traditional incident response, originally developed for commercial sectors like retail and finance, fails to account for the unique pressures and patient safety concerns of healthcare. A shift is needed, from a system-centric model to a patient-centric approach that places uninterrupted care at the core of cyber defense.

The Value of a Patient-Centric Approach

Incident response in healthcare should reflect the patient-centric approach seen in other critical areas of the industry. Unfortunately, most incident response programs, practices, and policies primarily focus on data protection. Even healthcare regulations and standards such as HIPAA, NIST CSF, and NIST 800-53 provide a false sense of security because every guideline, regulation, and requirement mainly focuses on protecting data rather than providing direction, best practices, or even advice on protecting the patient.

While safeguarding data is crucial and often the main justification for cybersecurity investments and compliance with regulations like HIPAA, healthcare’s primary focus should always be protecting the patient. Technological solutions must ultimately ensure uninterrupted patient care.

Cybersecurity responsibilities often fall under IT, and most programs across industries are extremely hierarchical. However, the most effective clinical teams operate with minimal hierarchy, especially in critical life-or-death scenarios. This non-hierarchical approach to patient care should be mirrored in incident response planning. IT leaders should learn from clinicians and prioritize patients. For example, with a patient-centric approach, responsibilities extend to other teams as well, such as clinical staff, clinical engineering, compliance, etc.

Determining Attack Violence and Velocity

It is essential to understand the concepts of violence and velocity during an attack, particularly in the context of disaster recovery. The violence of an attack refers to the severity of its impact on a scale of one to five, ranging from minor disruptions to complete destruction of systems and/or patient lives. For instance, a level-five attack can render systems unusable to the extent that reinstalling operating systems and applications is impossible, necessitating the disposal of affected equipment or adversely impacting human life.

Equally important is the concept of velocity, which pertains to the speed at which an attack spreads across the healthcare environment. Understanding the velocity of an attack is crucial for devising effective strategies to mitigate its impact and prevent further proliferation.

It is worth noting that attackers often operate covertly within healthcare networks instead of launching immediate attacks. They gather intelligence and conduct reconnaissance over extended periods before executing precise and devastating attacks. Recent reports indicate that attackers spend an average of 200 days within a network before being discovered, highlighting the need for improved detection and response mechanisms in the healthcare sector. During this time, attackers glean critical information about the healthcare organization’s infrastructure, network topology, end-of-life systems, cache levels, and backup systems, enabling them to orchestrate highly targeted and damaging attacks.

The combination of violence and velocity can lead to increased stress and the breakdown of established incident response protocols.

Understanding the Emotional and Psychological Aspects of an Attack

Most cyberattacks are typically executed within minutes. As a result, organizations have an extremely narrow window to identify, detect, and determine which actions to take to respond to threats effectively. Failing to do so within this timeframe immediately places the organization in recovery mode.

Traditional hierarchical response plans, which involve multiple layers of approval and permission-seeking, are impractical in this context. In high-velocity and high-stress incidents, conventional playbooks and practices are often abandoned and ad-hoc measures take precedence. To mitigate these challenges, training teams to respond instinctively based on repeated practice of incident response strategies, rather than relying solely on written plans crafted to satisfy auditors, is crucial.

Neglecting the emotional and psychological dimensions of responders within an incident response plan significantly increases the likelihood of failure and can lead to adverse outcomes. Understanding attackers’ perspectives, including their audacity, psychology, motivation, and passion, is also vital, as this can provide valuable insights that inform more robust incident response strategies. Unfortunately, many programs overlook these crucial aspects. Moreover, the hierarchical structure of most incident response programs inadvertently plays into attackers’ hands, hindering effective response efforts.

In the high-pressure healthcare environment, time is of the essence when responding to potential cybersecurity events. By comprehensively addressing the emotional, psychological, and practical facets of incident response, organizations can better defend against increasingly sophisticated threats.

Mortality Rates Increase After a Breach

A Vanderbilt University study found that IT security measures implemented following data breaches at hospitals may cost valuable time in delivering life-saving care. Using breach data from the Department of Health & Human Services and quality data on more than 3,000 hospitals over a four-year period, researchers found that critical measures such as time-to-EKG in emergency situations and mortality rates rose following a breach.

Average time-to-EKG increased by as much as 2.7 minutes, and an increase in the 30-day mortality rate for heart attacks translated to as many as 36 additional deaths per 10,000 heart attacks per year. And this is just one example of how a significant cyberattack can increase patient mortality.

Ransomware Attack Example: Once the attack begins, the entire healthcare environment is thrown into a state of frenzy. Conversations across various departments revolve around the attack’s implications—from concerns about compromised systems and the reliability of critical patient data to questions about personal data security. The focus shifts from patient care to the potential fallout of the cyberattack, leading to a demonstrable decline in the standard of care provided.

Moving to Patient-Centric Incident Response: A Four-Step Plan

Cyberattacks inevitably affect patient care, even if patients are not the direct targets of the attack. To effectively mitigate the impact, the entire organization must recognize its primary role in safeguarding patients when orchestrating a response. For example, clinical staff should have defined actions to take once a cyberattack is known to be in process (for example, immediately take current vital signs of patients connected to medical devices). Keeping the patient at the forefront is paramount, and every aspect of incident response, including disaster recovery, should prioritize patient well-being.

When developing a modern patient-centric incident response plan, the following four elements should be considered and integrated:

Step 1: Patients

The incident response plan must be designed to ensure there is no impact on patient care. When prioritizing system recovery, decisions should be based on what will benefit the patients the most.

Step 2: Staff

Supporting and empowering the staff on the ground during a cyberattack is essential for delivering excellent patient care. Addressing their concerns and uncertainties is crucial. This support should extend beyond the IT department to the entire organization, ensuring that everyone is aware of how to respond and can stay focused on patient safety.

Step 3: Family

Proactively addressing the concerns of patient families and friends is vital. Effective and early communication is necessary, especially in the aftermath of a cyber incident. People will seek answers and reassurance, so having a plan for addressing their valid concerns is essential.

Step 4: Systems

The long-term goal is to restore and protect the IT systems. The recovery order should align with clinical guidance from teams prioritizing patient care. When bringing systems back online, consideration should be given to the acuity of patients in the ICU, for example, and the plan should be aligned with patient care objectives.

In summary, a thorough patient-centric incident response plan will prioritize patients, evaluate staff needs, address family concerns, and consider system status and recovery objectives. This will remain the ongoing focus, minute by minute and hour by hour, until a known state is achieved.

Anatomy of an Attack Response: The First 72 Hours

The choices and actions taken in the critical first 72 hours following a cyberattack are of the utmost importance and will be the most high-liability decisions. Incident response plans should center around the actions taken within this critical timeframe, focusing on implementing a sell-rehearsed response strategy.

The impact of an incorrect or delayed decision or the psychological and emotional toll of an attack can be profound during incident response and recovery. It’s essential to approach the situation with a clear and deliberate mindset.

Within the first 90 minutes of an incident, ensure that patients are effectively managed, and clinicians have the necessary resources to stabilize the situation. At the same time, map different areas of responsibility. Engaging in open conversations with clinicians and hospital staff is essential in transitioning from the initial 90 minutes to the first eight hours, during which staff care becomes a pivotal consideration. Assessing staff morale, psychological well-being, and overall engagement is paramount in maintaining an effective response.

Moving into the subsequent eight- to 24-hour window, ensure family communications are ready. Efforts should be directed toward maintaining effective communication and reducing disruptions to keep teams focused on patient care. As the timeline progresses from 24 to 72 hours, the focus shifts towards prioritizing and recovering systems. At all times, priorities should be aligned with patient acuity and needs, guided by insights from clinicians, and dictated by real-time circumstances—not the playbook. This is a very different form of disaster recovery, and few organizations know how to execute it.

Throughout these stages, it’s essential to distinguish between known and unknown factors, emphasizing the validation/confirmation of information and the identification of critical unknowns. Asset valuation and high-value targets are crucial in this context, informing the strategic response to the incident.

Establishing a blended model for the command center, managed by on-site personnel focused on patient safety and complemented by an executive command center handling operational and legal aspects, can also help to ensure a comprehensive and effective response throughout a cybersecurity incident. Adapting to the challenges that arise, particularly during non-traditional hours, is crucial. This may involve rethinking the composition and operation of the command center to maintain an effective response even during off-peak hours.

Regarding system restoration, recognize that simply bringing systems back online does not guarantee immediate usability. Restoration processes, especially in cybersecurity incidents, can be lengthy and complex. This underscores the need to diligently assess and clear systems for operational use, even after they have been technically restored.

Cybersecurity Advisory Services

Strategic support is essential for healthcare organizations looking to build long-term cyber resilience. CloudWave’s Cybersecurity Advisory Services provide expert guidance to strengthen your cybersecurity posture and prepare for real-world threats.

Incident Response Training – Develop critical response capabilities to handle cyberattacks while protecting patients and systems.
Cybersecurity Tabletop Simulation – Simulate real-world attack scenarios to test readiness and identify gaps across departments.
Penetration Testing – Uncover internal, external, wireless, and social engineering vulnerabilities before attackers do.
Cybersecurity Maturity Modeling – Assess and map your current capabilities with a roadmap for advancing security maturity.
Compliance and Risk Assessment & Management – Reduce regulatory risk with tailored guidance and prioritization.

CloudWave Managed Security Services

Truly effective cybersecurity in healthcare demands an integrated strategy—one that protects systems, devices, and data without compromising clinical workflows. CloudWave’s Managed Security Services platform is purpose-built for healthcare and offers 24/7 protection, automation, and expert-driven incident response.

Comply – Meet HIPAA, NIST CSF, and HICP standards with policy management and maturity tracking.
Manage – Offload day-to-day security operations with expert support from CloudWave’s 24/7 Security Operation Center (SOC).
Detect – Leverage deep-packet inspection and deception technology to identify real threats across endpoints, networks, and medical devices.
Respond – Rapidly contain incidents with automated countermeasures and expert-led playbooks.

Medical Device Security Program

Medical devices are among the most vulnerable assets in a healthcare environment. CloudWave’s Medical Device Security Program ensures these devices are protected through 24/7 monitoring, FDA-compliant deception technologies, and tailored response plans that safeguard both devices and patient care.

Cybersecurity Security Operations Center (SOC)

CloudWave’s Security Operations Center, powered by Google Security Operations, delivers real-time threat detection and response. With 24/7 monitoring, intelligence-sharing, and partnerships with DHS, FDA, and CISA, our team works side-by-side with yours to protect your healthcare environment from today’s most advanced threats.

Conclusion

Understanding the unique challenges and timelines associated with recovery from a cyberattack is essential for effective planning. A modern response framework must prioritize patients, support staff, communicate with families, and restore systems in a way that aligns with clinical care. With the right strategies and support, healthcare organizations can minimize harm and maintain trust in even the most difficult situations.