Healthcare’s Reckoning: Why Identity Is Now a Patient Safety Issue

Healthcare has always understood risk. Long before “cyber” entered the vocabulary, clinicians learned to respect infection control, chain of custody, redundancy, and fail-safe design. You don’t improvise in an operating room. You prepare, you rehearse, and you assume something will eventually go wrong.

Yet in the digital corridors of modern healthcare, that discipline has quietly eroded.

Over the last year alone, healthcare breaches didn’t merely increase, they accelerated. Not in isolated bursts, but as a steady drumbeat of compromise. Ransomware. Third-party exposure. Identity abuse. Operational disruption. The pattern is no longer surprising; what is surprising is how many organizations still treat these events as technical anomalies instead of systemic failures.

As I’ve written in Ghosts in the Machine and expanded on in my later work, modern breaches are rarely about a single failed control. They are failures of trust, how identity is issued, extended, and left to decay over time.

This is not a technology problem. It’s a trust problem.

The Illusion of Containment Is Gone

Healthcare leaders often take comfort in a familiar belief: our core clinical systems are locked down. And in many cases, that’s technically true. EHRs may be hardened. Perimeters may exist on paper. Compliance boxes may be checked.

But attackers are no longer battering down the front doors.

They’re walking in through identity.

Most modern healthcare breaches do not originate in clinical systems at all. They come through vendors, business associates, APIs, remote access paths, forgotten service accounts, and human credentials stretched far beyond their original intent. The identity fabric of healthcare, human and non-human alike, has become porous, over-privileged, and poorly observed.

This is precisely the failure pattern that led me to define IAM 3.0: a recognition that identity can no longer be treated as a static directory problem, but as a living control plane that governs access continuously, not episodically.

When identity fails, everything downstream fails with it:

• Access controls collapse
• Segmentation evaporates
• Monitoring becomes meaningless
• Recovery slows to a crawl

And patient care suffers, quietly at first, then visibly.

Why Healthcare Remains a Prime Target

Attackers are rational. They follow incentives.

Healthcare offers three things few industries can match:

• Irreplaceable data: Medical records don’t expire. They can’t be canceled or reissued. Once exposed, they carry value forever.
• Operational fragility: Hospitals can’t “pause” safely. Downtime isn’t inconvenient, it’s dangerous. That pressure shortens negotiation timelines and raises ransom leverage.
• Expanding, unmanaged identity surfaces: Connected devices. SaaS platforms. AI-assisted workflows. Third-party integrations. Each one adds identities, many of them non-human, that rarely receive the same governance as staff accounts.

In The New Age of Identity, I warned that unmanaged non-human identities would become the silent accelerant of future breaches. Healthcare is now living that prediction in real time.

The result is predictable: identity becomes the easiest way in and the hardest thing to unwind once compromised.

Cybersecurity Is No Longer an IT Conversation

This is the uncomfortable truth many boards still resist:

Cybersecurity failures in healthcare are patient safety failures.

When systems go down, care is delayed. When identities are abused, data integrity is questioned. When trust erodes, patients hesitate, and outcomes follow.

Treating security as an IT or compliance function is a legacy mindset. It belongs to a time when systems were static, perimeters were real, and users were human. That world is gone.

IAM 3.0 starts from this reality: modern healthcare operates in a continuous, identity-driven environment where access decisions happen thousands of times per second, often without a human in the loop. Static controls, quarterly reviews, and after-the-fact audits cannot keep pace.

“Healthcare doesn’t need more identity tools, it needs an identity operating model built for continuous risk. IAM 3.0 recognizes that trust must be evaluated in real time, across humans and machines alike, or it will fail when patients can least afford it.”

— CISO Major US Payer Organization (Name withheld by request)

What Must Change Now

Healthcare organizations that want to remain standing over the next few years must confront several realities head-on:

• Identity must be treated as critical infrastructure, not plumbing.
• Third-party access must be governed with the same rigor as internal staff.
• Non-human identities, services, APIs, automation, AI, must be discovered, constrained, and continuously monitored.
• Access decisions must shift from static permission models to contextual, risk-aware enforcement.
• Leadership must understand that resilience is built before the incident, not during the press conference.

These are not theoretical principles. They are the hard-earned lessons distilled across decades of identity failures, and the foundation of the IAM 3.0 model.

This is not about buying another tool. It’s about rebuilding how trust is issued, evaluated, and revoked.

A Direct Call to Action for Healthcare Leaders

If your organization cannot confidently answer the following questions, you are already behind the threat curve:

• Do we know every identity, human and machine, that can touch patient data?
• Can we see, in real time, when access behavior deviates from normal?
• Are third-party identities constrained to exactly what they need, for exactly as long as they need it?
• Have we tested what happens to care delivery when identity systems fail, not in theory, but in practice?

Waiting for “the right time” is no longer a strategy. The threat environment is not waiting, and neither are regulators, insurers, or patients.

Healthcare has always risen to meet hard moments by adapting without losing its values. This is one of those moments.

The organizations that act now, deliberately, intelligently, and without illusion, will protect more than systems. They will protect trust, continuity of care, and the people who depend on them when it matters most.

What IAM 2.0 Gets Wrong in Healthcare

IAM 2.0 assumes identities are mostly human, access is mostly static, and risk can be reviewed quarterly without consequence. In healthcare, where vendors, APIs, devices, and automation now outnumber staff, those assumptions quietly turn identity into a single point of systemic failure.

If you want to understand what must change now, and how to move forward without breaking what already works, it’s time to have the IAM 3.0 conversation.

Not after the breach. Now, before it becomes inevitable.