Safeguarding Patient Information: The Significance of Cybersecurity in Clinical Decision-Making

Digital transformation in healthcare has enhanced care but also increased cyber risks. With rising threats like ransomware, phishing and data breaches, clinical decision-making is jeopardised when patient data is compromised. Effective cybersecurity is now a clinical imperative, not just an IT concern, requiring robust systems, staff training and regulatory compliance to protect data integrity, availability and confidentiality across all healthcare sectors.

Key Points

• Cyberattacks threaten the safety, trust and continuity of digital healthcare systems.
• Ransomware and phishing disrupt clinical workflows and delay critical patient care.
• Compromised data can lead to misdiagnoses and undermine clinical decision-making.
• Cybersecurity must be embedded across all healthcare sectors and digital tools.
• Regulatory compliance alone is insufficient without proactive, strategic security measures.

Introduction

Healthcare is the fastest-adopting digital transformation trend. Today, technology has infiltrated all aspects of the patient care continuum, from wearable biosensors to telehealth consults, from electronic health records (EHRs) to AI-driven diagnostics. Not only are these advancements raising the bar on care and care management, but they are also reshaping the way physicians receive, analyse and leverage patient information. The decisions are thus faster, smarter and more personal, since they are made in a data-rich context.

But there’s a dangerous compromise being made in this digital revolution. As healthcare systems become ever more networked and data-driven, they are also growing increasingly susceptible to cyberattacks. The framework that was supposed to make clinical operations more efficient and improve patient outcomes can, if breached, compromise safety, disrupt continuity of care and erode trust between patients and providers. Cyber incidents in healthcare are no longer hypothetical risks; they are recurring events with real-world consequences. The 2017 WannaCry ransomware attack on the UK’s National Health Service and the surge of attacks during the COVID-19 pandemic underscore the fragility of healthcare’s digital backbone.

This two-sided coin of digitisation — at once more efficient and more vulnerable than before — represents a major new challenge for healthcare leaders. Clinical decision-making is only as reliable as the integrity of the data on which it relies. Compromised systems result in compromised data and compromised care providers in their ability to provide timely and accurate care.

In this context, unmatched cybersecurity is not a technological amenity, but a clinical necessity. All healthcare professionals have taken an Oath that every medical decision, diagnostic test and procedure starts with the confidentiality of patient information, the integrity and availability of that information. This paper contends that cybersecurity should be regarded not simply as an IT responsibility but as a vital enabler of safe, trustworthy clinical decision-making.

The Digital Healthcare Landscape

In recent years, we have observed a swift shift towards digital healthcare, consisting of EHR, telemedicine, AI-based diagnostics and IoT-based medical devices. They provided increased efficiency in care, increased personalisation of treatment and greater access, especially in underprivileged areas.

Today, EHRs are the workhorses of hospital data systems. In the U.S., greater than 96% of non-federal acute care hospitals have adopted electronic health records (EHRs) (Office for Civil Rights 2023), and other nations, including Denmark and Estonia, cite complete national coverage. The use of telemedicine has also skyrocketed (notably during COVID-19)—global use rose over 400% from 2020 to 2022 (World Economic Forum 2024). Such tools give companies agility, but they also bring new risks as potentially sensitive information is exposed on personal, unsecured devices.

Diagnostics based on AI are poised to revolutionise sectors such as radiology and dermatology, but their accuracy is only as good as the data. A 2022 breach at a French hospital led to corrupted imaging data and diagnosis being held up for hundreds of patients (ENISA 2023). IoT medical devices—such as wearable monitors—often contain unpatched vulnerabilities and weak security protocols. More than 60% of these systems are running on obsolete software and are easily prey to attacks (HC3 2023).

These tools produce enormous volumes of data, such as an average of 50 petabytes annually in a hospital (World Economic Forum 2024). Outside of clinical care, this information is used for predictive analytics, for public health planning and drug discovery. Yet its strategic importance also makes it a prised target. Romanosky (2016), for instance, finds that health data breaches are simply more expensive than those found elsewhere due to medical records on the underground marketplace and the administrative turmoil they induce. For example, in 2020, a ransomware attack at Universal Health Services caused the system to move back to paper-based operations, significantly impacting the delivery of care (Martin et al. 2017).

Understanding the Threats and Their Impact on Clinical Decision-Making

Medical centres are now prime targets for hackers. Their immense caches of sensitive information, paired with the 24/7 pace of their operations, render them uniquely susceptible to a variety of advanced cyberattacks. Ransomware infections, for example, are one of the most common attacks in the past couple of years, as well as phishing, insider threat and vulnerabilities from third-party vendors (Kruse et al. 2017).

Ransomware has emerged as the most disruptive attack vector. It is what happens when a hospital’s data is encrypted by malicious software, and the attacker demands that the hospital pay a ransom to release it. One of the most prolific examples was the WannaCry breach in 2017, which risked the security of more than 80 UK NHS trusts. Operations were cancelled, ambulances diverted, patient records lost—all because of the inability to secure outdated Windows operating systems (Martin et al. 2017).

Amid the COVID-19 pandemic, the Ryuk ransomware gang also preyed on overburdened hospitals in the U.S., France and Germany. One German hospital had to turn away emergency cases, resulting in at least one death, providing a grim lesson that led to life-and-death impacts (ENISA 2023).

Phishing remains the primary method of system compromise. Stressed healthcare workers are also likely to accidentally click on fraudulent emails impersonating internal communications or official health advice. The US Department of Health & Human Services was breached through targeted phishing in 2020, boosting access to health-related data from the COVID-19 response systems (HC3 2023).

Insider threats—whether due to malicious intent or human error—also contribute significantly to cybersecurity risks. Employees leaving data unprotected, selecting poor passwords or not adhering to security policies and procedures lay the foundation for even the most sophisticated defences to be compromised. In this regard, factors involving third parties, like breached billing systems or diagnostic providers, effectively augment the threat landscape to reach beyond the hospital’s sphere of influence (Romanosky 2016).

These threats are compounded by well-known systemic flaws. Plenty of healthcare organisations use aging technology that no longer supports modern security standards. Others have poor encryption and weak identity and access management, thereby making unauthorised access a snap (World Economic Forum 2024).

The impact of these breaches is more than technical disruption, as they intrude into clinical decision-making. The data may be left inaccessible, and this lack of data can lead to a loss of both patient histories and medical records, as well as test results and medication can also result in lost medication for patients, delaying treatment and the potential for medical mistakes. If data is interfered with or corrupted, intentionally or unintentionally, it may result in misdiagnoses, wrong prescriptions, especially in systems that are based on algorithmic decision support.

Patient trust is another casualty of cyber breaches. After an incident, patients may become reluctant to share personal details, fearing misuse or exposure. This, in turn, inhibits health professional assessments and adversely affects the quality of care (Kruse et al. 2017). An analysis referenced in Martin et al. (2017) noted that more than a quarter of patients would be likely to conceal information from their health provider after a significant breach.

Data breaches can lead to disastrous consequences from a legal and monetary perspective related to institutions. Whether it’s HIPAA in the U.S. or GDPR in the E.U., healthcare institutions are severely fined for non-compliance or careless data use. As per the Office for Civil Rights (2023), the average healthcare data breach cost morethan €7.9 million ($9 million) in 2022, more than any other sector.

In short, cyber securityincidents are not IT issues, they are personal safety issues, clinical accuracy issues and threats to the stability of an organisation. With the on-going digitalisation of the health service, protecting data must be viewed not as a ‘compliance cost’ but as a clinical responsibility, pure and simple.

Challenges and Vulnerabilities

Cybersecurity risks manifest differently across segments of the healthcare ecosystem, shaped by distinct operational models, technologies and regulatory contexts. Addressing these unique vulnerabilities requires a tailored approach.

• Hospital systems are rife with legacy infrastructure together over decades. Interoperability continues to be a challenge, especially with modern cloud-based platforms. Hospitals are also at risk, internally, because of their workforce size — hundreds or thousands of people, some of whom are more aware of cybersecurity risks than others. A crack in one ministry can expose the whole network.
• Primary care providers and non-hospital-affiliated clinics generally have fewer resources. Many depend on off-the-shelf systems or small IT outfits, leaving them without the resources to put up strong, multitier defences. Regular training for employees is sometimes as little as annual, along with the accompanying phishing and social engineering growth.
• Pharmacies, especially chain retail pharmacies, control valuable data such as prescription histories, billing information and insurance claims. Their logistics role also brings with it supply chain compromise risk. Successful hacking of a pharmacy's system would enable drug diversion, insurance fraud or counterfeit medication scams.

• Telehealth platforms are especially susceptible because they depend on patient-side technology — devices that are not under the control of the provider. Video consultations, data uploads and messaging functionality may not be end-to-end encrypted. Also, platform APIs are a possible attack surface, pursued by attackers to gain unauthorised data access.

• Diagnostic laboratories generate and retain extensive amounts of clinical and genetic information. The pace and complexity of lab operations pose challenges when cybersecurity practices are not integrated into operations. Neglected lab data may delay accurate diagnoses, influence research and introduce mistakes in patient treatment plans.

• Health insurers are threatened by the financial and personal information they oversee. Fraudsters frequently use claims systems to carry out fraud and steal identities. Furthermore, any failure in actuarial models or underwriting algorithms can expose systemic risks for entire population groups.

Cybersecurity as a Pillar of Clinical Integrity

Cybersecurity underpins the trustworthiness of clinical data, and the systems for interpreting and acting upon clinical data are reliable. Data integrity ensures that clinical decisions are based on accurate, unaltered information. Data availability guarantees that healthcare professionals have timely access to necessary records, while confidentiality protects patient privacy and maintains compliance with legal and ethical standards.

Clinical Decision Support Systems (CDSS), which assist healthcare professionals in diagnostic and treatment processes, are wholly dependent on accurate and real-time data inputs. If the underlying data is compromised, whether through manipulation or technical fault, CDSS output can become misleading or dangerous, potentially leading to inappropriate interventions.

The Implementation of Cybersecurity in Healthcare. Regulatory Frameworks and Compliance

The importance of data handled in health means that the healthcare sector is one of the most regulated in the world, especially in terms of clinical data management. The Health Insurance Portability and Accountability Act (HIPAA), as well as the Health Information Technology for Economic and Clinical Health (HITECH) Act in the U.S., establish national standards for protecting health data. In Europe, the General Data Protection Regulation (GDPR) sets stringent rules on data consent, access and transfer. Also, the newer NIS2 Directive seeks to harmonise cybersecurity standards across critical sectors, including health.

When it comes to Compliance—it’s not equal to security since many breaches occur in technically compliant organisations—we need a proactive security measure and continuous improvement, given by the international standards such as ISO/IEC 27799:2016 provide frameworks for building a robust information security management system tailored to data environments.

Considering this, building resilience requires not only strategy but investment and cultural change. Key practices include Risk Assessment (continuous evaluation of threat landscape and vulnerabilities) and adopting a Zero-Trust Architecture (framework that assumes no inner or outer user, device or system, can be inherently trusted), Education and Training and Security by Design (in the sense that cybersecurity must be integrated into the design of all new systems and digital health tools).

Several best practices can be found in the Mayo Clinic (Spain), which has implemented a layered defence strategy that combines endpoint protection, internal network segmentation, real-time anomaly detection and employee training. They also conduct regular red-teaming exercises to simulate breaches and improve incident response. Another example comes from the Cleveland Clinic (USA), which uses AI-powered cybersecurity solutions to monitor behavioural anomalies across its digital infrastructure. Their system can flag unusual data access patterns or external communication attempts in real-time, preventing attacks before they escalate.

Future Trends and Conclusions

New technology carries both promise and peril. Quantum computing risks making existing encryption obsolete, resulting in the need for investment in post-quantum cryptographic algorithms. Federated learning and differential privacy also enable AI models to be trained on sensitive data without revealing individual records.

For their part, patients could have greater ownership of their health data across environments with secure digital identity platforms, enhancing portability and transparency. To be effective, such advancements should be accompanied by sound governance frameworks to guarantee that these methods add value to — and do not detract from — clinical quality.

As a result, cybersecurity is not just a backend issue the IT team worries about. It is vital to safe care delivery, patient-provider trust and stability of health systems. As the healthcare industry faces digital transformation, too, we must approach securing patient data evolution.

Conflict of Interests

None.