Top 5 Challenges Using NIST in Healthcare
Post Summary
Implementing the NIST Cybersecurity Framework in healthcare is no easy task. While it’s essential for protecting sensitive patient data, organizations face several hurdles that complicate its adoption. Here are the top challenges healthcare providers encounter:
- High Costs: With healthcare breach costs averaging $9.77 million, the financial investment required for tools, staff, and training often exceeds budgets.
- Technical Complexity: Legacy medical devices and delayed vendor patches make securing systems difficult.
- Regulatory Confusion: Misalignment between NIST, HIPAA, and HITECH creates overlapping and sometimes conflicting requirements.
- Knowledge Gaps: Many healthcare leaders mistakenly equate HIPAA compliance with cybersecurity, leaving NIST’s advanced protections underutilized.
- Risk Assessment Difficulties: NIST’s detailed risk management process overwhelms organizations lacking the resources or expertise for continuous monitoring.
These challenges underscore the need for a shift from basic compliance to a proactive cybersecurity approach. Tools like Censinet RiskOps™ can help streamline processes, reduce costs, and improve security posture.
Top 5 NIST Implementation Challenges in Healthcare with Key Statistics
Ep#230 Healthcare and Cybersecurity from the Challenges to the Solutions
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1. Limited Resources and Budget
For healthcare organizations trying to adopt NIST guidelines, budget constraints are one of the toughest hurdles. The costs start stacking up in several areas: hiring cybersecurity specialists, training staff, upgrading outdated systems, and maintaining tools for ongoing monitoring. Recruiting and keeping skilled cybersecurity professionals comes with a hefty price tag, and the ongoing need for digital literacy training adds recurring expenses - often exceeding what many budgets can handle [5][6]. On top of that, managing devices and paying for insurance only deepen the strain on resources.
Medical devices bring an extra layer of complexity. Organizations must invest heavily in identifying and addressing vulnerabilities in networks of connected devices. When vendors are slow to release patches, hospitals often have to fund their own fixes, adding to the financial burden.
"Understanding the risks posed by IoT devices is an expensive and time-consuming undertaking for hospital systems and will only become more burdensome as these devices become more integrated into care." - Sutter Health [2]
Cybersecurity insurance costs are another challenge. Premiums jumped 48% in the third quarter of 2022 alone [2]. While adopting the NIST Cybersecurity Framework (CSF) can reduce premium increases by as much as 66% [6], implementing the framework requires significant upfront investment. At the same time, healthcare supply chain security challenges are demanding more attention. In 2022, 85% of organizations increased their budgets for supply chain risk, with 20% doubling their spending [2]. These competing priorities force healthcare organizations to make tough decisions about where to spend their limited cybersecurity funds.
2. Overlapping Regulatory Requirements
Healthcare organizations operate in a maze of regulations, juggling HIPAA, HITECH, and NIST guidelines. The difficulty isn't just the sheer number of requirements - it’s how these frameworks overlap, leading to redundant work and confusion. This tangled web of rules strains both time and resources.
HIPAA sets the legal groundwork for protecting electronic protected health information (ePHI), while NIST dives deeper with detailed security guidelines. For example, a single HIPAA-required risk analysis might involve cross-checking multiple NIST subcategories like ID.AM-1, ID.AM-2, and ID.RA-1 [8]. This constant back-and-forth can be overwhelming.
One key difference is enforcement. HIPAA is federally mandated, with penalties for non-compliance. NIST, on the other hand, is voluntary. This often pushes organizations to focus on meeting HIPAA requirements for audits, leaving NIST’s more advanced recommendations - like stronger cybersecurity measures - on the back burner [3].
"You need HIPAA to remain legal. You need NIST to remain operational." - CompassMSP [3]
HIPAA zeroes in on ePHI, but NIST takes a broader approach, requiring an inventory of all assets, even IoT devices like smart infusion pumps or HVAC systems. These devices are often overlooked in HIPAA audits but can pose significant security risks [3].
The numbers tell a worrying story. From 2018 to 2022, large breaches reported to the Office for Civil Rights increased by 93% (from 369 to 712), and ransomware breaches soared by 278% [8]. Simply passing a HIPAA audit doesn’t guarantee protection from modern cyber threats. For instance, HIPAA’s focus on basic access controls, like unique IDs and passwords, might leave gaps if advanced measures such as Multi-Factor Authentication or Zero Trust architecture - emphasized by NIST - are not in place [3].
To help bridge the gap, the Department of Health and Human Services created a "HIPAA Security Rule Crosswalk to NIST Cybersecurity Framework" [4] [9]. This tool maps HIPAA standards to NIST guidelines, highlighting overlaps and exposing areas that need attention. Additionally, NIST’s Cybersecurity and Privacy Reference Tool (CPRT) allows organizations to interactively map and customize these standards [8]. By using these resources, healthcare organizations can turn regulatory overlap into an opportunity, aligning their efforts for both compliance and stronger security.
3. Technical Implementation Difficulties
After financial and regulatory challenges, technical hurdles add another layer of complexity to adopting NIST standards in healthcare.
A major issue lies in the cybersecurity vulnerabilities of many older medical devices. While these devices still function as intended, they were not designed to handle modern cybersecurity threats. This leaves them exposed to risks that NIST standards, such as SP 800-53 and C-SCRM, aim to address [10].
One of the biggest challenges is that these legacy systems often lack the ability to support secure, automated updates. Additionally, they frequently rely on proprietary protocols, making it difficult for standard security tools to interact with them effectively. This complicates efforts to meet NIST guidelines.
"Legacy medical devices... still perform their primary function but may be vulnerable to cybersecurity risks." - MITRE [10]
Another stumbling block is continuous monitoring, which is a cornerstone of the NIST Risk Management Framework. Many older systems lack standardized logging or the ability to integrate modern monitoring tools, making real-time threat detection a challenge. As a result, hospitals often have to implement expensive workarounds, especially when patches for these systems are delayed [2][7].
Adding to the complexity is the unclear division of security responsibilities between manufacturers and healthcare providers. This lack of clarity can weaken risk management efforts [10]. To address this, healthcare organizations can turn to NIST SP 800-221, which helps translate technical vulnerabilities into enterprise-level risks. Implementing a unified risk operations approach can further streamline these efforts across clinical and business teams. This approach can also help justify investments in infrastructure upgrades [7]. Furthermore, the NICE Framework provides a guide for building the specialized expertise needed to secure these intricate medical environments, supporting a more comprehensive risk management approach [7].
These technical challenges, combined with financial and regulatory pressures, highlight the layered difficulties of implementing NIST standards in the healthcare sector.
4. Limited Understanding of NIST
Beyond technical and regulatory challenges, a major hurdle lies in grasping the NIST Cybersecurity Framework (CSF). A lack of understanding has slowed its adoption, with healthcare organizations showing only 47% alignment with NIST CSF controls compared to 72% compliance with the HIPAA Security Rule [12]. This highlights a deeper issue that goes beyond implementation.
As Mac McMillan, CEO of CynergisTek, points out, many healthcare leaders mistakenly equate compliance with security. Passing a HIPAA audit is often seen as sufficient protection, but HIPAA merely sets a basic compliance standard. NIST, on the other hand, provides a strategic guide to achieving true cyber resilience [12][3]. This misconception fosters a "check-the-box" mentality, leaving organizations vulnerable.
Another problem is the disconnect between technical teams and leadership. IT teams often struggle to explain NIST controls in terms of business risks that boards can understand and act on [7][13]. This communication gap is significant, as 95% of mature healthcare organizations with a senior-level security leader, such as a CISO, have adopted the NIST CSF [13]. Yet many CEOs still view cybersecurity as an IT issue rather than a core business concern [12][13].
Smaller healthcare organizations face additional challenges, often perceiving NIST as overly complex or suited only for large hospital systems. This belief persists despite the framework's scalable "Implementation Tiers", which are designed to accommodate organizations of any size [3][1]. The introduction of the "Govern" function in NIST CSF 2.0 further emphasizes leadership's role in managing cyber risks alongside financial and clinical metrics - a shift that many healthcare boards are not yet prepared for [3].
The consequences of this knowledge gap are costly. With the average healthcare data breach now reaching $9.77 million [3], organizations relying solely on basic compliance remain at significant risk. On the flip side, fully adopting the NIST CSF can lower cyber insurance premiums by as much as 66% [3], demonstrating the financial advantages of a deeper understanding of the framework.
For organizations aiming to close this gap, solutions like Censinet RiskOps™ can make a meaningful difference, offering support for NIST CSF 2.0 and HHS Cybersecurity Performance Goals. These platforms translate technical controls into actionable business insights, helping leadership engage more effectively and strengthening overall security strategies.
Bridging this understanding gap is a critical step before addressing broader challenges in risk assessment.
5. Difficult Risk Assessment Process
Even when healthcare organizations are familiar with NIST guidelines, conducting its risk assessments can feel overwhelming. The NIST Risk Management Framework involves a detailed seven-step process - Prepare, Categorize, Select, Implement, Assess, Authorize, and Monitor - which can be especially challenging for organizations without a solid risk management foundation [14]. On top of that, aligning these technical requirements with broader business goals often proves to be a stumbling block for many teams [5]. Limited resources and a reactive approach to operations only make the process harder.
With resource constraints and a tendency to act only after incidents occur, many organizations fail to adopt continuous monitoring [5]. This reactive mindset is particularly troubling when you consider the numbers: data breaches in healthcare have doubled over the past five years, and ransomware attacks have surged to nearly 400 incidents during the same period [11].
"With data breaches having doubled over the past five years and ransomware attacks reaching almost 400 in the same period, it is clear that the healthcare industry needs to up its game." - Bryan Cline, Chief Research Officer at HITRUST [11]
The sheer scope of NIST assessments adds another layer of complexity. For example, a NIST risk assessment typically examines around 108 controls, compared to just 64 in a standard HIPAA assessment [15]. Without automated tools, many organizations resort to using manual spreadsheets to manage these controls, which often results in duplicated work and incomplete evaluations. The integration of new devices with outdated legacy systems further complicates things, introducing vulnerabilities that are tough to assess and prioritize [5].
But identifying risks is only half the battle - acting on those findings is where many organizations stumble. Translating technical risks into actionable insights for business leaders can be a challenge, especially when it comes to communicating the financial or operational impact to executives who control budgets and resources [5]. This disconnect is evident in the healthcare sector, particularly in the "Govern" and "Identify" functions of NIST CSF 2.0. These areas scored the lowest in coverage, with supply chain risk management and asset management performing poorly at just 52% and 53%, respectively [16].
For organizations grappling with these challenges, platforms like Censinet RiskOps™ offer a lifeline. By automating workflows, using intelligent questionnaires, and mapping HIPAA requirements directly to NIST controls, these tools streamline the entire process. They help replace cumbersome spreadsheets with guided solutions that not only speed up assessments but also centralize documentation and reporting - critical for organizations with limited resources dedicated to risk management.
Conclusion
Navigating the implementation of NIST in healthcare comes with its fair share of hurdles - tight budgets, overlapping regulations, technical barriers, knowledge gaps, and intricate risk assessments. With the average cost of a healthcare data breach hitting a record $9.77 million, and the industry leading breach costs for 14 years straight, the stakes couldn’t be higher [3]. These numbers are a stark reminder of the financial and operational risks at hand.
This is why a proactive, resilience-focused approach is so critical. As Emily Zaczynski aptly put it:
"You need HIPAA to remain legal. You need NIST to remain operational." [3]
Focusing solely on compliance isn’t enough anymore. True resilience means being prepared to endure and recover from a ransomware attack, rather than just filing reports after the fact. It means ensuring clinical operations continue even when digital systems fail, uncovering shadow IT and IoT vulnerabilities before they’re exploited, and presenting cybersecurity risks to your board in the same way you would financial or clinical metrics.
Specialized tools can make a big difference here. For example, Censinet RiskOps™ offers automated risk assessments, smart questionnaires, and compliance management tools that align HIPAA with NIST controls. Organizations using the NIST CSF have even reported reductions in cyber insurance premiums of up to 66% [3]. That’s a clear return on investment - cutting costs while fortifying security.
The alternative? Millions of dollars lost and weeks of operational downtime. A ransomware attack alone can cause over 20 days of disruption [3]. The question is: Can your organization afford not to tackle these NIST challenges head-on?
FAQs
Where should we start with NIST if our budget is tight?
If you're working with a tight budget, start by exploring the NIST Cybersecurity Framework's quick start resources. These include the "Getting Started with the NIST Cybersecurity Framework" guide and the CSF 2.0 overview. These resources break down practical, cost-effective steps to help you implement the framework efficiently. Prioritize foundational actions that deliver the greatest impact without requiring a large financial investment.
How can we align NIST with HIPAA and HITECH without duplicating work?
Aligning NIST's Cybersecurity Framework (CSF) with HIPAA and HITECH can be simplified by using tools like crosswalks. These tools map the CSF to HIPAA Security Rule requirements, making it easier to spot overlaps and address gaps while avoiding unnecessary duplication. To ensure a seamless integration, focus on prioritizing risks, aligning security controls, and utilizing automation platforms for continuous assessments and monitoring. This approach not only streamlines efforts but also enhances the overall security posture.
What’s the fastest way to assess and reduce risk from legacy medical devices?
To tackle risks associated with legacy medical devices, start by pinpointing vulnerabilities, ranking risks, and applying specific mitigations. Use risk assessments aligned with frameworks like the NIST Cybersecurity Framework and tools such as Censinet RiskOps™ to simplify the process. Focus on key actions like keeping an up-to-date inventory of devices, deploying security measures such as network segmentation, and crafting customized incident response plans to handle high-risk devices effectively.
