May 5, 2025

A practical guide to IoMT security for healthcare IT leaders

TL;DR

IoMT devices are multiplying—visibility is essential.
Balance security with clinical workflow.
Automate updates and segment networks.
Start small, measure, and improve.
Continuous progress beats perfection.

‍

It's 2 AM, and your phone lights up with an alert.

A connected insulin pump on your network is behaving strangely, sending unusual traffic patterns that don't match its normal behavior. Is it a malfunction that could affect patient care? A security breach? Or just a firmware update gone sideways?

Welcome to the reality of managing IoMT devices in 2025, where the promise of connected healthcare meets the pressure of keeping it all running securely, at scale, and without interruption.

‍

The numbers tell only half the story

For most healthcare IT leaders, the IoMT landscape is expanding at a dizzying pace. The market has ballooned to over $230 billion this year, with projections showing 18% annual growth through 2030. More telling: the average hospital now manages 10-15 different device types per patient room, with large health systems responsible for 100,000+ connected medical devices.

But numbers don't capture what this means for those in charge—the weight of responsibility that comes with each new connected device added to the network.

Unlike traditional IT assets, these aren't just endpoints that might leak data or slow down if compromised. These are devices that monitor vital signs, deliver medication, and support clinical decisions. Devices where downtime isn't measured in lost productivity, but potentially in patient outcomes.

‍

The dual burden no one talks about

IT leaders reportedly feel like they have to accelerate while hitting the brakes. Leadership wants all the benefits of connected health—remote monitoring, predictive analytics, automated documentation—but they also expect perfect security, compliance, and uptime.

This captures the fundamental tension most healthcare IT leaders face: they're expected to be both visionaries and guardians.

As visionaries, they're tasked with enabling new care models—remote patient monitoring that extends the hospital into the home, AI-powered diagnostics that catch conditions earlier, and workflow automation that gives clinicians back precious time with patients.

As guardians, they're responsible for protecting systems where failure isn't an option—ensuring perfect uptime, ironclad security, and meticulous compliance with regulations that weren't written with thousands of distributed IoMT devices in mind.

And unlike their colleagues in retail or finance, failures don't just mean downtime or data leaks—they can impact patient care in ways that keep IT leaders up at night.

‍

The visibility paradox

Perhaps the most frustrating reality is what experienced leaders call the "visibility paradox." When everything works perfectly—when thousands of connected devices seamlessly and securely support clinical workflows—the work is invisible. No one notices the insulin pump that didn't get compromised, the patient monitor that didn't go offline, or the data that didn't leak.

But when something goes wrong? Suddenly, everyone notices.

‍

The challenge beneath the challenge

The technical hurdles are substantial enough:

Device diversity that makes standardization nearly impossible
Legacy clinical systems that weren't designed for today's connected world
Resource constraints that force difficult trade-offs between innovation and maintenance
Regulatory requirements that multiply with each new device type

But beneath these visible challenges lies something deeper—the psychological weight of being responsible for an expanding universe of devices that directly impact patient care, while often lacking the resources, recognition, or roadmap needed to manage them effectively.

Healthcare IT leaders frequently harbor the same private concerns:

"Do we really know every device on our network?"
"Are we one zero-day vulnerability away from a major incident?"
"How do we scale our management approach as devices multiply?"

‍

A path forward exists

For those nodding in recognition, know that you're not alone. The challenges are real, but so are the solutions—approaches that dozens of healthcare organizations have implemented to bring order to IoMT chaos.

In conversations with CIOs, CISOs, and IT Directors who've successfully navigated these waters, certain patterns emerge:

They've moved from reactive to proactive device management
They've implemented scalable automation rather than manual processes
They've built defense-in-depth security that doesn't disrupt clinical workflows
They've created clear metrics that translate technical success into business and clinical value

Throughout this article, we'll share their practical, battle-tested approaches—not theoretical frameworks, but real-world solutions that acknowledge the constraints and pressures healthcare IT leaders face daily.

Because the truth is, managing IoMT at scale isn't just a technical challenge—it's a leadership challenge that requires balancing innovation and protection, visibility and security, clinical needs and technical realities.

And it starts with acknowledging that the expanding IoMT frontier brings both extraordinary promise and unprecedented pressure to those tasked with managing it.

‍

Managing complexity, security, and risk at scale

Ask any healthcare IT leader about their IoMT challenges, and you'll hear a consistent refrain: complexity that outpaces resources. The numbers tell a sobering story—80% of healthcare organizations experienced IoMT-related security incidents in the past two years, while only 60-70% of devices receive consistent security updates in even the best-run environments. This gap isn't from lack of effort or awareness; it stems from the perfect storm of technical diversity (10+ device types per room), vendor fragmentation (each with proprietary management tools), and integration requirements with decades-old clinical systems that weren't designed for today's connected world.

Behind these technical challenges lurks a deeper psychological burden that rarely makes it into board presentations or vendor discussions. Healthcare IT leaders carry what might be called "the steward's burden"—knowing that a single compromised insulin pump or patient monitor could impact care delivery, while simultaneously lacking the visibility tools and automated management capabilities needed to guarantee security at scale. As one CISO put it bluntly: "I'm accountable for devices I can barely see, let alone control." This invisible weight manifests in practical concerns: how to maintain compliance across thousands of devices, how to implement security without disrupting clinical workflows, and how to stretch limited teams across an ever-expanding digital surface area.

Perhaps most frustrating is what security experts call the "zone of compromise"—the space where healthcare IT leaders must balance perfect security (which would require locking down systems to the point of clinical unusability) against perfect clinical access (which would create unacceptable security and compliance risks). Finding this balance means navigating difficult conversations with clinicians who want frictionless technology, executives who demand both innovation and zero risk, and security teams who identify vulnerabilities faster than they can be remediated. The path forward isn't about eliminating these tensions—they're inherent to healthcare's unique mission—but about building scalable, defensible approaches that acknowledge real-world constraints while systematically reducing risk.

‍

Building a defensible, scalable IoMT management strategy

The gap between where most healthcare organizations are today and where they need to be with IoMT management can seem overwhelming. But leading healthcare systems have found that success doesn't require unlimited resources or perfect technology—it requires a systematic, phased approach that acknowledges real-world constraints while building toward comprehensive management.

The most effective strategies share a common foundation: they're defensible (to regulators, executives, and security teams), scalable (as device fleets grow), and clinically sensitive (recognizing that patient care can't pause for security initiatives).

Start with visibility: You can't secure what you can't see

The cornerstone of any effective IoMT management strategy is comprehensive visibility. Surprisingly, 67% of healthcare organizations can't identify all connected medical devices on their networks, according to Forescout's 2025 report.

What leading organizations do differently:

Implement passive discovery tools that identify devices without disrupting clinical operations
Create a unified inventory database that consolidates information from multiple sources (network scans, procurement records, biomedical databases)
Classify devices by risk level based on clinical impact, data sensitivity, and connectivity profile
Map dependencies between devices and clinical systems to understand the potential impact of security measures

A Midwest academic medical center reduced unknown devices on their network from 22% to less than 3% using this approach, while simultaneously cutting inventory management time by 60%. They thought they had about 15,000 connected medical devices. After implementing automated discovery, the number climbed to 22,000. You can't secure what you don't know exists.

Build segmentation that respects clinical reality

With visibility established, the next critical step is implementing network segmentation that contains potential threats without impeding clinical workflows.

Practical implementation approaches:

Start with monitoring before enforcing — observe normal traffic patterns before implementing restrictions
Create clinically logical segments based on department, function, or risk profile
Implement graduated controls with stricter measures for high-risk devices
Test extensively with clinical stakeholders to identify potential workflow disruptions before they affect patient care

This phased approach allows for "small, safe experiments" that build confidence without risking clinical disruption. One children's hospital successfully implemented microsegmentation across 18,000 devices over 18 months with zero reported clinical disruptions by following this methodology.

Automate the security basics at scale

Manual management becomes impossible as IoMT fleets grow. Organizations successfully managing large device populations have systematically automated core security functions:

Vulnerability management

Automated scanning calibrated for medical devices (60% of organizations still use IT-focused vulnerability scanners that can disrupt medical devices)
Risk-based prioritization that considers clinical impact alongside technical severity
Integration with clinical engineering workflows for coordinated remediation

Patching and updates

Scheduled maintenance windows aligned with clinical operations
Automated testing of patches in staging environments before production deployment
Rollback capabilities for when updates cause unexpected issues

Authentication and access control

Centralized policy management for device credentials
Automated provisioning and deprovisioning as devices enter and leave service
Default credential identification and remediation

A regional healthcare company automated 85% of routine tasks for IoMT. This doesn't just improve security—it frees their team to focus on the complex edge cases that require human judgment.

Leverage AI for anomaly detection and response

With basics automated, leading organizations are deploying AI-powered monitoring to identify behavioral anomalies that signature-based approaches miss.

Key capabilities to develop:

Behavioral baselining that establishes normal patterns for each device type
Contextual alerting that considers clinical impact when prioritizing responses
Automated containment options for high-confidence threats
Human-in-the-loop workflows for complex scenarios requiring clinical judgment

AI-based systems now detect 95 %+ of known attack signatures in real time, according to recent Springer research, while dramatically reducing false positives compared to traditional rule-based approaches.

Build defensible compliance documentation

Regulatory requirements for IoMT continue to evolve, with HIPAA, FDA guidance, and various state laws creating a complex compliance landscape. Forward-thinking organizations are implementing:

Automated compliance documentation that maintains continuous evidence of security controls
Policy enforcement validation that verifies controls are functioning as intended
Audit-ready reporting that demonstrates due diligence in device security
Risk assessment frameworks specifically calibrated for connected medical devices

This approach transforms compliance from a periodic scramble into a continuous, defensible process that can withstand regulatory scrutiny.

Create a lifecycle management strategy

Perhaps the most overlooked aspect of IoMT management is comprehensive lifecycle planning—from procurement to retirement.

Essential components include:

Procurement controls

Security requirements in purchasing contracts
Pre-deployment security assessment protocols
Vendor security questionnaires and validation

Midlife management

Ongoing vulnerability monitoring and management
Performance degradation tracking
Scheduled reassessment of security posture

End-of-life handling

Secure decommissioning procedures
Data sanitization protocols
Validated destruction or recycling processes

A healthcare security architect was reportedly able to reduce security incidents by 72% since implementing their lifecycle management program. Most vulnerabilities now get caught before devices ever touch their clinical network.

‍

Crawl, walk, run

The most successful IoMT security programs recognize that comprehensive management can't be implemented overnight. They follow a phased approach:

Phase 1: Foundation (1-3 months)

Implement passive discovery and inventory
Establish basic monitoring
Develop incident response procedures specific to IoMT

Phase 2: Protection (3-9 months)

Deploy network segmentation
Implement vulnerability management
Automate basic security functions

Phase 3: Optimization (9+ months)

Deploy AI-powered anomaly detection
Implement advanced authentication
Develop comprehensive lifecycle management

This phased approach allows healthcare organizations to demonstrate progress while systematically reducing risk, building credibility with stakeholders and acknowledging resource realities.

Metrics that matter

Effective IoMT management requires clear metrics that demonstrate progress and justify continued investment:

Security Effectiveness Metrics:

Percentage of devices with current security patches
Mean time to detect and remediate vulnerabilities
Number of security incidents involving medical devices

Operational Efficiency Metrics:

Device inventory accuracy
Time saved through automation
Mean time to onboard new devices

Clinical Impact Metrics:

Clinician satisfaction with security measures
Security-related clinical workflow disruptions
Availability of critical systems and devices

‍

Gaining buy-In, bridging silos, and measuring what matters

Even the most technically sound IoMT management strategy will fail without organizational alignment. The hard truth many technology leaders discover: the greatest barriers to effective device management aren't technical—they're human. Successful programs require navigating the complex landscape of stakeholder concerns, departmental boundaries, and competing priorities that define healthcare organizations.

Tailoring your message

Healthcare organizations operate with distinct professional cultures, each with their own priorities, languages, and concerns. Effective IoMT leaders learn to translate technical imperatives into terms that resonate with each audience.

For clinical leadership

Clinicians don't inherently resist security—they resist anything that slows patient care. When approaching clinical stakeholders:

Frame security in patient safety terms: "This isn't just about data protection—it's about ensuring devices deliver reliable care."
Quantify workflow impacts: "This change will add approximately 15 seconds to login once per shift, but eliminate the need for three separate passwords."
Involve clinical champions early: Identify respected clinicians who understand both technical and clinical concerns to help bridge the gap.

For executive leadership

C-suite leaders need to understand IoMT management in business and strategic terms:

Connect to strategic priorities: Show how device management enables key initiatives like remote care expansion or value-based care metrics.
Translate to risk language: Frame in terms of enterprise risk—regulatory, financial, reputational, and clinical.
Provide benchmark comparisons: Show how your organization compares to peers and industry standards.
Focus on ROI beyond security: Highlight operational efficiencies, clinical improvements, and competitive advantages.

A particularly effective approach: create a one-page executive dashboard that visualizes device security posture, compliance status, and operational metrics in business terms.

For technical teams

IT and biomedical engineering teams need to understand how IoMT management affects their daily work:

Emphasize automation benefits: Show how comprehensive management reduces firefighting and repetitive tasks.
Address skill development: Frame new approaches as professional development opportunities.
Acknowledge implementation challenges: Demonstrate understanding of the practical hurdles they'll face during deployment.

‍

Breaking down organizational silos

IoMT management inherently spans traditional departmental boundaries. Successful programs bridge the historical divides between IT, biomedical engineering, clinical departments, and security teams.

Practical approaches to organizational alignment

Create cross-functional governance: Establish a medical device security committee with representation from IT, clinical engineering, security, compliance, and clinical leadership.
Implement shared metrics: Develop KPIs that span departmental boundaries to create shared accountability.
Define clear roles and responsibilities: Create RACI matrices that clarify decision rights and responsibilities across teams.
Co-locate key personnel: Consider physical or virtual co-location of IT and biomedical engineering staff to foster collaboration.

One academic medical center reduced IoMT-related incidents by 64% after implementing a unified Medical Device Security Operations Center (MDSOC) that brought together previously siloed teams.

‍

Demonstrating value through meaningful metrics

Healthcare leaders are drowning in data but starving for insight. Successful IoMT programs cut through the noise with metrics that matter to various stakeholders.

Metrics that resonate across the organization

For Clinical Leaders:

Device availability and reliability statistics
Clinical workflow impact measurements
Time saved through automation

For Risk and Compliance:

Regulatory compliance status
Vulnerability remediation timelines
Security incident metrics

For Financial Stakeholders:

Cost avoidance through incident prevention
Operational efficiency improvements
Resource utilization optimization

Visualization matters

How you present data significantly impacts its reception. Leading organizations use:

Executive dashboards with red/yellow/green indicators for at-a-glance status
Trend visualizations that show improvement over time
Comparative benchmarks against industry standards and peer organizations
Impact stories that connect metrics to real-world outcomes

‍

Building trust through transparency and small wins

Trust is the currency of organizational change. Building it requires both transparency about challenges and demonstrable progress through incremental wins.

The power of pilot programs

Rather than attempting an organization-wide deployment, successful leaders:

Start with limited-scope pilots in receptive departments
Gather detailed feedback and demonstrable results
Use successful pilots to create internal case studies
Leverage early adopters as advocates for broader rollout

Transparent communication about challenges

Counterintuitively, acknowledging difficulties builds more trust than projecting false confidence:

Be honest about implementation challenges
Provide regular updates—good and bad
Create feedback mechanisms for stakeholders to share concerns
Demonstrate responsiveness to feedback

The continuous engagement model

Successful IoMT management isn't a one-time project but an ongoing program requiring continuous stakeholder engagement:

Regular governance meetings that bring together cross-functional leadership
Operational working groups that address day-to-day challenges
Executive briefings that connect program status to strategic objectives
Clinical user groups that provide feedback on workflow impacts

‍

A constant dilemma of an IT leader in healthcare

The most effective healthcare IT leaders approach IoMT management not as a project with an endpoint, but as an ongoing journey of continuous improvement. They recognize that perfection is impossible in an environment where devices, threats, and regulations constantly evolve—but systematic progress is achievable. These leaders have moved beyond the paralyzing pursuit of flawless security to embrace what might be called "defensible diligence"—the ability to demonstrate thoughtful, risk-based decision-making even when resources are constrained and perfect solutions aren't feasible. This mindset shift from perfectionism to pragmatic progress often proves the difference between burnout and sustainable success in managing complex device ecosystems.

Behind closed doors, healthcare IT leaders acknowledge the psychological weight they carry—the impostor syndrome when facing novel threats, the fear of catastrophic blame if something goes wrong, and the constant pressure to do more with less. The most resilient leaders have learned to address these challenges not by working harder, but by building stronger systems: developing robust peer networks for knowledge sharing, creating psychologically safe environments where teams can acknowledge limitations, and implementing incremental improvements that gradually reduce risk without requiring heroic efforts. They've discovered that empathy, for clinicians navigating complex workflows, for team members balancing competing priorities, and even for themselves facing impossible expectations, isn't a soft skill, but a strategic advantage in environments where technology and human systems are inextricably linked.

Ultimately, sustainable IoMT management requires balancing the guardian and innovator roles that define healthcare IT leadership. The guardian ensures devices remain secure, compliant, and reliable; the innovator sees how these same devices can transform care delivery, improve patient outcomes, and enhance clinical workflows. Leading organizations cultivate both mindsets—implementing the disciplined processes and controls needed for security while maintaining the creativity and vision to leverage connected health for strategic advantage. They measure success not just by incidents prevented, but by care enabled; not just by vulnerabilities patched, but by possibilities created. In doing so, they transform IoMT management from a necessary burden into a strategic capability that advances their organization's fundamental mission: delivering exceptional care to the patients who depend on them.

‍

FAQ

1. What is the biggest challenge with managing IoMT devices in healthcare?

The biggest challenge is knowing exactly how many and what types of devices are connected to your network—and keeping them inventoried, updated, and secure without disrupting clinical workflows.

2. How often should IoMT device software and firmware be updated?

Ideally, devices should be updated as soon as security patches are available. In practice, patching cycles are typically quarterly or biannual, with critical vulnerabilities addressed immediately. Many organizations automate this process for efficiency and safety.

3. What steps can improve IoMT device security in a hospital setting?

Start with a comprehensive device inventory, segment networks, enforce strong authentication, monitor device behavior, and automate patch management wherever possible. Regular staff training is also key.

4. How does IoMT impact patient care and safety?

IoMT enables real-time monitoring, faster response to emergencies, and better data for clinical decisions. However, poorly managed devices can introduce risks if they fail or are compromised, potentially impacting patient outcomes.

5. What are the regulatory requirements for IoMT device management?

Hospitals must comply with HIPAA, FDA, and sometimes GDPR or other local rules. This means securing patient data, tracking device use, ensuring auditability, and maintaining up-to-date security measures across all connected devices.

‍