Medical Device Cybersecurity in the NHS: How to Protect Connected Medical Equipment

In today’s NHS hospitals, technology is deeply integrated, with potentially hundreds to thousands of devices in use. These include patient monitors, infusion pumps, imaging systems, smart beds, lab equipment, and diagnostic tools. Each of these devices links to hospital networks, clinical systems, monitoring platforms, vendor systems, or cloud services. This interconnectedness can enhance patient care, make workflows more efficient, and ensure quicker access to medical information. However, it also brings new cybersecurity challenges. Each network-connected device becomes a potential vulnerability point that requires careful oversight and protection.

To effectively address these cybersecurity concerns, NHS organisations must first gain a thorough understanding of their device landscape. This involves knowing what devices are present, their locations, their connection methods, and their associated security details. This foundational knowledge is crucial for assessing cyber risks and implementing protective measures.

This is where medical device cybersecurity becomes essential. Effective protection requires more than securing the wider NHS network. It also means understanding the connected medical-device estate and managing its risks throughout the device lifecycle.

What is a Medical Device Cybersecurity?

Medical device cybersecurity refers to the measures used to protect connected medical devices, the data they handle, and associated systems from unauthorised access, disruption, manipulation, and other cyber threats throughout the device lifecycle.

Unlike traditional IT security, medical device cybersecurity must account for the clinical role and operational constraints of medical equipment. A cyber incident affecting a medical device may not only compromise data, but it could also disrupt essential care.

Medical devices present unique cybersecurity challenges because their availability can directly affect patient care, while many remain in service for years and may run outdated operating systems or software. Patching can require manufacturer involvement, and taking a device offline for maintenance may disrupt clinical services. Security responsibilities may also span IT, Clinical Engineering, clinical teams, and device manufacturers, making coordination essential.

Effective medical device cybersecurity therefore requires a lifecycle-based approach that balances security, clinical safety, device availability, and operational requirements.

Why Connected Medical Devices Create a Different Cybersecurity Challenge

Securing connected medical devices is not simply a matter of installing antivirus software. Medical equipment operates within clinical environments and has unique technical, operational, and governance requirements.

• Long Operational Lifecycles

Medical devices can remain in service for many years, often longer than standard IT equipment. This means their technology can age while the device continues to perform an essential clinical function.

• Legacy Software

Legacy software often poses a challenge for many devices because it depends on outdated operating systems or programs that no longer get regular security updates. This lack of updates can leave systems vulnerable, making it harder to ensure their security.

• Clinical Availability

When a medical device requires patching, maintenance, or security updates, it can disrupt routine clinical procedures. To minimize such disruptions, healthcare facilities must plan these security tasks meticulously.

• Third-Party and Vendor Connectivity

Many medical devices connect to external systems for remote monitoring, diagnostics, or support services. These connections introduce additional security considerations, necessitating continuous monitoring and safeguarding to ensure patient data remains protected.

• Complex Ownership

Responsibility for medical device security can span Clinical Engineering, IT, Cybersecurity, Procurement, and manufacturers. Clear ownership, communication, and governance are therefore essential for managing risk effectively.

The First Cybersecurity Challenge: Know What is Connected

Before an organisation can safeguard its connected medical devices, it must first identify what it possesses. Without this knowledge, assessing the risks associated with any device becomes nearly impossible. NHS England advises maintaining an up-to-date inventory of assets, including these devices, but it does not mandate a specific registry or method. Each organisation should therefore keep information that aligns with its own environment and governance needs.

For connected medical devices, essential details might include the device type, manufacturer or vendor, model, location, responsible owner or department, network connectivity, software versions, and support and maintenance agreements. It’s also crucial to know if devices are segmented, whether suppliers have network access, and, if relevant, specifics like network name or IP address.

Why does this visibility matter? The cybersecurity risk of a device involves more than just being aware of its existence. Organisations need to grasp where the device is located, what it connects to, which software it operates on, its criticality, and whether it receives regular support and maintenance. A precise asset inventory lays the groundwork for spotting vulnerabilities, prioritising risks, and making informed decisions about network security and device lifecycle management.

Asset visibility is a cybersecurity capability.

For healthcare organisations, knowing what is connected is therefore not just an administrative or asset-management task. It is the starting point for understanding and managing the cybersecurity risk of the clinical technology that supports patient care.

What is a Connected Medical Device Register?

A connected medical device register is a structured record that helps authorised teams understand the organisation’s connected medical-device estate. NHS England recommends that organisations have a way to catalogue connected medical devices and states that there is no single prescribed way to do this. An organisation can expand an existing medical-device register, extend its IT asset register, or create a separate connected-device register. Where possible, these records should be linked or synchronised to avoid duplication and conflicting information.

The purpose is not simply to create a list of devices. Good asset information can help teams identify devices, understand ownership, assess risk, plan maintenance, investigate vulnerabilities, respond to incidents and make informed lifecycle decisions. NHS England guidance specifically highlights the importance of knowing details such as device type, location, software, ownership, support and maintenance arrangements, connectivity and network information.

This information does not necessarily need to sit in an isolated spreadsheet maintained only for cybersecurity. A more useful approach is to connect device information with the wider processes that already manage the estate, including asset management, maintenance, Clinical Engineering, IT and risk management. This creates a more consistent view of each device and makes it easier to keep information current as devices are installed, maintained, updated, transferred or decommissioned. NHS England also recommends assigning ownership and maintaining asset information throughout the asset lifecycle.

This is particularly important for medical devices because their cybersecurity and operational risks can be closely linked. Maintenance arrangements, supplier access, software versions, network connectivity and device support status can all influence how an organisation manages a vulnerability or responds to a security incident. NHS England recommends involving relevant clinical colleagues when planning incident response for compromised medical devices, reinforcing the need for cybersecurity information to connect with operational and clinical processes.

Ultimately, a connected medical device register should be more than a record of what equipment exists. It should provide structured, usable information that helps different teams understand the devices they are responsible for and make better decisions throughout their lifecycle.

7 Key Cybersecurity Risks for Connected Medical Devices

Connected medical devices improve clinical care, but their connectivity also introduces new cybersecurity risks. From outdated software and weak access controls to network exposure and limited visibility, these risks can affect both digital security and clinical operations. Understanding the key risks is the first step toward managing them effectively.

• Unsupported or Legacy Software

Sometimes, medical devices continue to perform their intended functions even when their software ages. However, certain risks arise if the operating systems are no longer supported, security updates cease, or vendors withdraw their support. Instead of automatically replacing every outdated device, it’s important to conduct a thorough risk assessment. This approach ensures safety while considering the functionality of older equipment.

• Unpatched Vulnerabilities

Patching medical devices is more complex than updating a typical office computer. Manufacturer validation is important because updates must not affect device safety or performance. Clinical availability also matters, as devices may be needed continuously and downtime must be carefully planned. Updates must be compatible with the device’s hardware and software, while healthcare change-control and documentation requirements add further steps.

• Unknown Devices

When devices connect to your network without proper oversight or ownership, they introduce potential risks. To manage this effectively, ensure every device is promptly logged in the device register.

• Weak Access Controls

Weak access controls can expose systems to unauthorized access. Common issues include unchanged default passwords, excessive permissions, inappropriate role-based access, and accounts that remain active after staff leave. Applying least-privilege access and regularly reviewing user accounts can significantly reduce these risks.

• Third-Party Connectivity

When dealing with remote maintenance, manufacturer access, and supplier connections, ensuring proper governance for third-party access is crucial. Effective management of these external interactions helps protect sensitive data and maintain the integrity of your systems. By establishing clear policies and protocols, organisations can facilitate secure collaborations with external partners while minimising potential risks.

• Poor Network Segmentation

Network segmentation helps separate medical devices and other hospital systems so that a security problem in one area does not automatically spread to others. Poor segmentation can increase the impact of a compromise, potentially giving attackers access to more devices, systems, or sensitive information. For connected medical devices, appropriate separation can help limit exposure and contain incidents while supporting the availability of critical clinical services.

• Incomplete Lifecycle Management

Cybersecurity should be considered throughout the medical device lifecycle from procurement and deployment to operation, maintenance, upgrades and decommissioning. Managing security at every stage helps reduce risks, maintain support, and prevent outdated devices from becoming security gaps.

A Practical Framework for Managing Medical Device Cyber Risk

Managing connected medical-device cybersecurity is an ongoing process rather than a one-time assessment. A practical, risk-based approach can help healthcare organisations understand their device estate, address the most important risks first, and maintain security throughout the device lifecycle.

Step 1 — Identify

Know what devices exist, where they are, and how they connect.

Step 2 — Classify

Understand each device’s connectivity, clinical importance, ownership and lifecycle status.

Step 3 — Assess

Consider known vulnerabilities, software and support status, network exposure, and potential operational consequences.

Step 4 — Prioritise

Not every vulnerability creates the same level of risk. Risk-based prioritisation helps focus resources where they matter most.

Step 5 — Mitigate

Depending on the situation, actions may include updates, configuration changes, access restrictions, network controls, increased monitoring, manufacturer engagement or replacement planning.

Step 6 — Monitor

Device risk can change over time as vulnerabilities emerge, software becomes unsupported, or connectivity changes. Continuous monitoring is therefore essential.

Step 7 — Retire Securely

Decommissioning should address both the physical device and any information or data associated with it, ensuring the device does not remain an unmanaged security risk.

Why Medical Device Cybersecurity Is a Team Responsibility

Medical device cybersecurity cannot sit with one department alone. Connected devices bring together clinical, technical, operational and supplier-related risks, so effective protection requires collaboration across the organisation.

• Clinical Engineering / EBME

Understands device functionality, maintenance, lifecycle and clinical requirements.

• IT

Manages infrastructure, connectivity and integration with organisational systems.

• Cybersecurity

Identifies vulnerabilities, assesses threats and helps establish appropriate security controls.

• Procurement

Ensures cybersecurity requirements are considered when selecting and purchasing devices.

• Clinical Users

Provide practical insight into how devices are used and how security measures may affect clinical workflows.

• Suppliers / Manufacturers

Provide technical support, security updates, vulnerability information and guidance.

• Leadership / Governance

Establishes ownership, accountability and organisational priorities.

The Role of Clinical Engineering in Medical Device Cybersecurity

Clinical Engineering plays a central role in managing the cybersecurity of medical devices because it understands both the equipment and its clinical context. By maintaining accurate device inventories, maintenance records, lifecycle status, manufacturer details, equipment criticality and device locations, Clinical Engineering can provide the information needed to identify and assess risks.

Clinical Engineering can also support replacement planning for ageing or unsupported equipment and coordinate with IT and cybersecurity teams when devices require updates, risk assessment or other security measures.

Ultimately, strong Clinical Engineering processes help ensure that cybersecurity decisions are based on an accurate understanding of the devices supporting patient care.

Why Legacy Medical Devices Need a Risk-Based Approach

An older medical device is not automatically a security risk. Decisions should consider clinical importance, known vulnerabilities, vendor support, available mitigations, replacement feasibility, operational impact and lifecycle cost.

A risk-based approach helps organisations choose the right action such as protect, upgrade, replace or retire without compromising clinical needs.

The Future of Medical Device Cybersecurity

As the integration of medical devices into digital networks grows, healthcare organisations must enhance their strategies for managing these devices. This involves developing comprehensive inventories, gaining deeper insight into potential vulnerabilities, fostering collaboration between Clinical Engineering and cybersecurity teams, and adopting a risk management approach that considers the entire lifecycle of a device. It is crucial to integrate cybersecurity measures from the procurement phase and maintain them throughout the device’s use.

While the connectivity of medical devices offers significant advantages, it also demands heightened vigilance. Effective cybersecurity starts with a clear understanding of all connected devices. NHS organisations, in particular, must proactively manage cyber risks throughout a device’s lifespan, rather than merely reacting to security flaws as they arise.