Lacking Basic Cyber Defenses, Rural Hospitals Drawing the Attention of Bad Actors

Rural hospitals across the United States are facing an escalating cybersecurity crisis, with constrained resources and outdated technology leaving them highly vulnerable to cyberattacks, according to a new report from Microsoft.

These hospitals, which serve 14% of the U.S. population, have become prime targets for ransomware attacks and other cyber threats, posing risks not only to patient care but also to their financial viability. Cybercriminals increasingly view rural hospitals as soft targets due to their aging IT infrastructure and limited cybersecurity expertise.

“Ransomware-as-a-service models are fueling an industrialized cybercrime economy, making it easier than ever for attackers to exploit hospitals with weak defenses,” the report said. Cyberattacks on hospitals have surged, with ransomware incidents in the healthcare sector increasing by 130% in the past year, according to the report.

Attackers often breach systems through phishing emails, exploiting outdated software and weak network security. “The financial and operational constraints on rural hospitals mean they lack the tools and workforce to adequately protect against sophisticated cyber threats,” the report said.

In a Microsoft analysis of 13 hospital systems, including rural hospitals, 93% of detected malicious activity stemmed from phishing campaigns and ransomware. The consequences of these attacks extend beyond financial losses. Affected hospitals often experience service disruptions, delays in patient care, and increased mortality rates for critical conditions such as heart attacks and strokes.

The report cited data showing that 20% of hospitals hit by cyberattacks reported an increase in patient mortality. Additionally, hospitals that experience cyber incidents suffer significant operational downtime. The report found that hospitals impacted by ransomware attacks experience an average of 18.7 days of downtime, costing an estimated $1.9 million per day.

These interruptions force staff to revert to manual operations, increasing the likelihood of medical errors and delayed treatments. Many rural hospitals struggle to implement even basic cybersecurity measures. Microsoft’s assessment of over 250 rural hospitals revealed widespread vulnerabilities:

• The report found that many hospitals continue to rely on outdated IT systems that lack modern security features. Legacy systems, which may not receive regular security updates, create significant entry points for cybercriminals.
• “Most rural hospitals do not have a robust cybersecurity training and awareness program, making them highly susceptible to social engineering attacks,” the report said.
• Threat actors frequently exploit weak credential hygiene, phishing vulnerabilities, and unpatched software to gain access to sensitive patient data.

The 2020 ransomware attack on Sky Lakes Medical Center in Oregon illustrated the impact of cyber threats on rural hospitals. The 90-bed facility, which serves a vast rural area, was forced to operate on paper documentation for nearly a month after its systems were encrypted by attackers. Hospital leadership chose not to pay the ransom, instead spending $10 million to rebuild their digital infrastructure.

“Recovering from a cyberattack is not only costly but can take months, diverting resources from patient care,” the report said. Beyond financial and operational damages, Sky Lakes Medical Center experienced long-term setbacks, requiring six months to re-enter all manually recorded patient data into the system.

Similar disruptions have been reported in rural hospitals across the country, where limited IT resources hinder effective response and recovery efforts. To mitigate cyber risks, Microsoft launched its Cybersecurity Program for Rural Hospitals, offering security assessments, training, and discounted cybersecurity products.

Since its launch, over 550 rural hospitals have registered, with 375 participating in risk assessments. Early findings indicate that hospitals implementing security best practices, such as multi-factor authentication and endpoint protection, have significantly reduced their exposure to threats.

Microsoft’s cybersecurity assessments highlight common vulnerabilities, such as lack of endpoint security, inadequate email protection, and insufficient IT staffing. To help rural hospitals close these gaps, the company provides access to training programs tailored to frontline healthcare workers and IT staff, equipping them with essential cybersecurity knowledge.

Rural Hospital Leaders Can Take Proactive Steps to Improve Cybersecurity

Securing rural hospitals requires a collaborative approach between healthcare providers, technology firms, and policymakers, the report contended. “Cybersecurity is a top priority for America’s hospitals and health systems. It is also a shared responsibility,” said Rick Pollack, president and CEO of the American Hospital Association.

“Rural hospitals are essential lifelines in their communities, and keeping them secure must be a national imperative.” In response to growing threats, policymakers are being urged to provide more funding and regulatory support for rural hospitals to enhance cybersecurity infrastructure.