Ransomware attacks on hospitals have occurred repeatedly at home and abroad, with reported cases where the EHR was encrypted, care stopped, and regional healthcare was seriously affected. For hospitals that cannot stop care, cyberattacks are no longer only about data leakage but a risk to business continuity itself.
This article organizes why hospitals are targeted and how attacks work, then compiles concrete measures you can start now — layered defense, backups, and drills — plus BCP and recovery thinking to keep care going even if systems stop. Because rules and technology change, also consult primary sources from the relevant ministries for the latest measures.
Why hospitals are targeted
Several factors overlap behind why hospitals are prone to being targeted: because care directly involves lives and cannot be stopped, attackers tend to see them as high-pressure targets for ransom payment, and many devices and systems are connected, widening the area to defend.
Maintenance connection paths used by outside vendors and old devices past support that tend to remain are also weak points. Because attackers look for such hard-to-manage entry points to attempt intrusion, whether you know what connection paths your hospital has can decide the outcome.
- Care cannot be stopped, so response urgency is high
- Many devices and systems are connected, widening the defense area
- Maintenance connections and end-of-support devices easily become weak points
How attacks work and how damage spreads
Ransomware enters through vectors such as email attachments, malicious links, and vulnerabilities in externally connected devices. After intrusion, it typically spreads while seizing privileges inside the network, eventually encrypting business data to render it unusable and demanding ransom in exchange for recovery.
In recent years, beyond encrypting data, tactics that add pressure by threatening to publish stolen information have appeared. Damage is not limited to the EHR and can extend to linked systems such as testing and accounting, with recovery requiring long time and great effort.
What makes it troublesome is that there can be a time lag between intrusion and encryption. Attackers may lurk undetected, investigate even the state of backups, and then trigger encryption all at once. That is exactly why both entry defenses to prevent intrusion and monitoring to detect lurking early are important.
What to do now: layered defense
The basis of defense is layered defense — not relying on a single barrier but protecting in multiple layers. Thinking in three stances — block at the entrance, limit internal spread if breached, and recover even if encrypted — makes any single breach less likely to be fatal.
Standing on the premise that perfect defense does not exist paradoxically leads to realistic readiness. Assuming intrusion can happen makes clear the value of internal segmentation that keeps damage local and backups you can reliably restore. Having both the effort to prevent and the ability to recover after a breach is essential.
- Entry: training on suspicious email, updating OS and devices, multi-factor authentication
- Containment: network segmentation, least privilege, cutting unnecessary paths
- Recovery readiness: isolated backup storage and regular restoration tests
- Monitoring: mechanisms to detect suspicious traffic or behavior and notice early
The right way to think about backups
The last line of defense against ransomware is backups. However, backups kept connected to the network can be encrypted together during an attack. It is important to store them separated from the production environment, ensuring a state the attack cannot reach.
Simply having backups is not enough; regularly testing whether they can actually be restored is essential. To avoid situations where restoration fails or needed data was not included, run recovery procedures as drills and understand the time they take.
- Keep multiple generations and media, with some isolated from the network
- Perform restoration tests regularly to confirm you can reliably recover
- Measure recovery time and compare it against the target
Drills and staff training
No matter how much you harden technical measures, human behavior ultimately shapes the damage. Whether all staff have internalized the basics — not opening suspicious email, verifying unfamiliar contacts — is what is tested. Training sticks not as a one-off but through repetition.
Drills that assume an actual attack scenario are also effective. Confirming, on paper or in practice, whom to contact, which systems to isolate, and how to switch to manual operations lets you act calmly when it matters. Issues found in drills should feed back into improving procedures.
It also matters to share that training and drills exist to protect, not to blame. An atmosphere where careless mistakes are reported early rather than hidden lets you nip damage in the bud. Building a culture where reporting is easy is a strong organizational defense, no less than any technical measure.
Drawing up a BCP (business continuity plan)
A BCP is a plan to continue and quickly restore critical operations even when normal operations become difficult due to disaster or cyberattack. For hospitals, the core is predefining procedures to switch to manual work and which operations to prioritize, so care can continue even when the EHR is down.
The plan is not finished once written; specify the contact network, alternative means, recovery priorities, and decision owners, and verify effectiveness through drills. Sharing premises such as target downtime and which data to protect and to what extent supports decision-making amid confusion.
- Decide manual operations and priority tasks when the EHR is down
- Document the contact network, responsible persons, and decision criteria
- Agree recovery priorities and target times in advance
- Verify the plan through drills and update it reflecting the issues
Data preservation and recovery during disasters and outages
Beyond cyberattacks, preparation for physical disasters such as earthquakes, floods, and power outages is essential. The server room's location, securing uninterruptible and emergency power, and storing data in a geographically distant location as well are the basics for not losing data during a disaster.
Keeping data only on in-house servers makes recovery hard if the whole facility is hit. Combining backups to remote sites and storage in locations less affected by disasters raises the chance of protecting clinical information even in the worst case.
Cyberattacks and natural disasters look like separate preparations, but the goal of protecting data and continuing care is shared. Remote storage, securing power, and switch-to-manual procedures help in either case. Designing both together as a single set of readiness makes the most of limited resources without waste.
- Use emergency and uninterruptible power to prevent shutdown and equipment failure
- Back up to remote sites to prepare for facility-wide disasters
- Prepare alternative means such as paper operations during downtime
Benefits and cautions of using cloud
Cloud-based EHRs and backups can hold data distributed outside the hospital as well, giving the advantage of protecting data even if the facility is hit. With a specialized provider handling operations, security measures, and updates, they can also ease your organization's burden.
That said, it is not as simple as cloud automatically being safe. You need to confirm in advance the responsibility split between provider and hospital, operations when communication is lost, and ease of data extraction. Weigh both benefits and cautions to judge whether it fits your conditions.
On-premise and cloud are not necessarily either-or; combinations such as replicating critical data to the cloud while running on-premise day-to-day are realistic. Starting from where to place data copies to withstand facility disasters or attacks, it is important to choose a configuration consistent with your BCP.
- Data can be stored distributed, resilient to facility disasters
- Providers handle operations, updates, and measures, easing your burden
- Confirm responsibility split, operations during outages, and data extraction in advance
Measures checklist
To review your readiness, listing items and assessing the current state is effective. The following is an example of the thinking; conduct the actual check while referring to the latest guidelines and public materials, recording what is and is not in place with evidence, and prioritizing improvements.
- Are OS and device updates done, and end-of-support items identified?
- Are backups stored isolated, with restoration tested?
- Do you know external connection paths and have closed unnecessary ones?
- Is there a BCP and manual procedure for when the EHR is down?
- Are there contact and response structures and drills for incidents?
- Is there disaster-ready data preservation such as emergency power and remote storage?
Common misconceptions and how to avoid them
Misconceptions around measures enlarge damage. A typical one is the assumption that a hospital of your size will not be targeted. Attacks do not choose by scale and automatically look for weakly defended entry points, so size is no reason for safety. Whether you are prepared is what divides outcomes.
The assumption that measures require huge investment also delays getting started. Many basics — thorough updates, isolated backups, and training — can begin without large cost. Rather than waiting for perfection, a stance of stacking up what you can, in priority order, reliably reduces damage.
- Myth: small hospitals aren't targeted → Fix: harden basics regardless of scale
- Myth: having backups is enough → Fix: isolate storage and run restoration tests
- Myth: measures are IT's job → Fix: engage management and all staff
Points of caution (as general guidance)
This article organizes general thinking on measures; what specifically to implement, and to what extent, varies with facility scale, system configuration, and threat trends. Design actual measures based on the latest guidelines, expert advice, and primary sources from the relevant ministries.
When considering a foundation resilient to disasters and cyberattacks, cloud use such as our Sakigake Platform is also a comparison candidate from the angles of data distribution and reduced operational burden. Confirm both benefits and cautions, and choose in a way consistent with your BCP.
Anticipated Q&A
Q. Where should we start? A. Updating OS and devices, isolated backups with restoration tests, and suspicious-email training are three high-priority basics. Hardening these alone makes you less likely to be hit and easier to recover if you are.
Q. What if we are attacked? A. Follow predefined procedures, isolate affected devices and report to contain spread, and consult experts and relevant bodies on the premise of not readily paying ransom. Prior BCP and drills determine the quality of this initial response.
Initial response flow when an incident occurs
When you actually notice an anomaly, how you move in the first few hours shapes the scale of damage. Operating devices in a panic can erase evidence or spread damage, so it is important to decide the initial-response steps in advance and keep them on paper too. Preparing a printed contact list and procedure on the premise that the network is unavailable lets you act reliably when it matters.
The basic flow is assessing the damage scope, isolating devices suspected of infection, reporting to the responsible person and relevant bodies, and preserving records. Even if there is a ransom demand, act on the premise of consulting external contacts such as experts or police rather than readily complying on the spot. Predefining who decides what keeps the initial response from lagging amid confusion.
- Isolate devices suspected of infection from the network
- Report promptly to the responsible person and relevant bodies, and preserve records
- Do not readily pay ransom; consult an external expert contact
Disaster recovery (DR) and target-time thinking
To raise the ability to recover from damage, it helps to predefine targets: how quickly you aim to recover and to which point in time you can restore data. The former is the recovery time objective and the latter the recovery point objective; setting these two lets you concretely judge the needed backup frequency and level of structure.
Because setting targets higher makes cost and structure heavier, it is important to choose realistic levels according to each operation's importance. Rather than restoring everything at top speed, a prioritized plan — first the core of care, then peripheral operations phased within an acceptable range — makes the most of limited resources.
- Set the recovery time objective (how fast to restore) per operation
- Define the recovery point objective (to which point data is restored)
- Prioritize by importance and recover in phases
Summary
Hospitals are prone to being targeted precisely because they cannot stop care, and ransomware damage threatens business continuity. The basics are layered defense across entry, containment, and recovery readiness, isolated backups, and staff training and drills. Aligning both technology and people is essential.
In addition, having a BCP to keep care going even when the EHR stops, and data preservation prepared for disasters, keeps impact minimal even in the worst case. While including cloud use as an option, put effective readiness suited to your conditions in place during peacetime.
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