How a rural health system built a sustainable cybersecurity program | Viewpoint

Across the country, rural and community health systems are under extraordinary pressure.

Financial constraints, workforce shortages, and rising regulatory expectations have become part of daily operations. At the same time, these organizations face the same cybersecurity threats as large academic medical centers including: ransomware, misuse of privileged access, and third-party exposure. And this is often with far fewer resources to manage them.

For many smaller systems, cybersecurity efforts begin reactively. Controls are added in response to audit findings. Policies are updated after an incident. Risk discussions happen episodically, rather than as part of routine governance. While this approach may address immediate issues, it becomes increasingly unsustainable as the threat landscape evolves and regulatory scrutiny intensifies.

One rural integrated delivery network serving multiple counties in the Midwest reached a familiar inflection point. With under 200 licensed beds, dozens of outpatient clinics, and a lean IT team, leadership recognized that their existing approach (which was largely driven by point-in-time fixes) was no longer sufficient. Cybersecurity had become an enterprise risk, but the organization lacked a structured way to see that risk clearly, prioritize action, and demonstrate progress.

When compliance alone isn’t enough

Like many community hospitals, this health system did not start from a position of neglect. Staff were working hard, responding to issues as they arose, and doing what they could with limited time and funding. But documentation was fragmented, policies were inconsistent, and risk decisions were often implicit rather than deliberate.

Perhaps most importantly, there was no consistent mechanism for distinguishing between high-impact risks and lower-priority findings. Without that clarity, remediation efforts competed with daily operational demands, and leadership lacked a reliable way to assess readiness for audits or enforcement actions.

The turning point was not a breach or a failed audit. It was a recognition that cybersecurity could not remain a reactive function if the organization wanted to protect patient data, support clinical operations, and maintain access to care in the communities it served.

Shifting from tasks to risk management

The most significant change was not technological, it was actually conceptual. Rather than treating cybersecurity as a series of compliance tasks, the organization began to manage it as an ongoing risk discipline.

This meant asking different questions:

• Where does risk concentrate across our environment?
• Which issues materially affect patient safety, operational continuity, or regulatory exposure?
• What does “acceptable risk” look like for our organization?

To support this shift, the IT and compliance teams established a regular cadence for risk work. Dedicated time was set aside each week to review findings, update documentation, and track remediation efforts. While carving out this time was initially difficult, it quickly became a stabilizing force transforming cybersecurity from an occasional scramble into a predictable operational process.

Turning visibility into action

With better visibility into risk, the organization was able to move from generalized concern to targeted remediation. In one case, the team identified excessive privileged access within a critical ambulatory application, which was an issue that had existed for some time but had not been fully understood in terms of impact.

By evaluating the risk in context and aligning remediation with operational realities, the team reduced access to an acceptable level without disrupting care delivery. This approach (addressing real risk rather than pursuing theoretical perfection) became a guiding principle.

Nationally recognized healthcare cybersecurity frameworks also played a role, not as static checklists, but as practical roadmaps. In several instances, the organization discovered policy gaps it had not previously recognized. Rather than viewing these findings as compliance failures, leadership treated them as opportunities to strengthen governance and operational consistency.

Building confidence with leadership and regulators

As risk management practices matured, cybersecurity efforts became more visible to senior leadership and the compliance committee. Documentation improved. Decision-making became easier to explain. Leaders could see what risks were being addressed, what remained open, and why certain priorities were set.

This transparency had a meaningful impact. Conversations with leadership shifted from uncertainty to confidence and that’s not because risk had disappeared, but because it was understood and actively managed. Audit preparation became less stressful, and the organization felt better positioned to respond to regulatory inquiries if they arose.

Lessons for peer organizations

For other rural and community health systems facing similar challenges, the lessons are clear:

• Cybersecurity does not require a massive team or unlimited budget but it does require consistency.
• Small, regular investments of time can yield outsized improvements in risk posture.
• Managing cybersecurity as a living program, rather than a collection of tasks, enables better decisions and stronger governance.

Most importantly, shifting from reactive fixes to a risk-driven strategy allows healthcare organizations to align cybersecurity with their broader mission: protecting patients, supporting clinicians, and keeping care accessible both today and in the future.

Jackie Mattingly is the senior director of consulting services for small/medium hospitals at Clearwater.