Through the Looking Glass: Reflecting on Ransomware Reality and Healthcare ResilienceLet me take you back to a dark moment in healthcare cybersecurity. It’s the middle of a crisp October night. A peaceful lull. Then, suddenly, the silence is flooded by panic. Phones stop ringing. Emails won’t send. Servers refuse to heed commands. Systems that once worked harmoniously are now handcuffed by a silent, invisible intruder. A hospital’s heartbeat has stopped—not due to a biological crisis, but a digital one. This was the vivid scenario Nate Couture, CISO of UVM Health, and I unpacked during our session, “From Crisis to Resilience: Zero Trust’s Role in Breach Recovery,” at HIMSS25. What ensued wasn’t just an analysis of a ransomware event but a call-to-action for healthcare leaders: if you don’t think it will happen to you, think again. Here’s the truth: the healthcare industry is under siege. Cyber attackers have evolved into cunning opportunists who mask themselves in legitimacy, weaponizing vulnerabilities to disrupt critical care delivery without a second thought. During our talk, Nate and I dissected a ransomware attack that infiltrated a health system’s entire lifeblood—phones, emails, records, and a staggering 600+ applications. This wasn’t just a systems issue. It was a care crisis, a communication nightmare, a revenue standoff, and, above all, a wake-up call for everyone in the room. A Silent Epidemic: The Anatomy of Ransomware in Healthcare Ransomware attacks are no longer the anomaly—they’ve become the expectation. Attackers no longer “just” encrypt data for ransom—they steal it, doubling-down to extort you twice. They weaponize legitimate tools, exploiting poorly configured systems and overexposed networks. In the case we discussed, the attackers bypassed legacy security configurations using a compromised email account and a VPN vulnerability. Within minutes, access was lost to all on-prem security tools, over 5,500 devices were infected, pieces of malware gliding silently through the system like a Trojan horse on autopilot. Systems collapsed, and patient care ground to a near halt. By the time the dust settled, it wasn’t a matter of “how to stop” the attack—it became “how do we crawl out of this crater?” Zero Trust Isn’t a Buzzword—It’s Survival in 2030 and Beyond Months of recovery revealed a singular, glaring reality: legacy security no longer works in a healthcare sector primed for hyper-digitalization. How many times have we heard, “We’ll just patch that tomorrow?” Or worse, the phrase, “We’ve been doing it this way for years”? That’s a ticking time bomb in today’s attack landscape. Zero Trust isn’t a product or a static solution—it’s a philosophical shift in everything we thought we knew about security. “Assume breach and verify everything” isn’t just a tagline; it’s the ethos of resilience. Here’s why Nate and I emphasized Zero Trust as the frontline defense for breach recovery and a proactive security posture: Reducing the Attack Surface: By rendering internal systems and assets invisible, Zero Trust makes your organization a digital needle in a haystack of hackers’ targets. If attackers can’t see it, they can’t exploit it. Role-Based Access Controls: Every request to access systems is evaluated in context, ensuring that a compromised credential doesn’t equate to a system-wide key. Microsegmentation Saves Lives: Had UVM been able to isolate infected devices during the breach, many systems could have remained operational. Dynamic Monitoring: The Zero Trust model thrives on continuous authentication and live visibility, flagging adversarial movements before real damage occurs. This isn’t theory—it’s operational necessity. Zero Trust isn’t just reactive. It’s revolutionary. Every Ransom Breach is an Atlas Stone Recovery isn’t about flipping a switch. For UVM Health, recovery meant three painstaking months of clawing systems back online—often manually and piece-by-piece. Communication reverted to the basics—the face-to-face sneakernet. Eventually phones came back. The priority decision-making framework became one of life-and-death triage: Which systems needed to come online to restore care at its most critical points? One hard truth surfaced during this ordeal: Your recovery plan IS your business continuity plan. If one fails, the other goes with it.Executives, board members, and technology leaders must collectively align on this reality. Cultivating cyber resilience post-breach is an admittance that—yes—your systems could fail, but your organization can’t afford to.Resilience Isn’t a Destination—It’s Iterative Evolution Several golden lessons emerged from our session: Prevention Is Expensive; Recovery Is Priceless: Post-disruption, budget approvals come through significantly faster—but at what cost? Are you prepared to negotiate cybersecurity investments in the aftermath of a breach? Nate and his team shifted from envisioning security to business resilience, redrawing IT roadmaps for aftershocks they hope never come but know could. Build Relationships Now, Not During Chaos: Partnerships with law enforcement, federal agencies, and cybersecurity vendors should be pre-built—not frantically stitched together mid-crisis. Operational Hierarchies are Dead During Recovery: Recovery is a war room, not a boardroom. When crisis strikes, throw out your organizational silos and lean on cross-functional teams to act decisively. Rehearse, Fail, Repeat: The power of rehearsing disaster recovery plans can’t be overstated. Dusting off binders gathering dust isn’t enough—practice those scenarios with real-life implications. Walking Away Wiser “If you’re reachable, you’re breachable.” It’s a haunting phrase we left attendees with. The network perimeters of old are increasingly obsolete, migration to modern infrastructure can no longer be a “tomorrow” problem, and leadership alignment must extend beyond IT teams. As I looked out into that crowd of executives, CIOs, CTOs, and fellow CISOs, I hoped the story of UVM’s battle underscored one inarguable takeaway: Recovery is not resilience, and survival hinges not on avoiding breaches but on mitigating their inevitability. So, ask yourself, what would your first 24 hours look like if this happened? And more provocatively—what are you doing today to prepare?
[#item_full_content] Through the Looking Glass: Reflecting on Ransomware Reality and Healthcare ResilienceLet me take you back to a dark moment in healthcare cybersecurity. It’s the middle of a crisp October night. A peaceful lull. Then, suddenly, the silence is flooded by panic. Phones stop ringing. Emails won’t send. Servers refuse to heed commands. Systems that once worked harmoniously are now handcuffed by a silent, invisible intruder. A hospital’s heartbeat has stopped—not due to a biological crisis, but a digital one. This was the vivid scenario Nate Couture, CISO of UVM Health, and I unpacked during our session, “From Crisis to Resilience: Zero Trust’s Role in Breach Recovery,” at HIMSS25. What ensued wasn’t just an analysis of a ransomware event but a call-to-action for healthcare leaders: if you don’t think it will happen to you, think again. Here’s the truth: the healthcare industry is under siege. Cyber attackers have evolved into cunning opportunists who mask themselves in legitimacy, weaponizing vulnerabilities to disrupt critical care delivery without a second thought. During our talk, Nate and I dissected a ransomware attack that infiltrated a health system’s entire lifeblood—phones, emails, records, and a staggering 600+ applications. This wasn’t just a systems issue. It was a care crisis, a communication nightmare, a revenue standoff, and, above all, a wake-up call for everyone in the room. A Silent Epidemic: The Anatomy of Ransomware in Healthcare Ransomware attacks are no longer the anomaly—they’ve become the expectation. Attackers no longer “just” encrypt data for ransom—they steal it, doubling-down to extort you twice. They weaponize legitimate tools, exploiting poorly configured systems and overexposed networks. In the case we discussed, the attackers bypassed legacy security configurations using a compromised email account and a VPN vulnerability. Within minutes, access was lost to all on-prem security tools, over 5,500 devices were infected, pieces of malware gliding silently through the system like a Trojan horse on autopilot. Systems collapsed, and patient care ground to a near halt. By the time the dust settled, it wasn’t a matter of “how to stop” the attack—it became “how do we crawl out of this crater?” Zero Trust Isn’t a Buzzword—It’s Survival in 2030 and Beyond Months of recovery revealed a singular, glaring reality: legacy security no longer works in a healthcare sector primed for hyper-digitalization. How many times have we heard, “We’ll just patch that tomorrow?” Or worse, the phrase, “We’ve been doing it this way for years”? That’s a ticking time bomb in today’s attack landscape. Zero Trust isn’t a product or a static solution—it’s a philosophical shift in everything we thought we knew about security. “Assume breach and verify everything” isn’t just a tagline; it’s the ethos of resilience. Here’s why Nate and I emphasized Zero Trust as the frontline defense for breach recovery and a proactive security posture: Reducing the Attack Surface: By rendering internal systems and assets invisible, Zero Trust makes your organization a digital needle in a haystack of hackers’ targets. If attackers can’t see it, they can’t exploit it. Role-Based Access Controls: Every request to access systems is evaluated in context, ensuring that a compromised credential doesn’t equate to a system-wide key. Microsegmentation Saves Lives: Had UVM been able to isolate infected devices during the breach, many systems could have remained operational. Dynamic Monitoring: The Zero Trust model thrives on continuous authentication and live visibility, flagging adversarial movements before real damage occurs. This isn’t theory—it’s operational necessity. Zero Trust isn’t just reactive. It’s revolutionary. Every Ransom Breach is an Atlas Stone Recovery isn’t about flipping a switch. For UVM Health, recovery meant three painstaking months of clawing systems back online—often manually and piece-by-piece. Communication reverted to the basics—the face-to-face sneakernet. Eventually phones came back. The priority decision-making framework became one of life-and-death triage: Which systems needed to come online to restore care at its most critical points? One hard truth surfaced during this ordeal: Your recovery plan IS your business continuity plan. If one fails, the other goes with it.Executives, board members, and technology leaders must collectively align on this reality. Cultivating cyber resilience post-breach is an admittance that—yes—your systems could fail, but your organization can’t afford to.Resilience Isn’t a Destination—It’s Iterative Evolution Several golden lessons emerged from our session: Prevention Is Expensive; Recovery Is Priceless: Post-disruption, budget approvals come through significantly faster—but at what cost? Are you prepared to negotiate cybersecurity investments in the aftermath of a breach? Nate and his team shifted from envisioning security to business resilience, redrawing IT roadmaps for aftershocks they hope never come but know could. Build Relationships Now, Not During Chaos: Partnerships with law enforcement, federal agencies, and cybersecurity vendors should be pre-built—not frantically stitched together mid-crisis. Operational Hierarchies are Dead During Recovery: Recovery is a war room, not a boardroom. When crisis strikes, throw out your organizational silos and lean on cross-functional teams to act decisively. Rehearse, Fail, Repeat: The power of rehearsing disaster recovery plans can’t be overstated. Dusting off binders gathering dust isn’t enough—practice those scenarios with real-life implications. Walking Away Wiser “If you’re reachable, you’re breachable.” It’s a haunting phrase we left attendees with. The network perimeters of old are increasingly obsolete, migration to modern infrastructure can no longer be a “tomorrow” problem, and leadership alignment must extend beyond IT teams. As I looked out into that crowd of executives, CIOs, CTOs, and fellow CISOs, I hoped the story of UVM’s battle underscored one inarguable takeaway: Recovery is not resilience, and survival hinges not on avoiding breaches but on mitigating their inevitability. So, ask yourself, what would your first 24 hours look like if this happened? And more provocatively—what are you doing today to prepare?
