Regardless of a healthcare provider's size, cyber threats remain a financial, emotional, and operational burden. In countries like Germany, accessing qualified cybersecurity engineers with experience in healthcare continues to be a challenge for providers as they struggle to recruit and keep this valuable talent to cope with the rise in the global threat landscape.
An ENISA study revealed that healthcare also reported the most software- or hardware-related incidents, with 80% of providers starting over 61% of their security incidents stemming from these vulnerabilities. 
ForeNova's managed detection and response service (MDR) offerings have become a critical partner for the healthcare industry in Germany. These offerings help reduce security operations costs and lower attack surface risk through 24/7 monitoring, automated incident response, and compliance reporting.
The good news is that all healthcare providers will continue to have access to funding from Germany until the end of the year to cover the costs of MDR services.
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What is the Cybernation Germany Initiative?
The Cybernation Germany initiative, started in early 2024, represents a significant national commitment to enhancing resilience, developing Germany's cybersecurity capabilities, and reducing advanced threats.
This initiative aligns with the NIS-2 Directive and the Cyber Resilience Act (CRA), both of which mandate essential cybersecurity practices and incident reporting requirements for organizations.
What are the key cybersecurity challenges for healthcare in Germany?
Around 80% of healthcare organizations use over ten security products and advanced security solutions, complicating the identification of potential attacks and increasing the risk of unauthorized access to sensitive data or ransomware deployment.
Like healthcare providers in the U.S., these organizations face considerable uphill battles, including costly modernization, constant regulation changes, medical device breaches, access to experienced cybersecurity and IT talent, and expensive adoption of artificial intelligence (AI) and machine learning (ML) capabilities.
Modernization
German health providers allocate millions to upgrading electronic medical records, running pharmacies, and assisting the elderly. However, because of a lack of funding and experienced resources, many modernized efforts result in cost overruns and poor performance.
Along with facing these challenges, healthcare providers' having to support legacy medical device equipment, manual processes inpatient services, laboratory sciences, and billing costs the organizations more each year. Maintaining two systems in parallel for an extended period also creates more opportunities for hackers to exploit the various air gaps in their enterprise systems.
Regulation Upkeep
“Compliance regulations, such as the Healthcare Insurance Portability and Accountability Act (HIPAA), govern the industry's medical billing, protect patient information, and standardize electronic medical records.”
Like any new or existing compliance, changes happen. Healthcare providers continue to staff HIPAA-compliant resources to help follow and advise the organization on upcoming changes to the compliance mandate. Some of these changes could mean additional cybersecurity-protecting capabilities, adding to the workloads of the already overworked security operations (SecOps) teams.
Laboratory Sciences
Laboratory sciences handle most blood and urine tests. Updated test results become part of the patient's electronic medical resource. Germany and other parts of the European Union continue to outsource their blood testing and lab work to third parties.
"Because of the 2004 Law on the Modernization of Healthcare, hospitals increasingly use a further type of laboratory care."
While outsourcing lab work may help reduce operational costs for healthcare providers, this creates additional vulnerabilities. Hackers will target supply chains and third-party providers, looking for exploitable vulnerabilities. Third-party cyber breaches continue to be a problem in Germany and other countries. Healthcare providers could sustain a breach because their third-party lab providers become breached.
What Are The Key Healthcare Compliance Mandates in Germany?
Like other member states, Germany has several compliance mandates it must meet and sustain throughout the year. Like many compliance and privacy mandates, these mandates become law in response to cybersecurity events, including data breaches, manufacturing or process operations disruption, and financial fraud.
Specifically, the healthcare industry has also suffered several security breaches, which have resulted in medical record theft, disruptions in medical device operations, and financial extortion.
Here is a breakdown of the three critical compliance mandates for all healthcare providers:
GDPR
“The General Protection Data Protection Regulation (GDPR) continues to be the data privacy and security law governing the protection and ownership of personal data.”
Healthcare providers in Germany and the EU face hefty fines for any data breach or violation of GDPR. Safeguarding personally identifiable information (PII) within healthcare is critical for providers wanting to avoid the possibility of a 20 million euro fine.
NIS2
NIS2, adopted in 2024, requires all EU member states to adopt technical and operational cybersecurity controls. NIS2, adopted in 2024, requires all EU member states to implement these cybersecurity controls within all cloud instances, data centers, online websites, e-commerce, search engines, and social networking platforms. NIS 2 also defines standards for risk analysis, incident handling, business continuity, supply chain security, basic levels of cyber hygiene, data encryption, security awareness training, and multi-factor authentication.
“Under the NIS Directive, EU health organizations must notify the national authorities of cybersecurity incidents that significantly impact their country. EU health organizations collect, anonymize, and aggregate summary reports about these incidents each year.”
HIPAA
HIPAA Certification in Germany commits to safeguarding the confidentiality, integrity, and availability of protected health information (PHI) in the healthcare sector.
In Germany's varied healthcare environment, comprising hospitals, clinics, insurers, and third-party providers, HIPAA Compliance provides a thorough framework for protecting patient data.
PDSG
“The Patient Data Protection (PDSG) Act enables digital tools like e-prescriptions and electronic patient files while regulating health data protection. The telematics infrastructure connects all healthcare participants through digital health applications, including doctors, hospitals, pharmacies, and insurers.”
A History of Ransomware Attacks Targeting Healthcare
Ransomware poses a significant threat to the health sector (54%) in both incidents and impact, a trend likely to persist. Notably, 43% of ransomware incidents involve data breaches or theft, with disruptions also frequently occurring.
Ransomware remains a significant issue for businesses and government entities, with rising data leaks post-attack. However, fewer victims are paying ransom. LockBit is the most active group targeting Germany, listing 40 alleged victims, followed by BlackBasta and 8Base.
- “A recent ENISA study reveals that only 27% of healthcare organizations surveyed have implemented a dedicated ransomware defense program, while 40% need a security awareness initiative for non-IT personnel.”
- “Additionally, findings from another survey conducted by the NIS cooperation group show that 95% of healthcare organizations encounter difficulties in conducting risk assessments, and 46% have never carried out a risk analysis.”
These findings emphasize the urgent need for healthcare organizations to implement cyber hygiene practices, such as offline encrypted backups, training programs, vulnerability management, more robust authentication, and incident response plans.
“The ENISA NIS Investment 2022 study shows that the median cost of a significant security incident in healthcare is €300,000.”
Real-World Cybersecurity Impact on Patient Care and Delivery of Services
Ascension Healthcare
Eduardo Conrado, President of Ascension Healthcare, shared insights on the stark impact of ransomware attacks.
“Nurses could not look up patient records from their computer stations and were forced to comb through paper backups... imaging teams could not quickly send the latest scans up to surgeons waiting in the operating rooms, and we had to rely on runners to deliver printed copies of the scans to the hands of our surgery teams.”
Düsseldorf University Hospital
A 2020 BBC article reports on the first case of a patient's death directly caused by a cyberattack.
A ransomware attack at Düsseldorf University Hospital disabled several medical devices, preventing critical treatment. The hospital transferred the patient 19 miles away, but they tragically died en route.
German prosecutors started a homicide investigation to assess if the threat actors could be liable for negligent homicide, which could set a future precedent if prosecuted successfully.
Why is MDR Service for Healthcare Critical for All Providers?
German healthcare providers need 24x7x365 continuous monitoring of all their cybersecurity protection layers, digital assets, and EMR systems. Per NIS2 compliance, healthcare providers must also staff a security operations team capable of detecting, responding, and remedying all cyberattacks against their organizations. Most healthcare providers struggling to protect their patients' medical record information leverage MDR services from providers like ForeNova.
MDR services from ForeNova include several protection layers all healthcare providers will benefit from:
- Network Detection and Response
- Automated Incident Response
- Access to updated playbooks and updated compliance guides
Embedded within our MDR services, ForeNova offers several tools to assist healthcare providers in monitoring, incident response, and compliance reporting.
ForeNova offers a complete 24x7x365 service or hybrid engagement, including staff augmentation or after-hours coverage.
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