How German Healthcare Facilities Overcome IT Staffing Challenges with MDR Solutions

German healthcare sector providers having to cope with a shortage of qualified security operations (SecOpS) talent could not have happened at a worse time.

Like the United States, the German healthcare system continuously focuses on medical digital transformation projects, including increased deployment of electronic medical records (EMR), telemedicine, and extended insurance company access to sensitive data. These transformations will help modernize hospitals, patient care, clinics, and other medical-related services.

However, this modernization also creates more cybersecurity vulnerabilities and air gaps. With these new digital health technologies, the entire healthcare German market will face additional complex cyberattacks and increased attack velocities. A shortage of security talent will hinder the ability of these transformations to become fully operational.

Healthcare institutions in Germany, facing IT staffing shortages, are looking towards managed detection and response (MDR) providers to help with staffing and security operations coverage. ForeNova provides staff augmenting resources, 24/7 coverage, and automated incident response capabilities to help meet German healthcare compliance requirements and response to attacks.

Are you a healthcare provider seeking a solution for IT staff shortages? Click here to schedule an initial consultation with the ForeNova healthcare security team today!

What are the Immediate Benefits German Healthcare Providers Receive from MDR?

German healthcare providers who want to strengthen their security, reduce costs, and prepare for cyberattacks will immediately see positive results from leveraging an MDR service.

These benefits include:

Access to Advanced Cybersecurity Tools

MDR providers invest in the latest advanced technologies for endpoint security, security event information management (SIEM), and incident response automation functionality. Healthcare providers lacking SecOps engineer talent to test, evaluate, and support these tools will gain access to them as they become available through the MDR service offerings.

Scaling up Automated Incident Resources

Managed security service providers (MSSP) and MDR providers have access to global resource talent, extending their ability to scale up their cloud-based services to handle far more incident response events than most small-medium-enterprise (SME) healthcare providers. This benefit helps reduce operational costs and increase SecOps efficiencies by leveraging proven experts in SecOps from ForeNova.

Phase-out legacy on-premises security products

Healthcare organizations have various cybersecurity protection layers across their network, cloud, mobile devices, and hospital equipment. Healthcare providers implement many layers as a stopgap to protect a specific network segment, medical service application, medical devices within the operating room, or automated pharmacy dispensers.

The hospital’s cost for sustaining these standalone security layers, including hiring security engineers with the experience to manage them, continues to increase yearly. When acquiring these solutions, the hospital opted for long-term, perpetual license agreements instead of subscription-based models. Despite many outdated or technically obsolete devices, the hospital had to renew its maintenance contracts.

Many of these tools came with various medical devices or applications. They also added a layer of duplication for security protection, making the security operations far more complicated and expensive.

Moving forward with an MDR offering from ForeNova allows the health organization to phase out expensive and less effective cybersecurity tools.

Greater Access to Threat Intelligence Data

MDR providers can access more security telemetry information than most German health organizations. ForeNova collects and learns from the telemetry information by processing data through its large language models (LLM) within its artificial intelligence (AI) and machine learning (ML) engines. Combined with threat intelligence, these engines optimize ForeNova’s MDR automated incident response capabilities.

Other MDR offerings charge their clients for access to the Threat Intelligence data. ForeNova understands the financial challenges SMEs in German healthcare face. The company supports many SMEs with its pricing model, which includes bundling several services under one price point.

More Robust Support for NIS, Patient Data Protection (PDSG), and GDPR Compliance

Like the U.S., Germany’s healthcare industry has several compliance mandates that must be completed and sustained. These mandates, including NIS2GDPR, and PDSG, all require similar cybersecurity protection layers, continuous monitoring, automated incident response, robust reporting and notification, and enablement of the cybersecurity adaptive controls commonly available throughout the German health service.

MDR helps German health providers meet their compliance requirements.

Reduce Downtown and Operational Disruptions

Another critical benefit healthcare providers gain from leveraging MDR is the reduction of downtown and production system effects caused by a cyberattack.

MDR providers also support their clients as security architecture and solutions recommendations specialists. Integrated health organizations are extending their supply chain, adding Internet-of-Things (IoT) medical devices, or expanding the ability for doctors to access response services at a remote clinic remotely. With the constant change in the global threat landscape, hackers can breach these new medical business operations after deployment. MDR providers can make recommendations and assist in the implementation before the new medical functions become operational.

This decision helps the German medical provider reduce the downtown of the various digital assets, patient record systems, and operating room equipment.

Challenges When Enabling MDR Solutions

MDR offers considerable benefits, including reducing cyber threats through proactive threat hunting, reducing alert fatigue of their current staff, and leveraging advanced analytics for faster incident response.

Yet, even with these success factors, enabling MDR capabilities is challenging.

MDR is a subscription service that requires the German medical firm to contract with a provider like ForeNova to leverage its services. SME medical providers may need more money to use this cybersecurity service. Another challenge is resistance to change. Members of the existing internal IT and security teams recognize that outsourcing their daily functions could affect their job status. This resistance element often prevents many outsourced cybersecurity services from becoming fully functional.

Another challenge with MDR offerings is working with legacy security tools. Legacy email security tools, endpoint solutions, and log collection functions may have capability issues with the MDR solution.

A critical part of the MDR journey mandates that the healthcare provider and the MDR service providers collaborate to conduct pre-deployment assessments and decide which existing security solutions should be replaced or moved to the out-of-scope bucket.

What is the cost of MDR compared to staffing in in-house SecOps?

Healthcare providers moving from an in-house security operations center to an MDR provider extends several cost savings opportunities.

  • Phasing out existing cybersecurity solutions and canceling unused subscriptions.
  • Recreating updated security policies and phasing out obsolete IT and security operations procedures.
  • Re-purposing internal IT and cybersecurity resources for more strategic roles.
  • There is no immediate need to update existing security infrastructure if these controls become part of the MDR offering.

Here is an example of a cost-savings model German healthcare providers can use as a financial guideline:

Inhouse Comparision With MDR For Healthcare-3

Considerations

German healthcare providers evaluating an MDR service compared to their current in-house SecOps strategy need to consider:

  • The cost of security engineers and the availability of experienced talent will always be a challenge.
  • Healthcare providers will need to invest in continuous updates of new cybersecurity technology, training, and double pay for a few months while the legacy solutions are replaced.
  • Healthcare organizations must invest in continuous updates of new cybersecurity technology and training and pay double for a few months while they replace legacy solutions.
  • Healthcare providers will need to continue investing in engineering talent training and development and taking further steps to ensure these trained resources remain with the organization.

What Efficiencies Will Healthcare Providers Gain By Leveraging MDR Services?

Choosing to leverage an MDR offering delivers exceptional efficiencies for a health organization. These efficiencies represent a short list available for healthcare providers:

  • Develop and sustain consistency in SecOps procedures and the ability to respond to sophisticated cyberattacks.
  • Sustain a high-security posture status consistently.
  • Remain a high state compliance readiness throughout the business year.
  • Reduce the security operations to a predictable level with a fixed expense.
  • The ability to scale up cybersecurity resources with high accuracy.
  • Reduction of capital expenditures for security infrastructure
  • Gain peace of mind regarding cyber response, compliance readiness, and reporting.

What Components Comprise an MDR Offering?

MDR offerings leverage several technology controls, coverage models, and engagements. Most MDR offerings focus on the core services, including:

  • 24 x 7 monitoring
  • Automated incident response
  • Reporting for compliance notifications
  • Threat modeling
  • Access to Threat Intelligence

Additional services available for German health organizations include:

  • Staff augment to support existing internal SecOps
  • Enable endpoint security solutions

Why ForeNova?

Working with an experienced MDR provider like ForeNova is critical for all German Healthcare organizations that must address staffing challenges, meet compliance deadlines, and respond to more cyberattacks. ForeNova’s expertise in MDR services, along with its security architecture background, makes it an invaluable partner for the health sector in Germany and the rest of the EU.

Click here to schedule your first demonstration today with the ForeNova team

NIS2 Compliance Requirements for the Healthcare Industry in Germany

Like the General Data Protection Regulation (GDPR), NIS2 carries considerable fines for organizations that cannot meet their mandates. It also holds individuals accountable for failure to comply, and it mandates far more transparency and collaboration to help stop security breaches within their digital infrastructure.

Healthcare organizations in Germany must follow several compliance mandates to protect their critical infrastructure. HIPAA for Germany, GDPR, and the German Federal Data Protection Act.

Compliance mandates overwhelm healthcare organizations looking for ways to lower their security operations costs. To help meet these requirements, organizations turn to ForeNova’s managed detection and response (MDR) services.

Why is NIS2 Necessary for all Healthcare Providers in Germany?

Healthcare providers are still in the middle of the digital transformation journey, modernizing their various medical applications, upgrading devices, and extending access to electronic medical records. They need to account for the requirements for NIS2 by deploying required security measures and incident response plans during or after the transformation projects.

NIS2 mandates that all healthcare providers meet and exceed the compliance requirements.

Here is a list of the most critical NIS2 mandates all Germany-based healthcare providers need to enable or execute:

  1. Perform a risk analysis on all healthcare-related applications, current cybersecurity practices, and devices before and after the modernization project is finished to determine better what remediation steps will be required to meet NIS2.
  2. Embedding automated incident response and remediation capabilities within normal business operations helps reduce cybersecurity risks. Attempting to respond to every cyberattack with manual resources is no longer a valid option. Hackers leveraging adversarial artificial intelligence (AI) and machine learning (ML) capabilities increase their attack velocity, requiring healthcare providers to counter this threat with automated response functions. Managed detection and response (MDR) providers like ForeNova assist healthcare clients in meeting this challenge.
  3. All healthcare providers must maintain backup and recovery capability to ensure that all relevant healthcare data is accessible and retrievable during a ransomware attack.
  4. Healthcare providers have become increasingly dependent on global supply chains for medicines, medical devices, operating room equipment, and hospital supplies. Each provider must implement all necessary cyber controls to prevent attacks that steal medical data, breach other ecosystem parties within the supply chain, and disrupt hospital operations.
  5. Develop and implement a vulnerability management program to include continuous assessment, reporting, and recommendations for remediation.
  6. A significant part of the NIS2 mandate for healthcare focuses on physical security. Hospitals, clinics, and remote locations must implement and sustain proper physical security controls, including biometric access to sensitive hospital areas, badge readers, surveillance cameras, and trained security officers.
  7. Access to applications, systems, network devices, and workstations must be protected using multi-factor authentication (MFA), which is essential in meeting NIS2. Medical record breaches will occur once the hacker steals healthcare workers’ initial username and password credentials. Without MFA, which offers a second level of authentication, hackers will have easy access to medical data.
  8. Under NIS2, healthcare providers must enable encryption in all areas where personally identifiable information resides, including hosted applications, email systems, and databases. All data, whether in transit or at rest, must be encrypted.
  9. All healthcare providers in Germany and the rest of the EU member states must ensure that all employees complete cybersecurity awareness training to comply with NIS2.
  10. Another area addressed within the NIS2 mandate is the need for all healthcare providers to encrypt all phone, email, and text messaging.

Meeting and exceeding these ten requirements under NIS2 are critical for all healthcare providers in Germany. Failure to achieve and sustain these ten directives will cause several fines and penalties improved by the German national authority.

Corporate Accountability

Prior to changes within NIS2, if management teams cut funding for cybersecurity controls, managed services contract renewals, or reduced security operations resources, they would not become personally liable for negligence and intentional misconduct under NIS2.

NIS2 in Germany states, “Management within a healthcare provider is liable for any damages caused by the organization during a data breach or other cyberattack. Fines could exceed €10,000,000 or up to 2% annual turnover and suspension of services.”

Authorities could levy additional fines against the German health organization for failing to notify them within 24 hours of the security breach. The health organization must also file a formal report detailing the event within 72 hours of the initial notification, including a root cause analysis and other important artifacts.

Along with financial implications, German health organizations also face an impact on their reputation as trusted healthcare providers. The organization will face countless lawsuits for non-compliance.

How Should German Healthcare Providers Collaborate With National Authorities Surrounding NIS2?

NIS2 is an EU-wide cybersecurity law. Member states, including Germany, have the right to extend other requirements within the NIS2 framework specific to healthcare organizations operating within their borders.

The German government plans to update its NIS2 directive to reflect the changing global threat landscape and its impact on citizens’ personal information. In current drafts, the government added cybersecurity certifications for critical facilities to provide updated artifacts to the Federal Office of Information Security regarding their cybersecurity technical and operations every three years.

German healthcare organizations in the third category will need to ensure they comply with this additional NIS2 mandate. NIS2 may not apply to some entities because their size or other factors prevent them from being classified as essential or necessary. Germany recognized this and drafted a third category.

This third category is called critical facilities. While this supplement is still in draft stages, it shows the power each member state, including Germany, has in adding additional requirements for health providers beyond the initial scope of NIS2 compliance.

What is the Role of MDR Services For Meeting NIS2 Compliance?

With the adoption of NIS2, healthcare providers in Germany need to adopt a more proactive approach to security operations and focus more on a risk-based approach to protecting their regulated data.

This change in focus towards security operations and risk management alters how the organization needs to handle incident response, threat hunting, access to threat intelligence, and updating encryption policies and implementation. These changes in how the organization becomes more proactive and risk-based oriented directly reflect how management will become far more liable for breaches than in previous years.

    • Managed Detection and Response (MDR) offerings continue to become a lifesaver for many healthcare organizations regarding meeting Germain NIS2 directives. The value delivered by MDR offerings remains exceptional to healthcare organizations in Germany requiring automated incident response and other advanced capabilities.
    • 24x7x365 continuous monitoring of all healthcare systems, applications, and databases (NIS2)
    • MDR services help lower operations costs than staffing in-house security operations resources, infrastructure, and maintenance costs for security tools to handle everyday cybersecurity incidents. Cost savings are becoming a primary justification for investing in an MDR service.
    • ForeNova future proofing helps keep their clients updated with the latest protection capabilities to help prevent attacks using artificial intelligence (AI) without impacting the users.
    • MDR’s ability to automate NIS2 compliance reporting and event notification is also a critical service. Healthcare organizations in Germany have a very strict notification of a security event along with a 72-hour deadline for root cause analysis. MDR’s experience in compliance automated reporting helps healthcare providers meet NIS2 requirements.
    • Access to global talent helps MDR providers like ForeNova meet their service level agreement (SLA). Healthcare providers in Germany need help retaining security operations talent. ForeNova’s ability to staff to meet their clients’ NIS2 and other compliance requirements is one of their key differentiators in the managed services space.
    • MDR providers also help organizations stay current on compliance requirements by constantly evaluating new security adaptive control solutions, including artificial intelligence (AI) and machine learning (ML) capabilities, to enhance automated incident response and reporting.

Why ForeNova?

NIS2 in Germany, like other EU compliance mandates, will constantly change. The AI Act, DORA, and NIS2 will continuously become updated as the global threat landscape changes. Partnering with ForeNova, health providers in Germany will be a firm focused on helping them meet and exceed NIS2 and other compliance mandates while reducing risk and operations costs.

Are you interested in knowing more? Click here to schedule an MDR demo today with the ForeNova team!

Managed Detection & Response for Healthcare Providers in Germany, Becoming a Priority

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.

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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. 

Are you interested in learning more about ForeNova’s MDR offering for the healthcare industry?

Click here to schedule a demo today! 

What is the Cybernation Germany Initiative? 

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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 

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: 

  • Endpoint protection 
  • 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.