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Hospitals can make ransomware and intrusions harder to spread by dividing networks into clearly defined zones, allowing only necessary traffic between them, and monitoring attempts to cross those boundaries. The design must follow the hospital’s real clinical, business, and operational dependencies: segmentation can limit an attacker’s paths, but it cannot guarantee containment or replace a broader security and incident-response program.
What network segmentation does—and what it cannot do
Segmentation separates systems into zones and controls the connections between them. If one device or account is compromised, carefully enforced boundaries can make it harder for an intruder to move from that foothold to unrelated systems. CISA’s #StopRansomware Guide, with a revision date of October 19, 2023, says segmentation can help contain an intrusion’s impact and prevent or limit malicious lateral movement.
Segmentation does not remove risk inside a zone, stop every compromised account, or guarantee that essential services will remain available. CISA also warns that user error and devices connected to multiple segments can undermine the boundaries. It is one layer in defense in depth, alongside controls such as strong access management, logging, and incident response.
Start with assets, dependencies, and traffic—not subnet labels
A zone plan is only as useful as the hospital’s understanding of what needs to communicate. Begin with an inventory of IT and relevant operational technology (OT), including network interfaces, software, owners, criticality, data handled, external connections, and dependencies. Identify systems important to health and safety and the services that rely on them. Protect the inventory and keep an offline copy available for response.
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Then map the current network and its trust relationships. Diagrams should show major networks, IP schemes, topologies, internal and external endpoints, cloud connections, third-party or managed-service-provider access, and important system-to-system flows. Keep diagrams current and securely available to both operations teams and incident responders.
- Record which flows are required for clinical care, administration, building operations, and other essential services.
- Identify who owns each system and who can approve changes to its connectivity.
- Document vendor remote access and remote monitoring or management tools, including the systems and zones they can reach.
- Validate the maps with the teams responsible for the systems; an undocumented dependency can turn a security change into an operational outage.
Healthcare 405(d) practice material calls for a strategy with clearly defined zones, while CISA guidance supports separation by role or function and IT/OT separation where applicable. Neither provides a universal hospital zone template. Boundaries must be derived from each facility’s actual services, equipment, vendors, and dependencies.
Define zones around function and risk
Use the inventory and flow maps to decide which systems should share a zone and which connections should cross a boundary. A hospital may need distinct areas for user devices, production services, business or departmental resources, externally facing services, and OT, but the names and divisions are design choices—not a prescribed layout. Grouping every system that happens to be on the same subnet is not a substitute for deciding which systems should trust one another.
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Keep business and departmental resources apart from critical systems where the environment supports it. Maintain IT/OT separation where applicable, while carefully validating the communication paths that clinical and operational processes require. Before changing a boundary, check the effects with system owners and clinical or facilities teams; the available guidance does not specify which individual devices or services belong in a particular hospital’s zones.
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Choose controls that enforce the boundary
Different technologies can help create or enforce zones. CISA’s communications infrastructure guidance recommends strong segmentation using router access control lists (ACLs), stateful packet inspection, firewall capabilities, and demilitarized zone (DMZ) constructs. Healthcare practice materials also identify VLANs among possible mechanisms. These are building blocks, not interchangeable guarantees: the key question is whether policy actually restricts and records traffic between the groups.
| Mechanism | How it can help | What to verify |
|---|---|---|
| VLANs | Group devices into separate logical network segments. | A VLAN by itself does not establish a complete security boundary. Verify which devices can route between VLANs and where allowed traffic is enforced. |
| Router ACLs | Apply rules to permit or deny specified network traffic. | Confirm the rules cover the actual paths between zones and are reviewed as systems and dependencies change. |
| Firewalls and stateful inspection | Enforce policy between networks and assess traffic in the context of connections. | Keep permitted flows limited to operational needs; log and review relevant inter-zone traffic. |
| DMZ constructs | Place appropriate externally facing services in a separated area rather than exposing internal networks directly. | Define which connections to and from the DMZ are needed, and restrict access to internal systems. |
Across these mechanisms, the operating principle is to permit only required inter-zone flows and deny unnecessary ones. Document the purpose and owner of each exception so it can be reassessed rather than becoming a permanent, unexplained opening.
Restrict the paths administrators and vendors use
Remote access can bridge otherwise separate parts of a network. Apply least privilege to staff, vendors, and service accounts; limit which zones each identity can reach; and control remote access and remote monitoring or management tools. A VPN connection should not be treated as inherently trusted simply because it is encrypted or has authenticated the user.
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Use distinct administrative access paths where feasible, and monitor privileged activity. Review whether a vendor or managed service provider needs access continuously or only for a defined task, and whether its access reaches more systems than that task requires. These controls complement segmentation: a broadly privileged account or a device connected to multiple segments can weaken otherwise useful boundaries.
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Log and monitor movement between zones
A boundary that is not observed may be misconfigured or crossed without timely detection. Retain relevant network, host, and cloud logs; centralize and correlate them through a SIEM or an equivalent log-management process; and establish a baseline of normal traffic. Monitor for unusual connections, unexpected destinations, and lateral movement between zones.
CISA recommends retaining logs for critical systems for at least a year if possible. That is a CISA recommendation, not a claim that every hospital has the same retention requirement. Make sure logs are available to the people who investigate incidents and that monitoring covers the systems and crossings the hospital considers critical.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Plan how to contain an incident without losing sight of care
Decide in advance who has authority to isolate a device, network, or zone, and how that decision will be coordinated with clinical operations and other affected teams. Response procedures should identify the systems and dependencies involved, how to communicate if normal channels are unavailable, and how to preserve useful evidence while limiting spread. CISA advises coordinating isolation during an incident and using out-of-band communications where appropriate.
If a device cannot be disconnected, CISA says powering it down may be considered, while warning that doing so loses volatile-memory evidence. Treat that as a last resort in the circumstances described by CISA, not as a routine containment step. The response team should weigh the safety and operational impact against the containment need.
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Review and exercise the design
Networks and clinical workflows change: systems are replaced, services move, vendors change, and new dependencies appear. Reassess diagrams, access paths, inter-zone rules, and response procedures regularly. CISA recommends regular assessments but does not set a hospital-specific test schedule in the cited guidance.
Exercises can check whether teams can identify affected zones, coordinate isolation, preserve evidence, and sustain essential services. Use the results to correct unclear ownership, undocumented flows, rules that are too broad, and response steps that are difficult to carry out. The aim is a boundary the hospital can operate and maintain—not a diagram that quickly becomes obsolete.
Compare approaches by operational fit, not by a universal ranking
The cited guidance does not rank segmentation technologies or identify a universally best hospital architecture. When evaluating an approach, consider:
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- Granularity: Does it separate whole departments or zones, or can it enforce smaller workload-level boundaries?
- Operational fit: Can the hospital support it alongside clinical workflows, legacy equipment, vendor access, and required dependencies?
- Visibility: Can staff log, baseline, and investigate inter-zone traffic and attempted lateral movement?
- Manageability: Can the team document, troubleshoot, review, and update rules as systems change?
- Containment and recovery: Can responders isolate an affected area without unnecessarily disabling unrelated essential services?
CISA’s 2025 microsegmentation announcement describes microsegmentation as a zero-trust component with potential benefits including reduced attack surface, limited lateral movement, and improved visibility. The announcement concerned Part One, an introduction and planning document for federal civilian agencies, and said a later technical guide was planned. It is not, by itself, a hospital deployment recipe.
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