Hidden consequences of rural hospital closures: Patient care suffers – so does data security

Angela has lived with CoPD for many years. Her little home hospital was her lifeline during the outbreak – its staff knew her history and its electronic medical record system ensured that her care team could get instant access to Ephi. But in early 2023, the hospital was closed due to financial pressure and staff shortages. The nearest hospital is 45 minutes away, and during her next crisis, delays, repeated tests, and lack of records complicate her care.

In the following months, Angela's care was further dispersed. The regional hospitals that stabilized her were also closed – this time under pressure from ransomware attacks that disrupted operations and revenue cycles. With no local hospital, Angela bounced between clinics, retelling her story and doing the test results by hand. Even when her hometown reopened new hospitals, her medical history did not transition. Continuity disappears, and the risks of her health and her data grow with each handover.

Angela’s story is fictional, but the crisis is real. In 2023, an Illinois rural hospital closed after a ransomware attack hindered operations for more than 14 weeks. Although it was later reopened under new ownership, the shift has raised new concerns about Ephi security and system transition. Throughout the United States, nearly 700 rural hospitals are at risk of closure. When they are closed, affecting cascades: continuity of rupture, delaying care and increasing cyber risks to each new system that patients must navigate.

How rural hospitals protect patient care and the data behind it

Even with limited resources, rural hospitals today can take meaningful steps to protect patient care and enhance resilience, including the following:

1. Asset-based risk analysis that complies with HIPAA.

Comprehensive risk analysis based on assets is the basis of a strong cybersecurity program.

• Identify where Ephi lives, who accesses it and which vulnerabilities could harm care.
• Comply with standards for safety rules, aligned with OCR expectations, and provides a priority roadmap to protect patient care and sensitive data.

Without it, hospitals remain blind to threats that endanger patient safety and data security.

2. Use 405(d) practice to build a baseline

According to the Health Industry Cybersecurity Practice (HICP) framework published under 405(d), it provides practical safeguards designed specifically for resource-constrained hospitals. This is a good starting point for assessing current maturity and close distance gaps that may affect patient care.

• HICP provides actionable practices to help small hospitals prioritize basic controls for safe, uninterrupted operations.

Without a 405(d) baseline, small hospitals risk ignoring the critical safeguards that protect systems and ensure continuity of care.

3. Protect basic cyber hygiene to protect nursing delivery.

Basic cyber hygiene is crucial to preventing the most common attacks. Without these necessities, the hospital has a risk system that directly destroys patient care.

• Install endpoint protection.
• Filtered emails for phishing and malware.
• Ensure remote access to employees and suppliers.

Skip these basics to make critical systems vulnerable – threatening the safety of patients, operations and data security.

4. View vendor access and data sharing.

As services move to external partners, Ephi often follows – creating new exposure points that can destroy care if the supplier is safe and not dense.

• Verify HIPAA compliance Business Assistant protocols and confirm that suppliers have strong safety practices that can reduce risks and protect patient data.
• Map sensitive data flows to avoid unmonitored transfers and unexpected exposures.

Unstructured approaches such as email, fax, or USB may introduce unnecessary risks.

5. Continuously monitor the threat of protecting patient care.

Cyber threats are developing every day. Continuous surveillance enables hospitals to detect and respond quickly in an incident, thereby destroying critical systems or exposing sensitive information.

• When internal resources are limited, use hosting services to fill the gap.
• Monitor system activity in real time to maintain visibility and control.
• Respond to alerts immediately to include potential violations.
• Ensure compliance with HIPAA's expectations of visibility and incident response readiness.

Stopping threats early can keep critical systems running, protect sensitive data, and ensure patient care remains uninterrupted.

6. Enhance leadership resilience.

Cybersecurity is more than IT responsibility – it requires leadership at all levels to be actively involved to protect patients and ensure operational continuity.

• Think of cybersecurity as a hospital-wide responsibility and embed it into governance and decision-making.
• Engage boards, executives and clinical leaders in meaningful risk discussions.
• Use normal language to link cyber risk to patient safety, financial stability, and operational continuity.

When leadership champions cybersecurity, teams follow their lead – beating gap attackers can quickly take advantage of.

7. Develop a phased and realistic plan of improvement.

A strong cybersecurity program won't happen overnight. Rural hospitals can make steady progress by focusing on high-impact actions that align with their resources and capabilities.

• Use your risk analysis to map a multi-year strategy.
• Prioritize the greatest risk of the greatest impact.
• Match priority to your available funds, staff and technical capabilities.
• Tackle improvements to protect most data with minimal lift.

Skip this step to spread resources sparsely and leave critical gaps that attackers can exploit.

Protect patient care, especially when care delivery changes

When hospitals are closed (even for temporary use in ransomware recovery), it often forces care transitions that send patient data in new systems and providers. Hospitals may need to transfer services to new providers, refer patients to external clinics, and share Ephi in unfamiliar systems.

If these transitions are not carefully managed, visibility to Ephi may disappear, and new access points are created by attackers who are eager to exploit.

There is a way forward. Start with a HIPAA-compliant asset-based risk analysis to reveal where the data resides, access to the data, and what vulnerabilities can harm care. Prioritize safety basics. Training your staff. Participate in leadership. Develop a phased plan that protects patients and their data with each interruption.

Potential closure creates stress. Poor programs expand risks of care, compliance and patient trust.

Photos: All the best photos, Getty images

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