Zero-Trust Architecture Implementation for Securing Interoperable HealthTech Ecosystems

Abstract

Interoperable HealthTech ecosystems composed of electronic health records (EHRs), medical devices, health information exchanges (HIEs), mobile health (mHealth) apps, cloud services, and analytics platforms deliver great opportunities for coordinated care and innovation but also dramatically increase the attack surface for cyber threats. Traditional perimeter-based defenses are inadequate for these distributed, data-centric environments. Zero-Trust Architecture (ZTA), which enforces “never trust, always verify” principles with continuous authentication, least privilege, micro segmentation, and pervasive telemetry, provides a rigorous, adaptable security model for HealthTech interoperability. This article offers a comprehensive, scholarly treatment of ZTA applied to interoperable health ecosystems: we synthesize core ZTA principles and reference frameworks (notably NIST SP 800-207 and follow-on guidance), map ZTA components and operational controls to health-specific technologies (FHIR APIs, SMART on FHIR authorization, medical device telemetry, HIEs), provide a practical, phased implementation roadmap, propose metrics for evaluation, analyze regulatory and privacy implications (HIPAA, HITECH), and discuss deployment challenges and mitigation strategies. Throughout we emphasize measurable, risk-based decision making, human factors, and paths to clinical and organizational adoption. This manuscript is intended for security architects, clinical informaticians, Health IT leaders, and researchers working on secure interoperability in healthcare.