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06/06/2026 11:16 am
TL;DR: The ePA is governed by a strong legal and architectural framework, but the real risk sits in operating conditions such as compromised provider credentials, weak role separation, and insecure primary systems, according to Imprivata. For IAM teams, the lesson is that ePA security depends less on central platform design than on how identities, privileges, logging, and offboarding are enforced at the edges.
NHIMG editorial — based on content published by Imprivata: ePA security facts check and measures for healthcare protection
By the numbers:
- 97% of NHIs carry excessive privileges, increasing unauthorised access and broadening the attack surface.
- Only 5.7% of organisations have full visibility into their service accounts.
- 79% of organisations have experienced secrets leaks, with 77% of these incidents resulting in tangible damage.
Questions worth separating out
Q: How should healthcare teams secure ePA access in practice?
A: Healthcare teams should secure ePA access by treating provider authentication, role separation, and logging as one control set rather than three separate projects.
Q: Why do provider credentials create such a large ePA risk?
A: Provider credentials matter because they can inherit legitimate institutional authority and reach sensitive patient data through approved channels.
Q: What breaks when privileged access is not tightly separated in healthcare IAM?
A: When privileged access is not tightly separated, administrators and recovery operators can cross into clinical data pathways that were meant to be isolated.
Practitioner guidance
- Separate provider, administrator, and recovery identities Map every ePA access path to a distinct identity type and prohibit shared credentials for clinical use, administration, and backup recovery.
- Treat primary systems as part of the ePA trust boundary Include connected practice, pharmacy, and hospital systems in the ePA risk assessment, then harden them with segmentation, restricted local admin rights, and patch enforcement.
- Operationalise privileged session monitoring for ePA access Create a dedicated monitoring use case for privileged sessions, mass access patterns, and unusual record queries.
What's in the full article
Imprivata's full article covers the operational detail this post intentionally leaves for the source:
- TI-specific authentication and authorisation requirements for healthcare deployments
- The control structure behind logging, accountability, and patient-facing transparency
- Operational guidance for integrating ePA access into ISMS and BSI-oriented processes
- Practical handling of privileged roles, break-glass access, and recovery workflows
👉 Read Imprivata's analysis of ePA security and IAM controls in healthcare →
ePA security and IAM gaps: are healthcare controls keeping up?
Explore further
06/06/2026 11:58 am
ePA security is only as strong as the institutional identity that reaches it. The article makes clear that the central platform can be designed with strong cryptographic controls, yet compromised provider credentials still create a direct path to protected records. That means the trust boundary is not the ePA core alone, but the issuing institution and its access hygiene. Practitioners should read this as a reminder that regulated health platforms fail at the identity edge before they fail at the control plane.
A few things that frame the scale:
- 97% of NHIs carry excessive privileges, increasing unauthorised access and broadening the attack surface, according to the Ultimate Guide to NHIs.
- 91.6% of secrets remain valid five days after the targeted organisation is notified, showing a critical gap in remediation procedures.
A question worth separating out:
Q: Who is accountable when ePA access controls fail?
A: Accountability sits with the healthcare organisation that operates the connected identities, not only with the central platform provider. Regulators expect organisations to manage access, logging, and recovery discipline across their own systems and processes. If primary systems, admin roles, or revocation workflows are weak, the operating entity owns the gap.
👉 Read our full editorial: ePA security in practice: where identity controls still fail
