How should healthcare teams prioritise PAM for cloud and connected devices?

Where PAM should start in cloud and connected healthcare environments

Healthcare teams should treat PAM as a way to contain reach, not just to protect logins. The first targets are the accounts that can change many systems at once: cloud administrators, maintenance users, integration operators, remote support accounts, and device-linked support channels. Those paths deserve the fastest inventory, the tightest approvals, and the shortest credential exposure window.

That order matters because cloud and connected-device estates tend to concentrate power in a few shared control planes. If a single account can administer identity, storage, networking, or remote device management, then misuse is rarely isolated to one endpoint. A practical PAM programme starts with the routes that can turn one compromise into many.

For cloud-specific access, the priority is not every user with some privilege, but the identities that can create, modify, or delegate access across workloads. For connected devices, the risk often sits in the support path rather than the device itself: vendor portals, management consoles, remote troubleshooting sessions, and maintenance credentials are frequently the shortest route into a fleet.

Good prioritisation therefore follows blast radius and ownership clarity together. Broad privileges with weak business ownership should move ahead of lower-impact accounts that are well understood, well reviewed, and easy to recover. That is why cloud administration and device support deserve early attention in healthcare, where uptime pressure often tempts teams to leave standing access in place longer than they should.

How cloud administration differs from device support access

Cloud administration is usually about control plane power: the ability to create resources, change policies, read secrets, or grant access to others. If those rights are exposed, an attacker or careless operator can pivot quickly across environments, not just within one server or application. The most important PAM question is whether the identity can expand its own reach.

Device support access is different but just as sensitive. Medical and connected devices often rely on remote service accounts, shared vendor workflows, or temporary maintenance channels that bypass normal user experience controls. If those channels are overused, hard to audit, or reused across customers, they become a high-value path for lateral movement and fleet-wide disruption.

Healthcare teams should not rank these two categories by technology label alone. A cloud role with permission to read secrets may be more dangerous than a device admin account with local scope, while a device support portal connected to many sites may be more dangerous than a narrowly scoped cloud role. The right sequence is driven by reach, delegation, and how much the account can do without human review.

What good prioritisation looks like in practice

Effective PAM prioritisation starts with a small set of questions: who owns the account, what can it reach, how long is access valid, and what evidence exists when it is used. If the answers are vague, shared, or manual, the account belongs high on the remediation list. That is especially true where privileged access crosses organisational boundaries, such as vendor support, MSP operations, or device maintenance.

In practical terms, teams should push early controls toward the accounts that meet all three conditions: privileged, broadly connected, and weakly governed. Those are the candidates for vaulting, just-in-time elevation, session oversight, and tighter approval routing. The aim is to remove standing power from the paths that can most easily touch cloud and connected devices at scale.

Healthcare environments also need to be realistic about exception handling. Emergency access, break-glass accounts, and service continuity processes are necessary, but they should be treated as special cases with stronger monitoring and explicit review. If a privileged path exists mainly because it is convenient, it should usually be a stronger candidate for restriction than one that exists because it is operationally unavoidable.

Risk and Threat Considerations

Cloud and connected-device privileged paths create a high-consequence attack surface because they often combine broad reach with weak day-to-day visibility. A stolen admin secret, a vendor support credential, or an over-permissioned maintenance account can let an attacker move from one system to many, including device fleets, identity services, and clinical support tooling.

Failure mechanism: Standing privilege, shared credentials, and loosely governed support channels let a compromise scale far beyond its original entry point. Once a privileged cloud or device-management account is abused, attackers can disable controls, exfiltrate data, or trigger disruptive changes across multiple systems before detection catches up.

Impact: The result can be service interruption, unsafe device states, exposure of sensitive health data, and a much larger recovery effort. In healthcare, the operational impact matters as much as the confidentiality impact because privileged misuse can affect availability, safety, and clinical continuity at the same time.

Practitioner Guidance

What to prioritise: Start with the accounts that can affect the most systems with the least friction, then work outward. In most healthcare environments that means cloud admins, remote support channels, and maintenance identities before ordinary administrator roles.

What to verify: Confirm that every privileged account has a clear owner, a real business purpose, and a reviewable approval path. If an account exists because “the vendor needs it” or “operations might need it,” treat that as a risk signal until the access path is bounded and monitored.

Common mistake: Teams often spend effort on the number of privileged accounts instead of the quality of the access path. Fewer accounts do not help if the remaining ones can still reach many systems, reuse secrets, or operate without session oversight.

Practitioner takeaway: In healthcare, PAM priority should follow blast radius first and convenience last, because the most dangerous privileged path is usually the one that can quietly reach cloud control planes and connected devices at the same time.

Related resources from NHI Mgmt Group

• How should security teams prioritise NHI remediation in cloud environments?
• How should security teams govern non-human identities in cloud environments?
• What should IAM and PAM teams prioritise when cloud velocity is increasing?
• What breaks when healthcare teams do not know which connected devices are on the network?