Whitepaper

Bridging the Gap: Decrypting Cryptography

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Reading time:
15
minutes
May 1, 2025
Implementing cybersecurity for modern medical devices requires compliance with complex regulations as well as adoption to a changing healthcare ecosystem where hospital networks are considered inherently hostile, devices are increasingly integrated, and data is moving into the cloud. Getting cybersecurity right requires mature processes, careful design considerations, and finding the right balance between the desired level of security and a device’s capabilities and utility. Getting cybersecurity wrong can have significant ramifications for patient safety, regulatory compliance and approval, and business and reputation. Read more for an introduction to achieving device security through cryptography.

Executive summary

Modern medical devices must balance safety, functionality, and cybersecurity amid increasingly connected healthcare environments. This whitepaper unpacks the complexity of implementing cryptography—the foundation of digital trust—in medical devices. It explores the technical, regulatory, and operational factors that determine whether encryption and authentication mechanisms actually make devices more secure or inadvertently create vulnerabilities. Readers will learn how to align cryptographic design with FDA expectations, NIST recommendations, and real-world device constraints.

Why it matters

Cryptography is often misunderstood or inconsistently applied in the medical device industry. Getting it wrong can undermine patient safety, delay regulatory approval, and damage brand reputation. As regulators tighten expectations around secure design, key management, and root of trust, medical device manufacturers must take a proactive approach. This whitepaper helps bridge the gap between theoretical cryptography and practical, compliant implementation across the device lifecycle.

Who should read

  • Product and cybersecurity engineers designing connected medical devices
  • Regulatory and quality professionals preparing FDA submissions
  • CISOs and product security leaders responsible for securing device fleets
  • R&D managers and system architects seeking to future-proof device designs

Key insights

    • Cryptography is not a plug-in—it requires system-wide planning from design through end-of-life.
    • Effective key management and PKI design determine the success of any security architecture.
    • Poorly chosen algorithms or shared keys can expose large device populations to attack.
    • Resource constraints in implantable or portable devices necessitate carefully balanced crypto strategies.
    • Regulators recognize the need for trade-offs but expect them to be well-documented and justified.
  • Table of contents

    1. Introduction: Getting Medical Device Cybersecurity Right
      1. Why security must be built in, not bolted on
      2. Balancing safety, utility, and security
      3. The role of proactive security mechanisms (root of trust, encryption, SBOM)
    2. Getting Cryptography Right
      1. Two key dimensions: strength of protection & key management
      2. Factors that influence success: scalability, cost, agility, compliance, and trust
    3. Core Cryptographic Concepts
      1. Algorithms: symmetric vs asymmetric
      2. Algorithm implementation and lifecycle management
      3. Key generation, protection, and rotation practices
      4. Certificates and Public Key Infrastructure (PKI)
      5. The role of the root of trust (RoT)
    4. Achieving Security Through Cryptography
      1. How cryptography supports confidentiality, integrity, and authenticity
      2. Mapping functions to device security needs (access, data protection, code protection)
    5. Security Functions Provided by Cryptography
      1. Device identity and authentication
      2. Data protection (at rest and in transit)
      3. Code signing and secure boot processes
    6. Cryptography in Device Design
      1. Design-time considerations (hardware, key protection, crypto management)
      2. Secure provisioning and manufacturing practices
      3. Postmarket support and exception handling
    7. Cryptographic Foundation and Infrastructure
      1. Designing crypto architecture and PKI
      2. Certificate structure, lifecycle, and format
      3. Implementing scalable cryptographic infrastructure
    8. Common Mistakes in Cryptographic Implementations
      1. Shared keys, lack of lifecycle management, poor algorithm choices
      2. Misapplied IT cryptography in device contexts
    9. Cryptography in Resource-Constrained Devices
      1. Design tradeoffs for low-power or implantable devices
      2. Balancing performance, longevity, and security
    10. Conclusion: What Now?
      1. Practical steps to “get security right”
      2. Recommendations for building trust with cryptography
  • Related resources

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