A practical cybersecurity framework for legacy medical devices

Legacy medical devices that cannot support standard cybersecurity controls present persistent risk to patient safety, care availability, and protected health information. Existing frameworks address network-borne threats but underserve two profiles: irreversible-consequence risk for life-sustaining devices, and the physical or insider attacker with legitimate device proximity. This paper presents five integrated, practitioner-oriented frameworks grounded in international risk-management standards: a constraint-indexed compensating controls playbook; STRIDE-HC (STRIDE for Healthcare), a clinical adaptation of the STRIDE threat model; a Medical Device Risk Score with an irreversibility-driven tier floor; a five-zone clinical network segmentation model; and a behavioral monitoring framework operationalizing detection-as-control. The frameworks address both healthcare delivery organizations and medical device manufacturers, align with major regulatory and industry standards, and are supported by a companion open-source artifact suite to enable practitioner adoption and empirical validation.