# Cybersecurity Access Control: Framework Analysis in a Healthcare Institution
## 1 Introduction
### Background  
Cyber threats continuously evolve, becoming increasingly advanced and adept at remaining undetected. Their frequency is rising, with statistics from 2023 indicating an average of 11.5 attacks occurring every minute across various industries [1]. Healthcare institutions experienced an average of more than 1463 cyberattacks per week, positioning it as the third most targeted industry [2]. The evolving cyber landscape has compelled healthcare institutions to adapt their cybersecurity strategy and defense posture. This adaptation has led the cybersecurity market to promote product solutions aligned with the Zero Trust Architecture (ZTA) framework. In essence, it is becoming a popular approach for building secure systems [3]. On the other hand, it has been discerned that most institutions still utilize a perimeter-based security model (PBSM), with Gartner reporting only 1% of large organizations achieving a ZTA and trends predicting only a 9% increase in adoption by 2026 [4, 5]. While some in the literature suggest that a PBSM is traditional and gettingoutdated [6, 7], the main drivers in the push for companies to adopt a ZTA are a shift in remote access, the use of blended workforces such as contractors, vendors, and full-time/part-time employees, as well as the explosive growth in organization's adoption of hybrid infrastructure (i.e., cloud and on-premises IT systems).  
Remote connectivity has shifted significantly since the start of the 2020 COVID-19 outbreak. The evolving model of the present-day workforce requires organizations to extend company intranet connectivity capabilities to a national and international scope, transitioning remote access services (i.e., VPN technologies) from significant to critical infrastructure. As of 2023, 40.9% of full-time employees work either from home or utilize a hybrid model, with the trend of remote workers expected to increase to 32.6 million Americans by 2025 [8].  
Moreover, identity, permission management, and isolation of network access to company-compliant end-user systems have developed into a more complex focus with the increased use of blended workforces. The combination of dedicated staff, contractors, and vendors utilizing company intranets and IT systems with managed and unmanaged systems has compromised the PBSM's effectiveness by introducing what has developed into a growing threat vector (e.g., trusted and untrusted assets inside the castle walls).  
Cloud computing enables organizations to access computing resources, capabilities, and services without requiring a hardware footprint, internal support personnel, or extensive capital expenses. Nonetheless, it has also initiated the transfer of organizations' essential services beyond the confines of on-premises data centers (DCs), aiming for cost-reduction strategies.  
It is worth noting that Company X utilizes a PBSM architecture with various production components that align with the ZTA framework. It also utilizes a defense-in-depth architecture that utilizes role-based and identity-based access control at the infrastructure level. The cybersecurity defense capabilities are delivered through market-leading hardware-based solutions (e.g., next-Generation Firewall [NGFW] and cloud-based services [e.g., Software as a Service]). However, as a case study for this research, Company X desires to find a reliable framework that mitigates cyberattacks while considering the cost-benefit analysis of investing in the chosen framework.