Agentic AI Multiplies Machine Identities-Why Zero Trust Now Matters Most in Healthcare
Agentic AI floods healthcare with machine identities and unpredictable agents, breaking people-first IAM. Identity is the new perimeter-apply zero trust to every workload.
Security Q&A: Why Agentic AI Makes Zero Trust More Urgent in Healthcare
Agentic AI is hitting healthcare fast - automating intake, prior auth, scheduling and RCM. It also creates an explosion of machine identities: bots, service accounts, workload identities and ephemeral processes that act without a human in the loop.
That changes the core problem. Traditional IAM was built for people. Agentic AI runs on machines that inherit privileges, spawn new workloads and act in ways that aren't always predictable.
"Identity is the new security perimeter." - Sitaram Iyer, VP of Emerging Technologies, CyberArk
Why agentic AI complicates identity
Autonomous agents execute tasks and call other systems using inherited permissions. If the caller is overprivileged, the agent is overprivileged by default.
These agents can chain actions, access multiple datasets and trigger downstream workloads. Static, human-centric controls don't fit that pattern.
The risk picture healthcare leaders should watch
- Credential theft and phishing move faster when tokens and API keys unlock machine-to-machine access.
- Overprivileged service accounts widen blast radius across EHR, billing and imaging systems.
- Inherited privileges from AI orchestration tools create unseen lateral paths.
- Unpredictable agent behavior makes one-time approvals unsafe.
CyberArk's analysis shows the ratio of machine-to-human identities often sits near 82:1. That scale breaks old access models.
Zero trust for humans and machines
"Never trust, always verify" still applies - but verification must be machine-centric. Treat every agent, workload and API as its own identity with scoped, time-bound permissions.
- Grant granular, least-privilege access per action, not per role alone.
- Continuously evaluate behavior, not just initial authentication.
- Maintain full visibility, audit trails and kill switches for agents and the workloads they touch.
A practical zero-trust rollout for healthcare
- Get full visibility: Build an inventory of all identities - humans, bots, service accounts, APIs, workloads (on-prem, cloud, SaaS). Classify by data sensitivity and patient impact.
- Map ownership: Tie every identity to an app and business owner. No owner, no access.
- Tighten privileges: Remove excess rights. Use just-in-time access, short-lived tokens and just-enough access for admins and agents.
- Secure secrets: Vault and rotate keys; eliminate hard-coded credentials. Prefer workload identity (OIDC, cloud-native identities) over static secrets.
- Control agent-to-agent access: Define which workloads can call which services, with conditional checks on context and intent.
- Continuously verify: Use behavior-based controls to detect anomalies (new data sources, unusual volumes, off-hours actions) and auto-revoke on risk.
- Audit and automate: Capture immutable logs; enforce policy-as-code in CI/CD; scan for leaked secrets; block risky configs before deploy.
Common pitfalls to avoid
- Applying the same policies to people and machines.
- Skipping the inventory step - you can't protect identities you don't see.
- Treating zero trust as a one-time project instead of a continuous program.
- Leaving service accounts and API keys static, unowned and overprivileged.
- Ignoring workload-to-workload trust paths across data center and cloud.
What good looks like
- % of identities discovered and owned (target: 100%).
- Machine-to-human identity ratio monitored and trending stable.
- % of service accounts vaulted and rotated (target: >95%).
- Median privilege lifetime in minutes, not days.
- Secrets rotation frequency aligned to risk tiers.
- Mean time to revoke access after anomalous behavior.
- Coverage of behavior analytics across high-risk agents and workloads.
Where to start this quarter
- Inventory all machine identities touching PHI and critical workflows; assign owners.
- Vault and rotate the top 100 high-risk service accounts and API keys.
- Implement just-in-time access for admin tasks and AI orchestration tools.
- Add behavior-based policies to monitor and auto-limit agent actions.
Resources
Agentic AI will multiply identities across your health system. Treat every identity - human and machine - as a gate to patient data, and enforce zero trust with continuous verification. That's how you ship AI safely without compromising care.
