Scenario: A hospital is deploying 500 smart infusion pumps that deliver medication intravenously. The security team must rank CIA triad priorities to guide design decisions when trade-offs are necessary.
Device Characteristics:
- Delivers insulin, chemotherapy, pain medication
- Dosage range: 0.1-100 mL/hour
- Network-connected (nurse station monitors doses)
- Patient data: Name, weight, medication history
- Battery-powered (8-hour runtime)
CIA Priority Analysis:
Integrity (HIGHEST Priority):
Risk: Incorrect dosage calculation or delivery
Impact: Patient death (overdose) or treatment failure (underdose)
Examples:
- Attacker modifies dose from 2 mL/hr to 20 mL/hr → 10× overdose → fatality
- Bit-flip error changes medication ID → wrong drug delivered
- Malware corrupts dosage algorithm → systematic under/overdosing
Quantified Impact:
- 1 integrity failure = 1 potential fatality
- Hospital liability: $2-10M per wrongful death lawsuit
- FDA recall: All 500 devices × $5,000 = $2.5M
- Reputational damage: Estimated $50M in lost sales
Availability (HIGH Priority):
Risk: Pump stops delivering life-sustaining medication
Impact: Patient death or serious harm
Examples:
- DDoS attack crashes pump software → no medication delivered
- Ransomware locks pump → medication interruption
- Battery exhaustion during critical infusion
Quantified Impact:
- Medication interruption >30 minutes = potential patient harm
- 8-hour battery requirement (can tolerate brief network outage)
- Temporary unavailability = serious but not immediate fatality (backup manual delivery)
Confidentiality (MEDIUM Priority):
Risk: Patient data exposure (name, weight, medication history)
Impact: Privacy violation, HIPAA fines, but NOT immediate physical harm
Examples:
- Attacker intercepts patient name and medication
- Pump screen visible to unauthorized visitors
- Data breach exposes medical histories
Quantified Impact:
- HIPAA violation: $50,000 per patient record
- 500 devices × avg 5 patients/day × 1 breach = $125M potential fine
- Reputational damage: $20-50M
- Physical harm: None (privacy violation, not safety)
Priority Ranking with Trade-Off Example:
Scenario: Pump CPU has 20% spare capacity. Allocate between: 1. Real-time dosage verification (integrity check): Requires 15% CPU 2. TLS 1.3 encryption (confidentiality): Requires 18% CPU 3. Redundant network paths (availability): Requires 12% CPU
Decision:
Allocation:
1st Priority (Integrity): Implement dosage verification (15% CPU)
2nd Priority (Availability): Implement redundant network (12% CPU) - OVER BUDGET
3rd Priority (Confidentiality): Defer TLS to next hardware revision
Justification:
- Integrity: Prevents immediate patient harm (fatality)
- Availability: 12% CPU allows backup network if primary fails
- Confidentiality: Important but can use alternative mitigation (encrypted database storage, network-level VPN) without consuming device CPU
CPU Budget:
Used: 15% (integrity) + 12% (availability) = 27% (exceeds 20% budget)
Resolution: Reduce network redundancy to 5% (less aggressive retries)
Final: 15% + 5% = 20% (exactly at budget)
Key Insight: CIA priorities are context-dependent. For medical devices: Integrity > Availability > Confidentiality. For security cameras: Confidentiality > Availability > Integrity. For industrial sensors: Availability > Integrity > Confidentiality. Always rank based on “which failure causes the most harm?”