LAS VEGAS – At HIMSS25 here on Wednesday, former U.S. National Security Agency Director Gen. Paul M. Nakasone discussed the healthcare sector's need to ensure it adapts, adopts and advances artificial intelligence technologies.

The emergence of generative artificial intelligence to more recent advancements in reasoning models is making significant improvements in healthcare today, he said. But, it is imperative to ensure that these revolutionary capabilities are utilized to empower cybersecurity and healthcare.

"Most importantly, how do we think about today, the present, and of course, the future?"

Increasing demands for efficiency, better patient outcomes and heightened security measures are transforming how healthcare is delivered, managed and accessed, he said.

Nakasone was responsible for defending Department of Defense networks, data and weapons systems from 2018 to 2024 and is now the founding director and leader of Vanderbilt University’s Institute of National Security. He also joined the OpenAI board of directors as a member of its safety and security committee last June.

He said three key reasons brought him to the HIMSS25 conference stage – his wife's work as an oncology nurse, his awe of the Arlington Fire Department's response at the Pentagon on 9/11 and the military's "golden hour" promise. 

"Any place that you are on the battlefield, if you are significantly wounded, you will have care within an hour that will likely save your life – 95% of those that are tragically wounded are saved based upon this 'golden hour' concept," he said.

Proceeding into a future with AI

The iPhone disrupted communications and propelled a device "that has everything" and sparked a revolution in technology.

"Those that adapted and adopted had an incredible run and have an incredible run based upon the capability to see a disruptive technology," Nakasone said. 

"I would also tell you that those that were avoiders had a much more difficult time," he said.

The healthcare sector is at a "Sputnik" moment as it considers how it will proceed in a "rapidly evolving landscape of technology change."

"We have this idea of how is it able to discover new drugs, the idea of being able to advance over the past two years of taking incredible data sets, machine learning, deep learning and bringing this together for not only new drugs – but predicted improvisations or improvements of old drugs."

AI can assist in diagnosing diseases – such as early detection of breast cancer – improve risk management and lower administrative costs. 

"We need to adapt," said Nakasone. "We need to adopt, and we need to advance those healthcare providers that can ensure the accuracy, that can streamline the operations and can offer this healthcare to our patients."

The ability to combine natural language processing with employee health records could revolutionize treatment plans, improve efficiencies and reduce costs, he said. 

"There is more that we have to do, more that we have to do," though he said he does not believe that AI will replace a clinician. But, it can make their work and the efficacy of their care better. 

"The smart, adaptive, instinctive feel that I get from my clinician when I see them, why not combine that with the incredible large language models that provide them a step up?"

On the policy side of integrating AI into healthcare, "we are early stages." 

"We will get through being able to improve our drug discovery and our disease detection, and we'll get through being able to understand how we do this with the [U.S. Food and Drug Administration] – with an important understanding that there is a degree of training and education that must underpin everything that we do," he said.

Shielding healthcare from cyber-warfare

During the COVID-19 pandemic, the national secretaries of defense and secretary of health called upon Nakasone to bring the resources of the NSA to make sure that a vaccine could be delivered on time, safely and securely. 

As part of Operation Warp Speed, he looked to secure U.S. Health and Human Services communications with private sector companies. By establishing the Cybersecurity Collaboration Center in 2020, NSA had a forum with the Defense Industrial Complex to allow experts to exchange information. 

AI will change how we fight "the scourge of what we're facing in the industry today" – ransomware, Nakasone said.

"This is the idea of radical partnerships. This is what I learned in Operation Warp Speed. Let's apply it to a problem that is almost unsolvable. Let's figure out how we start to have outcomes. This is exactly the same procedure we need to do with regard to ransomware," he said.

Reading Microsoft's new Rural Hospital Cybersecurity Landscape Report on the landscape of rural hospitals, "My first thought is, we need some type of center that can provide, first of all, threat information. Rapidly."

The NSA also provided scanning, secure email and protective DNS to the Defense Industrial Base. 

"The number of intrusions in the defense industrial base dropped dramatically. You know how much that cost us? $10 million a year," said Nakasone. 

That funding dropped the intrusions, the scans and the attacks dramatically. 

"Why don't we do the same thing with rural healthcare? Why don't we do that with healthcare in general? Why don't we figure out a way that we can provide major health providers and their subs, and everyone else that wants it, scanning and protective DNS and secure email to make the bar that much higher for attackers to come into?"

No other critical infrastructure sector has been hit harder by ransomware than healthcare – with $1.9 million per day lost in revenue, he noted. 

"You don't have to be the fastest gazelle in the jungle to maintain your security in cyberspace, but you just can't be the slowest." --Gen. Paul Nakasone

Nakasone also raised the dearth of technical talent nationally and the reality that healthcare and all areas are also facing a dramatic demographic shift in the workforce, he said.

In five years, Gen Z will replace millennials as the highest percentage of our federal workforce. 

"We need to think differently about those who are going to work national security," and develop, and retain talent ready to navigate AI integration in the workplace, he said.

"I often say in the future, I want policymakers who can code and coders who understand policy. Wouldn't it be nice to have clinicians who code? Coders who understand what clinicians do?"

The future of disruptive technologies and the workforce warrants aggressive talent investments, Nakasone said. 

"I'm very hopeful that we will have some type of National Defense Education Act that looks at technology for the future."

Updated on March 6, 2025, to reflect that NSA is an agency, not an administration. We regret the error in the earlier version.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.