Data Poisoning Vulnerabilities Across Health Care Artificial Intelligence Architectures: Analytical Security Framework and Defense Strategies

Abstract

Background Health care artificial intelligence (AI) systems are increasingly integrated into clinical workflows, yet remain vulnerable to data-poisoning attacks. A small number of manipulated training samples can compromise AI models used for diagnosis, documentation, and resource allocation. Existing privacy regulations, including the Health Insurance Portability and Accountability Act and the General Data Protection Regulation, may inadvertently complicate anomaly detection and cross-institutional auditing, thereby limiting visibility into adversarial activity. Objective This study provides a comprehensive threat analysis of data poisoning vulnerabilities across major health care AI architectures. The goals are to (1) identify attack surfaces in clinical AI systems, (2) evaluate the feasibility and detectability of poisoning attacks analytically modeled in prior security research, and (3) propose a multilayered defense framework appropriate for health care settings. Methods We synthesized empirical findings from 41 key security studies published between 2019 and 2025 and integrated them into an analytical threat-modeling framework specific to health care. We constructed 8 hypothetical yet technically grounded attack scenarios across 4 categories: (1) architecture-specific attacks on convolutional neural networks, large language models, and reinforcement learning agents (scenario A); (2) infrastructure exploitation in federated learning and clinical documentation pipelines (scenario B); (3) poisoning of critical resource allocation systems (scenario C); and (4) supply chain attacks affecting commercial foundation models (scenario D). Scenarios were aligned with realistic insider-access threat models and current clinical deployment practices. Results Multiple empirical studies demonstrate that attackers with access to as few as 100-500 poisoned samples can compromise health care AI systems, with attack success rates typically ≥60%. Critically, attack success depends on the absolute number of poisoned samples rather than their proportion of the training corpus, a finding that fundamentally challenges assumptions that larger datasets provide inherent protection. We estimate that detection delays commonly range from 6 to 12 months and may extend to years in distributed or privacy-constrained environments. Analytical scenarios highlight that (1) routine insider access creates numerous injection points across health care data infrastructure, (2) federated learning amplifies risks by obscuring attribution, and (3) supply chain compromises can simultaneously affect dozens to hundreds of institutions. Privacy regulations further complicate cross-patient correlation and model audit processes, substantially delaying the detection of subtle poisoning campaigns. Conclusions Health care AI systems face significant security challenges that current regulatory frameworks and validation practices do not adequately address. We propose a multilayered defense strategy that combines ensemble disagreement monitoring, adversarial testing, privacy-preserving yet auditable mechanisms, and strengthened governance requirements. Ensuring patient safety may require a shift from opaque, high-performance models toward more interpretable and constraint-driven architectures with verifiable robustness guarantees.

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