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How to Be HIPAA Compliant in the Cloud, in Five Steps

Posted on September 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Gilad Parann-Nissany, Founder and CEO of Porticor.

The Health Insurance Portability and Accountability Act (HIPAA) is the legal framework for keeping private health information – private. HIPAA protects personal health information from being exposed, and in particular – in the IT world – HIPAA defines how Electronic Personal Health Information (EPHI) should be protected. It imposes rules and also penalties.

A central goal for cloud-based health systems should be to achieve “Safe Harbor.” This means that your data is so well protected, even if bad things happen, you can reasonably show that EPHI was not exposed. This is HIPAA nirvana.

Some could say that HIPAA compliance is complex. Spoiler: they would be right. However, as Lao Tzu, founder of Chinese Taoism once said: “The journey of a thousand miles begins with one step.” Or, in our case, five steps.

1.     Investigate
Scope out your system, people and procedures
Start by studying your system architecture and your procedures and deciding where sensitive data resides and which procedures are relevant.

Nowadays, it is very popular to use cloud infrastructure for building out systems – rightly so, given the operational advantages. Cloud systems can be made HIPAA compliant. Start by making sure that all cloud accounts, cloud servers, cloud network segments and cloud storage – that will contain or process sensitive EPHI – are on your list.

Make sure you’ve also considered procedures and even people – they need to be part of your scope. Also consider which people should not see cloud-based EPHI – for example cloud provider employees and other cloud service providers you use.

2.     Analyze Risks
Discover where your Electronic Personal Health Information could get compromised
Go over everything on your list, whether a person, organization or a technical entity, and analyze where they get in contact with EPHI and the degree of risk involved. Document these risks carefully – they are the basis of your HIPAA compliance.

At this point, also consider possible mitigations to risks. Encryption and solid management of cloud encryption keys is one of the most important tools in your toolbox – if you encrypt data properly and keep the keys safe, you may enjoy “safe harbor,” and mitigate many of the penalties and risks of HIPAA.

3.     Define Policies
Establish procedures for security and privacy
HIPAA compliance is not just about doing things well, but also all about properly documenting that you have done them well. Going over your scoping list from step 1, you should identify the policies and procedures for each item, person or organization – that would ensure EPHI never leaks. Another set of documents should define your privacy policies.

Again, this is an important place to consider mitigations. As you go over the list and construct your procedures, pay attention to things that could go wrong. In the real world, something always goes wrong. Build in mitigations so that even if bad things happen – you will still enjoy “safe harbor.”

Ask your cloud service providers for a Business Associate Agreement, which ensures that they too have gone through a similar process – and are responsible for the service they provide you and its implications for HIPAA compliance.

4.     Train your people
Educate your employees and make sure your service providers are trained!
This is an obvious point, yet one of the most important ones. Trained staff make all the difference.

And yes, as always in HIPAA, it is not enough to train the staff, but also document the training. Require these proofs also from your service providers.

5.     Prepare for a breach
Be ready in case disaster strikes
Bad stuff happens. How will you deal with it? You need to plan this ahead of time, and – as always – also document your planning.

Our entire approach is based on achieving “safe harbor” – when you go through your “bad stuff” checklist, think carefully how each point can be mitigated. Often solid encryption will help, and one of the first things you want to check in the event of a breach – was the data encrypted and the keys kept safe? Make this part of your procedures.

HIPAA compliance in the cloud is within reach
By taking the right approach, thinking carefully through safe harbor possibilities, and covering the entire scope of your project – you can achieve proper HIPAA compliance and protect patient privacy. This is also a major competitive advantage for your business.

About the Author
Gilad Parann-Nissany, Founder and CEO of Porticor, is a cloud computing pioneer. Porticor infuses trust into the cloud with secure, easy to use, and scalable solutions for data encryption and key management. Porticor enables companies of all sizes to safeguard their data, comply with regulatory standards like PCI DSS, and streamline operations.

The HIPAA Final Rule and Staying Compliant in the Cloud

Posted on September 3, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Gilad Parann-Nissany, Founder and CEO of Porticor.

The HIPAA Omnibus Final Rule went into effect on March 26, 2013.  In order to stay compliant, the date for fulfilling the new rules is September 23, 2013, except for companies operating under existing “business associate agreements (BAA),” who may be allowed an extension until September 23, 2014.

As healthcare and patient data move to the cloud, HIPAA compliance issues follow.  With many vendors, consultants, internal and external IT departments at work, the question of who is responsible for compliance comes up quite often.  Not all organizations are equipped or experienced to meet the HIPAA compliance rules by themselves.  Due to the nature of the data and the privacy rules of patients, it is important to secure the data correctly the first time.

HIPAA and the Cloud
Do you have to build your own cloud HIPAA compliance solutions from scratch?  The short answer is no.  There are solutions and consulting companies available to help move patient data to the cloud as well as secure it following HIPAA compliance rules and best practices.

The following checklist provides a guide to help plan for meeting the new HIPAA compliance rules.

A Cloud HIPAA Compliance Checklist

1. Ensure “Business Associates” are HIPAA compliant

–          Data Centers and cloud providers that serve the healthcare industry are in the category of “business associates.”

–          Business Associates can also be any entity that “…creates, receives, maintains, or transmits protected health information (PHI) on behalf of a covered entity.”  This means document storage companies and cloud providers now officially have to follow HIPAA rules as well.

–          Subcontractors are also considered business associates if they are creating, receiving, transmitting, or maintaining Protected Health Information (PHI) on behalf of a business associate agreement.

–          As a business associate they must meet the compliance rules for all privacy and security requirements.

What can you do?

Ensure business associates and subcontractors sign a business associate agreement and follow the HIPAA compliance rules for themselves and any of their subcontractors. A sample Business Associate Agreement is available on the HHS.gov website.

What happens if you are in violation?

The Office of Civil Rights (OCR) investigates HIPAA violations and can charge $100 – 50,000 per violation.  That gets capped at $1.5 million for multiple violations.  The charges are harsh to help ensure that data is safe and companies are following the HIPAA rules.

2. Data Backup

– Health care providers, business associates, and subcontractors must have a backup contingency plan.

– Requirements state that it has to include a:

Backup plan for data, disaster recovery plan, and an emergency mode operations plan

– The backup vendor needs to encrypt backup images during transit to their off-site data centers so that data cannot be read without an encryption key

– The end user/partner is required to encrypt the source data to meet HIPAA compliance

What can you do?

If you handle the data backup internally, set a plan to meet HIPAA compliance and execute it.
If you have external backup solution providers, ensure they have a working plan in place.

3. Security Rules

–          Physical safeguards need to be implemented to secure the facility, like access controls for the facility

–          Develop procedures to address and respond to security breaches

–          There are an additional 18 technical security standards and 36 implementation specifications as well

What can you do?

Put a plan in place to protect data from internal and external threats as well as limiting access to only those that require it.

4. Technical Safeguards

Health care providers, business associates, and subcontractors must implement technical safeguards. While many technical safeguards are not required – they do mitigate your risk in case of a breach. In particular, encryption of sensitive data allows you to claim “safe harbor” in the case of a breach.

v  Study encryption and decryption of electronically protected health information

v  Use AES encryption for data “at rest” in the cloud

v  Use strong – and highly protected – encryption key management; this is the most sensitive and difficult piece on this list – consider to use split-key cloud encryption or homomorphic key management

v  Transmission of data must be secured: use SSL/TLS or IPSec

v  When any data is deleted in the cloud any mirrored version of the data must be deleted as well

v  Limit access to electronically protected health information

v  Audit controls and procedures that record and analyze activity in information systems which contain electronically protected health information

v  Implement technical security measures such as strong authentication and authorization, guarding against unauthorized access to electronically protected information transmitted over electronic communication networks

What can you do?

Adopt strong encryption technology and develop a plan to ensure data is transmitted, stored, and deleted securely. Develop a plan to monitor data access and control access.

5. Administrative Safeguards

For organizations to meet HIPAA compliance they must have HIPAA Administrative Safeguards in place to “prevent, detect, contain and correct security violations.”  Policies and procedures are required to deal with: risk analysis, risk management, workforce sanctions for non-compliance, and a review of records.

v  Assign a privacy officer for developing and implementing HIPAA policies and procedures

  • Ensure that business associates also have a privacy officer since they are also liable for complying with the Security Rule

v  Implement a set of privacy procedures to meet compliance for four areas:

Risk Analysis
“Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity”

Risk Management
“Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with §164.306(a).”

Workforce Sanctions for Non-Compliance
“Apply appropriate sanctions against workforce members who fail to comply with the security policies and procedures of the covered entity.”

Review of Records
“Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.”

v  Provide ongoing administrative employee training on Protected Health Information (PHI)

v  Implement a procedure and plan for internal HIPAA compliance audits

What can you do?

Develop an internal plan to meet HIPAA compliance and have a privacy officer to implement requirements.  Ensure that policies and procedures deal with analysis of risk, management of risk, policy violations, and sanctions for staff or contractors in violation of the policy.  Develop and maintain documentation for internal policies to meet HIPAA compliance as it will help define those policies to your organization and could assist during a HIPAA audit.

Gilad Parann-Nissany, Founder and CEO of Porticor, is a cloud computing pioneer. Porticor infuses trust into the cloud with secure, easy to use, and scalable solutions for data encryption and key management. Porticor enables companies of all sizes to safeguard their data, comply with regulatory standards like PCI DSS, and streamline operations.