HIPAA IT Compliance
The Essential Guide
There can be some confusion surrounding the Health Insurance Portability and Accountability Act (HIPAA) and exactly who it applies to. After all, only a small portion of HIPAA covers protected health information and the requirements to protect this Act. The effects of HIPAA do a lot to protect our collective information as patients and consumers from unsecured IT practices. Naturally, these compliance requirements impact IT within the healthcare sector, but they also extend into many other professionals, industries, and businesses, including law firms and attorneys, accountants, financial consultants, and more.
When it comes to safeguarding protected health information (PHI) and personally identifiable information (PII), there are a lot of protocols to follow to ensure data stays safe. The world of Information Technology (IT) has made all kinds of strides to make our lives easier. But with all these advancements, some considerations factor into how different professionals meet HIPAA compliance.
Storing patient data and other PHI and keeping it protected from unauthorized access can be a challenge. The reason is that managing an IT infrastructure and keeping a strong security architecture intact to prevent bad actors and data breaches requires a lot of time and resources.
Even so, it’s important to know that cybercriminals are constantly after this kind of personal information. This data can be stolen and used for exploitation, discrimination, and monetary gain. This is why there are HIPAA regulations in place–to give anyone who handles this kind of data an established list of guidelines for how to electronically store and process patient information.
Why does this matter? HIPAA compliance regulations keep patient medical records, test results, insurance details, and other PII safe from malicious use. It also restricts access to protect this data from unauthorized employees, bad actors, and third-party vendors.
With the right protocols in place, organizations that handle HIPAA-related information can provide their patients and clients with a sense of trust; they know they can feel secure and that their private information will stay protected.
What is HIPAA
HIPAA, also known as the Health Insurance Portability and Accountability Act, was introduced in 1996. And while technology has grown and evolved significantly since then, the core values are the same: To protect individuals and safeguard their medical information and personal records from cybercrime.
There are all kinds of standards so patients know and have control over how their personal information is being used. This Privacy Rule was put into place to keep PHI defended from bad actors while also promoting the ongoing flow of health information to ensure providers have the information they need to deliver exceptional care and protect patient health and well-being.
Health workers have to follow a set list of rules for record-keeping for proper care–which means cybersecurity is critical for any medical provider, healthcare system, as well as any third party that handles PHI and other medical data.
This includes everything from routine digital interactions with patients to handling large-scale solutions like blockchain technology.
Who’s subject to the Privacy Rule? Let’s start with the most obvious sector: Healthcare providers. This includes practitioners and providers of all kinds, regardless of the size of their practice, and all of their electronically transmitted health information, including patient forms as well as:
But healthcare providers aren’t the only ones who have to consider HIPAA Compliance. Health plans and insurance providers are also responsible. These include:
Who else is covered? Some may think that HIPAA only applies to hospitals, doctor’s offices, physicians, and insurance companies. And these requirements are mostly intended for healthcare providers and insurers, but they also cover other business associates:
Law firms and attorneys
Accounting firms and CPAs
Financial consultants and advisors
Why is this? Professionals who work in these fields often have to access patient data and related PII. This makes them just as responsible for abiding by the regulations outlined in HIPAA. Essentially, any organization with access to PHI or other sensitive medical-related data must be HIPAA compliant.
What Does HIPAA Mean for Cybersecurity? HIPAA guidelines recommend a comprehensive cybersecurity program to keep patient data safe, provide secure remote access, and protect things like medical devices and other wireless devices used for patient care and/or in healthcare settings.
These guidelines are broken down into 4 separate roles to maximize data protection and confidentiality:
ABOUT Windows and HIPAA
The introduction of Windows 11 opened the door to many questions regarding HIPAA compliance and how it impacts Windows 10 users who might be curious about an upgrade. Some Windows users are hesitant to adopt the latest operating system right away, no matter their industry, but those who handle PHI have to be especially careful.
Windows 11 seems to be a much-needed release of a new operating system with all kinds of security upgrades that can help healthcare providers and those subject to the HIPAA Privacy Rule keep up with changes in technology and security.
How Does Windows 11 Impact HIPAA Compliance?
HIPAA requires recorded and stored patient data to be handled with extra care—including printed files, forms, and patient records. For IT, hardware that contains sensitive HIPAA-covered information has to meet compliance standards. What about operating systems?
Out of the box, Windows 10 on its own was not HIPAA compliant–though it is now. Windows 11, however, has raised the bar when it comes to security, with high standards for minimum system requirements. It’s a solid choice for security-minded providers and all those looking for HIPAA-compliant solutions.
Computer systems and servers call for stout hardware to maintain protections:
Virtualization-Based Security (VBS)
Hypervisor-Protected Code Integrity (HVCI)
Using a Firewall
A firewall is a cybersecurity solution engineered to keep an organization’s information protected against unauthorized access. This security mechanism works by filtering incoming and outgoing information and serves as a “wall” between an entity’s private network and public networks.
Truly, any entity that uses more than one system to run its operations should have firewall protection to anticipate and ward off potential threats. Firewalls are one of the four main guidelines for HIPAA compliance–it’s a requirement in the healthcare system to strengthen cybersecurity with extra layers of protection between bad actors and PHI.
Without a firewall, healthcare data is much more vulnerable to data theft or cyber attack. The absence of a firewall also makes it harder to identify how data breaches happen.
A firewall is one of the strongest defenses against cyberattacks via unauthorized network access. It monitors traffic coming in and out and gives you the power to strengthen filters and prevent attacks.
How Do You Choose the Right Level of Protection? Choosing firewall protection will vary based on the scale, scope, and size of an entity’s operation as well as HIPAA requirements, but here are a few things to consider when selecting firewall protection:
Cyber Threat Prevention: Look for a network firewall with integrated threat prevention functionality and intelligence feeds. After all, the more access bad actors have to your network, the more challenging it will be to remediate the damage.
Cost: Modern firewalls are more affordable than the cost to recover after a security breach, and more cost-effective than an inefficient, outdated firewall that doesn’t hold up against more sophisticated attacks.
Virtual Private Network: Seek out a firewall with a virtual private network (VPN) to serve as a secure, safe infrastructure. A VPN creates a private network across a public network to send and receive data securely from anywhere. This increases functionality and security and makes your IP address anonymous to hackers.
Hybrid Cloud Support: Cloud computing and hybrid cloud deployment require different security measures compared to traditional or on-premises deployments. Healthcare entities and other organizations with cloud-based environments need a firewall that is scalable and offers hybrid cloud support.
Unified Security Management: Many organizations use a whole system of security solutions to maintain their operations and monitor for cyber risks. A great firewall solution should ease some of the complexity surrounding cybersecurity with an integrated unified security management (USM) functionality to enforce cybersecurity network-wide.
Restricting Network Access
Public access to your organization’s data opens the door to all kinds of attacks–it’s like giving cybercriminals the keys to the kingdom. Limiting this continuous access and establishing exactly which individuals can access your data is an easy and effective way to secure your assets and maintain compliance with HIPAA standards.
One way to do this is to create an independent wireless and service network to shield sensitive data and PHI by only granting access to authorized employees and guests. After all, not everyone within your organization needs access to your most sensitive data. Network access control helps dial-in access.
Every organization has a responsibility to protect personally identifiable information collected from clients and customers, and this is even more important when it comes to PHI. Sensitive patient data must be protected from unauthorized access from internal remote and onsite team members who don’t need this information.
Entities that handle health-based data also have to ensure this information is hidden from public access to prevent unwanted third parties from getting their hands on this information.
It’s a wise idea to create a separate platform for this sensitive data and to encrypt this information so that only a few users can access it. Additionally, each user should have their own logins and access codes to this platform to monitor individual user activity and track issues back to the source, should they happen to occur.
Backing up Sensitive Data
What happens if a ransomware virus locks you out of your network like this virus did several years ago? For some businesses and organizations, the effects can be critical, but none so much as in the healthcare sector where accessing patient data can sometimes be literally a matter of life and death. That’s why backing up your data is so crucial.
Your organization’s sensitive health-related data should be protected through a cloud-based backup system so that no matter what happens, vital data is still available whenever your team needs it–even in the event of data theft or a ransomware attack.
This keeps your data safe from corruption via malware, ensures you can keep going in the event of an attack, assures HIPAA compliance, and protects your organization’s reputation from damage.
If a cyber attack is successful, having a backup of all your data plus your organization’s network and all its devices is essential to getting back into operation and maintaining patient care. Routine backups are necessary to mitigate potential damage.
Attacks like ransomware don’t just prevent you from accessing your data. Often, ransomware attacks render many devices completely unusable. Onsite backups are extremely helpful, but off-site backups empower you to restore your data on any device; they’re an extra layer of protection to ensure you always have access to the data you need.
The best way to ward off a malware attack is to fortify your IT security strategies, but when there are hundreds of thousands of new attacks every day, you can’t say for certain that an attack won’t ever happen. That’s why an off-site, complete, daily backup is so essential. It’s the key to recovering all the files you need without paying a hefty ransom or waiting days to recover while you delay patient care. Backups should also include:
Any off-site devices including PCs and laptops
Third-party software data
Anything stored in cloud-based apps
Have a Recovery Plan
HIPAA IT compliance doesn’t just account for cybersecurity concerns. You need to be prepared for any kind of disaster that may affect PHI and health-related data. This is where having an IT Disaster Recovery Plan comes into play.
Like most businesses today, firms that handle sensitive health-related data are powered by a complex IT infrastructure that carries out all of that entity’s technology-supported operations. Any kind of disaster or outage can have devastating effects when it comes to treating patients and accessing their personal health records—without these records, there’s no real way to track medications, treatments, allergies, or anything else. In fact, there have been instances of ransomware attacks keeping healthcare systems from treating patients at all, because there was no way to access patient records to treat them safely.
This data can also be critical to advising a financial client on how to advocate for their future, helping a client within your law firm, or understanding a patient’s insurance claim. Often, busy professionals don’t have the luxury of time to wait for extensive recovery after a disaster to access data–and they need protections in place to ensure data redundancy in the event of a major disaster so this data can be restored and accessed.
Your disaster recovery plan is there to help you mitigate the damage after an incident that renders part (or all) of your network data inaccessible. This might be a cyber attack, but it could also include a natural disaster like a flood, fire, hurricane, tornado, or earthquake, or a total or partial failure or outage of your system.
It’s a lot like a fire escape plan and a fire drill: You make a plan detailing the best way to respond, and then you practice for an emergency. Similarly, a disaster recovery plan protects your organization and your patients.
Backups: Regular backups of all of your data–including at least 3 copies of data stored in different locations in the event of a local disaster.
Redundancy: Redundant systems like spare servers and duplicate data centers in case of a device, system, or component failure.
Recovery Testing: Much like a fire drill, your disaster recovery plan needs to be practiced to ensure that it works and that everyone knows what to do.
Off-site data backups protect this information from physical damage from a disaster as well as corruption or theft caused by ransomware or other attacks.
A business impact analysis that includes a detailed account of which operations are mission-critical for patient care, and which systems must be recovered first if there is a disaster or some other kind of operational interruption. This way, you can prioritize the systems, data, and assets you need to provide patient care after a disaster.
A plan for communicating with outside parties like third-party vendors, outside partners, government responders, IT support partners and data protection partners, and law enforcement officials.
An established line of communication for your internal teams so everyone knows how to identify, share, and contain a disaster, security breach, or cyber attack and limit interruptions.
Christo IT: Your Partner in Security for HIPAA-Qualifying Data
You may want to consider managed IT services to ensure continuous, dedicated monitoring of your system and support after an attack or a disaster. Your organization can work to encrypt patient data, enable firewalls, and manage access to systems and data, but this takes time and resources.
Having expert IT professionals on your side can ease daily operations and keep you on the ball when it comes to handling IT-related emergencies or other issues. When it comes to caring for patients or advising clients, there’s often no time to wait for a delay in operations–which is why having a dedicated IT team on your side is so important.
Outsourcing IT management for HIPAA-protected assets is a smart way to manage and secure patient data without draining resources or taking time away from your busy schedule. Christo IT utilized HIPAA-compliance solutions to organize and manage this sensitive data and keep remote access secure. Christo IT also provides support for legal teams and accounting firms.
Don’t leave HIPAA compliance or sensitive health data confidentiality to chance.
Christo IT is well-versed in meeting HIPAA regulations and working with busy, high-performing professionals to simplify security and make your IT solutions work for you.
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