The United States healthcare sector has experienced a steady rise in both volume and cost of data breaches in recent years. This is shown by the 61% increase in the number of HIPAA violations in 2020 over the previous year, with penalties totaling $13 million in the US healthcare sector. As of 2023, a single healthcare data breach incident cost US businesses an average of $9.3 million.

The Office for Civil Rights (OCR) has reported that the heathcare industry is struggling to meet HIPAA compliance clauses and violations are on the rise.

If you're a security manager endeavoring to make your organization HIPAA compliant, then this blog is for you. Get to know the most crucial HIPAA standards that your organization should comply with to secure electronic protected health information (ePHI), and estimate your HIPAA compliance score with our checklist.

A security manager's HIPAA checklist

Part 164, subpart C, of the Health Insurance Portability and Accountability Act, 1996 enumerates the security standards for the protection of ePHI. These standards are applicable to all covered entities and business associates as defined by HIPAA. The administrative safeguards to be practiced by healthcare organizations include:

1. Establishing a security management process

Do you remember the CIA triad? The model is the foundation for information security. It requires your team of security analysts to ensure the confidentiality, integrity and availability of information. Based on the CIA triad, this HIPAA standard requires you to implement policies to monitor, detect, prevent, and mitigate information security breaches by effective risk management. HIPAA puts forth the following checklist while establishing your security management process.

  • Risk assessment: Assessing potential risks and vulnerabilities in the network.
  • Risk management: Reducing the potential risk exposure of the network.
  • Sanction policy: Assessing the risk level of the workforce handling ePHI.
  • Information system activity review: Reviewing security information, including audit logs, access reports, and incident reports.

2. Ensuring workforce integrity

The most dangerous threats while managing ePHI are those that come from insiders. In order to ensure the integrity of information against insider threats, this HIPAA standard requires that you implement specific controls over user access, permissions, and privileges of the workforce members who manage ePHI. HIPAA directs you to ensure the following checklist while implementing policies to monitor the workforce.

  • Authorization and supervision: Implementing an authentication mechanism to authorize workforce members. This is part of the privileged account management strategy of the company.
  • Workforce clearance: Determining the risk levels of the workforce members before assigning access privileges to ePHI data.
  • Termination procedure: Establishing measures to deny access or terminate processes that are carried out by unauthorized members of the workforce.

3. Access management

As the name suggests, HIPAA requires you to set up policies and procedures to authorize and authenticate access to all network resources that deal with ePHI. HIPAA requires you to check the following list during access management.

  • Access authorization: Implementing procedures to authorize access to ePHI via a workstation, application, or process. This is a part of the privileged identity management mechanism of the company.
  • Access establishment and modification: Establishing a set of procedures to review and modify access privileges based on requirements.

4. Managing security incidents

Any event that indicates an impending threat is considered a security incident. HIPAA requires you to monitor, record, and analyze such security incidents in the beginning stages to detect and prevent potential breaches. For this, you have to adhere to the below standard.

  • Response and reporting: Implementing a definite process to record all security incidents and automating responses while identifying potential threats.

HIPAA score estimation

Are you ready to assess your organization's HIPAA compliance readiness? Use the checklist below to find out your score.

Internal Image HIPAA compliance using SIEM

Please answer all the questions to view your score
HIPAA requirements Yes No
As an IT admin, do you have complete visibility into your network?
Do you possess a security solution to help you monitor all of your network activity, including those on-premises and in the cloud?
Are your health information technicians able to manage your security information and audit logs efficiently?
Do your IT analysts receive instant alerts on potential data breaches?
Can your analysts track the activities of your employees and assign risk scores accordingly?
Is there 2FA or MFA to authenticate your health information technicians and analysts to access ePHI?
Can you manage user permissions and privileges with respect to ePHI easily?
Does your team have a predefined incident response plan?
Is your incident response plan automated?

 

(Disclaimer: The scores are estimated based on the information provided and should not be considered a definitive measure of your organization's compliance with HIPAA.)

ManageEngine Log360, a unified SIEM solution, can help in your journey towards HIPAA compliance with:

  • Out-of-the-box reports for HIPAA compliance.
  • Real-time alerts to detect data security breaches.
  • Real-time security analytics to estimate the risk exposure on your network.
  • Advanced threat detection with threat intelligence.
  • Automated workflows for effective and efficient incident response.
  • User risk monitoring to assign risk scores based on anomalous user and entity behavior.

HIPAA Overview dashboard in Log360 Figure 1: HIPAA Overview dashboard in Log360.

Log360: Going beyond HIPAA compliance

In 2015, a major healthcare organization in the US fell victim to a massive data breach affecting 78.8 million patient records. A phishing email was the point of initial access for the attackers. The attackers then moved laterally to escalate privileges and access patient databases. The damage was devastating, and the organization had to pay a sum triple its cybersecurity budget.

In addition to achieving HIPAA compliance, proactive security is now the need of the hour in the healthcare industry. Log360 can help you surpass your quest for HIPAA compliance and become proactive against cyberattacks.

Here is a glimpse of how Log360 can help you:

  • Log360's predefined MITRE ATT&CK® reports can track each and every movement of adversaries, from initial access to impact.
  • You can use the MITRE ATT&CK reports to create custom correlation rules for well-known attack scenarios following a definite pattern.
  • You can also create an alert profile for correlation rules and configure a workflow to automate incident response.
  • On encountering a familiar attack scenario, the incident response workflow will automatically execute to kill the process.

As today's threat landscape evolves, embattling cyberattacks is easier said than done. So get it done with help from Log360. Sign up for a personalized demo today.

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