Navigating HIPAA Compliance in the Cloud: 10 Tips for Healthcare Organizations

When it comes to storing and transmitting sensitive medical records on the cloud, there are certain regulations and compliances that must be met. For healthcare facilities and organizations, as well as their associates, this means choosing a cloud service provider (CSP) that’s compliant with the Health Insurance Portability and Accountability Act (HIPAA) as well as following several guidelines.

Continue reading to learn more about how to navigate HIPAA compliance in the cloud, including top challenges and 10 tips you can use to overcome them.

What Is HIPAA?

In 1996, the Health Insurance Portability and Accountability Act became federal law. It was enacted to give patients control over who could access their personal medical information. Since that time, HIPAA has been amended multiple times, with some of the most recent updates — Health Information Technology for Economic and Clinical Health (HITECH) and HIPAA Omnibus Rules — included in response to concerns surrounding electronic security and consumer privacy. 

HIPAA requires covered entities, or the businesses that handle Protected Health Information (PHI), to adhere to its guidelines. These include healthcare providers, healthcare clearinghouses, health plans, and business associates.

HIPAA Cloud Compliance Challenges

As an increasing number of healthcare facilities and related entities rely on the cloud for storage and transmission of PHI, it’s crucial to make sure that a chosen cloud storage provider is HIPAA compliant. However, this is only the first step. While a compliant provider delivers a framework that’s capable of meeting HIPAA standards, it’s up to the covered entity to ensure that those standards are met.

As a result, top challenges related to HIPAA cloud compliance include:

• Making sure that your business associate agreement (more on this later) is airtight 
• Ensuring that controls are configured to only give access to authorized parties 
• Putting the proper firewalls in place (i.e. ones that have logging enabled)
• Enabling integrity controls which allow the team to monitor for unauthorized access and changes to data
• Ensuring that the right level of encryption is maintained

10 HIPAA Cloud Computing Tips for Healthcare Organizations

Navigating HIPAA compliance in the cloud can be a complex task for healthcare organizations.  Here are 10 tips to help your organization overcome the challenges related to maintaining HIPAA compliance while using cloud services:

1. Understand HIPAA Regulations

Familiarize yourself with HIPAA’s provisions, especially the following two concepts:

• Privacy Rule: Establishes national standards to protect individuals’ medical records and personal health information. It gives patients control over their health information and gives them the ability to decide who can access this information and under what circumstances. The Privacy Rule requires healthcare providers to implement administrative, technical, and physical controls to protect patients’ PHI.

• Security Rule: Complements the Privacy Rule by establishing standards for securing electronic protected health information (ePHI). It requires healthcare providers to implement measures to ensure the confidentiality, integrity, and availability of ePHI. This includes: risk assessments, security safeguards, and security policies and procedures to prevent unauthorized access, use, or disclosure of PHI.

2. Choose a HIPAA-Compliant Cloud Provider

Select a cloud service provider (CSP) that offers HIPAA-compliant Infrastructure. Major cloud providers, such as Amazon Web Services (AWS), Microsoft Azure, and Google Cloud (GCP), offer specialized services designed to meet compliance requirements, including HIPAA.

However, even if a cloud service provider (CSP) certifies that their infrastructure is HIPAA compliant, that doesn’t mean that it solves the compliance issue for you. It is still up to the healthcare provider to deploy it correctly.

In short, the healthcare provider must take measures defined within the Privacy and Security Rules to protect patients’ PHI.

3. Execute a Business Associate Agreement

Before storing any PHI in the cloud, it’s crucial to establish a Business Associate Agreement (BAA) with your cloud provider. The BAA is quite literally a contract between the covered entity and, in this case, the cloud service provider. It defines the allowable uses and disclosure of PHI, as well as implements safeguards to prevent unauthorized access.

BAAs should be a non-negotiable requirement for all service providers who access or process PHI. This applies not only to cloud service providers but any service provider or data processor with access to a patient’s PHI.

Remember, the healthcare provider is ultimately responsible for protecting a patient’s health data.

4. Perform a Risk Assessment

Conducting a thorough risk assessment is the first step in identifying potential vulnerabilities and risks associated with your cloud environment. This assessment will help you implement the appropriate security measures to protect PHI.

The Security Rule does not mandate a specific risk assessment methodology (since methods will vary depending on the size, complexity, and capabilities of the organization), but the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) does provide guidance on risk analysis. 

Risk analysis is required to comply with the HIPAA Security Rule. It’s an ongoing process that will provide organizations with a thorough understanding of risks associated with the confidentiality, integrity, and availability of PHI.

5. Implement Strong Access Controls

The HIPAA Security Rule is clear that access to PHI must be based on the principle of least privilege. In other words, authorized users should only have access to the minimum information required to perform their specific job function. 

Entities must enforce strict access controls to ensure that only authorized personnel can access PHI. Use techniques like role-based access control (RBAC), and multi-factor authentication (MFA) to further enhance security.

6. Encrypt Data

Any data stored or shared via the cloud should be protected end-to-end with encryption. This is especially true in the case of PHI. Implement Transport Layer Security (TLS) for data in transit and encryption mechanisms provided by the cloud provider for data at rest. Encryption alone is not enough to ensure HIPAA compliance. In addition to encryption, healthcare providers must have processes and procedures in place for data classification, authentication, auditing, monitoring, and administrative controls.

The good news is that organizations do not have to go it alone. There are commercially available, HIPAA-compliant cloud storage solutions that can help you meet your HIPAA requirements. These solutions include:

• Acronis – Acronis provides several HIPAA compliant solutions that leverage AI-based, anti-malware to protect client data.

• Amazon Web Services (AWS) – AWS provides several storage solutions to satisfy your compliance needs and can provide guidance on managing and configuring HIPAA-compliant storage.

• Atlantic.Net – Atlantic.Net is SOC2/SOC3 certified, HIPAA/HITECH audited, and designed to protect PHI/ePHI data.

• Box – Box’s auditing and monitoring capabilities make it possible for healthcare providers to verify what data was accessed, when it was accessed, and by whom.

• Carbonite – Carbonite’s robust security controls make it an excellent solution for off-site backup.

• Dropbox – An established cloud storage provider — Dropbox’s business service is HITECH- and HIPAA-compliant.

• Google Drive – Provides full control over access permissions and audits to protect PHI.

• Microsoft OneDrive – Many organizations have standardized on the Microsoft productivity suite, and OneDrive integrates with Microsoft’s full suite of products.

Remember, no matter which cloud storage provider you choose, a BAA is required when using other parties to store or process a patient’s protected health information.

7. Regularly Update and Patch Systems

The HIPAA Security Rule doesn’t define a patch management process, but patching vulnerable software is an essential element of HIPAA compliance.

No software, operating system, or firmware is perfect. Software often contains defects that could potentially be exploited by malicious actors to gain access to systems and data, including PHI. Patches are developed to address defects and prevent bad actors from exploiting vulnerabilities. Therefore, it’s vital to keep your cloud infrastructure and software up to date with the latest security patches. 

8. Monitor and Audit Activities

Implement robust monitoring and auditing processes to track access to PHI and detect any unauthorized or suspicious activities. At a minimum, healthcare providers should regularly review logs and implement intrusion detection and intrusion prevention systems (IDS/IPS).  

Sample safeguards include:

• Firewalls: Industry best practice is to place all data centers and workstations behind a firewall. HIPAA rules take this a step further by requiring logging and auditing access to PHI data, which means that any firewall — whether on-premise or in the cloud — will need logging enabled.

• File Integrity: Controls must be in place to ensure that PHI has not been accessed, altered, or destroyed.  With the proper controls, healthcare providers can guarantee the integrity of patient healthcare data.

Unfortunately, data breaches are still possible; but in the event that one does happen, it should be detected by your logging and monitoring safeguards. However, your responsibilities don’t end there. 

Covered entities and their business associates are required to document and investigate incidents. All breaches must be reported to HHS/OCR. Therefore, it is imperative that service providers establish a process for notification of a breach.

9. Train Employees

Your employees can be both your weakest link and first line of defense. They present potential risks to your organization through possible mishandling of PHI (whether accidental or intentional), which may result in disclosure.

To reduce this risk, train your staff members on HIPAA compliance and cloud security best practices. Educate them on the proper handling of PHI and the potential security threats that exist as a result of poor practices. Training must be completed annually, and your employees’ progress should be tracked.

10. Have a Data Backup and Recovery Plan in Place

HIPAA requires that covered entities securely backup exact copies of electronic health information, and must be able to restore any lost or damaged data. The security rule further states that backups should be frequent, encrypted, and stored off-site. It’s not enough to backup your data, you must ensure it can be recovered.

It is incumbent upon the covered entity to create a comprehensive data backup and recovery plan to ensure the availability and integrity of PHI and regularly test backup and recovery procedures to ensure they work effectively.

Stay HIPAA-compliant with VividCloud

Maintaining HIPAA compliance is an ongoing effort that requires constant vigilance. You must review and update your security measures regularly in response to new threats. If you’re unsure about any aspect of HIPAA compliance in the cloud, consider consulting with security professionals who specialize in healthcare data protection.

VividCloud can help. Our Continuous HIPAA Assessment and Remediation with AWS Audit Manager offering can help identify and remediate many compliance issues and misconfigurations, helping to ensure your organization remains in compliance. To begin the conversation, contact our team today.