Over the years, the healthcare industry has increasingly moved from the traditional pen and paper system to the more digital world of telehealth, healthcare analytics, and cloud computing. And while this transformation has shaped care delivery and even boosted patient satisfaction, it’s not without its shortcomings. One major challenge is the risk of data loss, especially with electronic protected health information (ePHI).
Securing sensitive patient information such as names, medical records, social security numbers, and financial information is an ongoing challenge for most healthcare providers that have gone digital. Luckily, a couple of industry standards and regulations can guide these organizations to avoid potential data breaches.
One such standard is the HIPAA regulations that govern how protected health information (PHI) should be collected, used, stored, retrieved, or transmitted. This rule applies to both the traditional medical records and electronic data stored in computers or the cloud. Below is a quick guide on HIPAA compliance, HIPAA risk assessment, and their respective benefits.
What Is HIPAA Compliance?
HIPAA stands for the Health Insurance Portability and Accountability Act, a set of rules enacted in 1996 by Congress to prevent medical fraud. HIPAA regulations are divided into four rules that are necessary to ensure compliance. These are the HIPAA Security Rule, HIPAA Privacy Rule, the Omnibus Rule, and the Breach Notification Rule.
The U.S Department of Health and Human Services (HHS) manages and enforces the HIPAA rules through the Office for Civil Rights (OCR). To ensure compliance with the HIPAA rules, HHS’s Office for Civil Rights investigates filed complaints and conducts compliance reviews to determine whether covered entities and their business partners are HIPAA compliant. The body also educates all the respective entities on how to maintain HIPAA compliance.
Under the HIPAA rules, covered entities are any organizations, individuals, and agencies that fall under either of the three categories below:
- Healthcare providers – these are medical practitioners such as doctors, dentists, clinicians, and psychologists.
- Health plans – these are health insurance companies and health plan providers, including government health plans such as Medicare.
- Healthcare clearinghouses – these are third-party firms that process nonstandard health data received from a healthcare entity.
If the PHI of any of the entities identified above is compromised due to a data breach, that particular entity may be subject to HIPAA violations. Common data breach events such as ransomware, phishing attack, malware attack, and even physical break-ins may cost these organizations some significant financial penalties and loss of trust from patients and business partners.
HIPAA Risk Assessment
One of the fundamental steps to ensuring HIPAA compliance is to carry out a HIPAA risk assessment. HIPAA risk assessment is a rigorous compliance evaluation that seeks to identify the most appropriate and effective physical, technical and administrative safeguards to protect ePHI.
Considering the complexity of the cybersecurity world and the varying needs of the different covered entities, there’s no one way to accurately carry out a HIPAA risk assessment. Even so, the HHS provides an objective overview of what a HIPAA risk assessment should entail.
The goal is to map all the potential security risks and vulnerabilities to the availability, confidentiality, and integrity of all ePHI that an entity collects, maintains, creates, or transmits. To ensure a thorough HIPAA risk assessment, the HHS recommends covered entities to:
- Map how PHI is collected, stored, received, retrieved, maintained, and transmitted.
- Identify, then document all the possible threats and vulnerabilities.
- Evaluate current security measures that safeguard PHI.
- Evaluate the integrity of the existing security measures.
- Analyze the security landscape and determine the chances of a reasonably anticipated threat.
- Determine the likely consequences of a potential data breach.
- Map the potential vulnerabilities and assign risk levels to each.
- Document the entire HIPAA risk assessment and take the necessary action.
And while this risk-assessment exercise follows a definite pattern, covered entities should not limit their evaluations to the scope of the documented framework. A rule of thumb is to dig deeper and uncover as many threats and vulnerabilities in a way that’s relatable to the nature and size of your business or organization.
That said, HIPAA risk assessment isn’t a one-time event. The exercise needs to be reviewed regularly as new guidelines, resources, and technologies come to market. And while HHS doesn’t provide guidance on how many times to review the assessments, annual reviews could be an excellent place to start. However, this also depends on the nature of the organization, the sensitivity of the PHI, and the probability and impact of data breaches.
Tips To Developing A Sound HIPAA Risk Management Plan
After conducting a HIPAA risk assessment, what follows is to develop and implement a risk management plan. Based on the vulnerabilities and threats you found, the risk management plan should implement new procedures and policies that are relevant to your organization.
Things to guide your risk mitigation strategy include the risk levels of each vulnerability and the current security measures in place. For optimum results, the remediation plan should feature new and better procedures and policies. You can also accompany this with workforce awareness programs and training for the best results.
Besides keeping up to date with the risk assessment policies, you also want to invest in the best risk management and remediation tools and technologies. Working with an expert such as a healthcare risk professional or partnering with a risk management company will make the whole process easy and convenient. Not only will you minimize errors, but you’ll also save time and benefit from expert insights.
Benefits Of HIPAA Risk Assessments
HIPAA risk assessment is mandatory under the HIPAA regulations, but this exercise still comes with several benefits for all the covered entities. Some of the obvious benefits include protecting your organization from data breaches and fines.
Even then, ensuring compliance with HIPAA regulations gives you some peace of mind. It also lays a foundation for robust data privacy and cybersecurity measures that will benefit your organization in the long run.
Last but not least is that ensuring HIPAA compliance saves your business from reputational damage. Today’s business landscape is so informed and fragile. Any news of a data breach could cost your most reliable clients, which could translate to poor business performance.
If you are a health care plan or provider, any incident that exposes the patients’ PHI is a huge problem that will see your patients not only file class-action lawsuits but also move on to your competitor.
Managing HIPAA Compliance
Whether you are a healthcare provider, Health Insurance Company, or a third-party business partner working with a covered entity, maintaining HIPAA compliance is necessary. Achieving HIPAA compliance requires that you understand the hundred-plus pages of detailed regulations, sort through the relevant rules, and implement them.
For many businesses in the healthcare space, this is tedious work that’s prone to errors, and the last thing they want is to fail compliance audits and attract hefty fines. To avoid this mess, many have been turning to HIPAA compliance management software to handle reporting, audit management, policy training, and risk assessment.
Even then, not all automated software works in similar ways. Some are more advanced and perform self-audits, identify compliance gaps, and keep track of compliance history. A rule of thumb is to choose a highly effective HIPAA compliance software solution that will save you time without compromising accuracy, transparency, and trust amongst your clients and patients.