May 17, 2020

5 tips to prepare for Phase 2 HIPAA audits

Asaf Cidon
Patient Care
6 min
Phase 2 HIPAA audits should be taken as a sign that the OCR is beginning to crack down harder on compliance.
This summer, healthcare providers all over the United States began agonizing about HIPAA compliance, as the Office for Civil Rights (OCR) sent out preli...

This summer, healthcare providers all over the United States began agonizing about HIPAA compliance, as the Office for Civil Rights (OCR) sent out preliminary surveys to begin its long-awaited Phase 2 HIPAA audits. After months of delays, the audits could begin as early as this fall. If you’re daunted about getting your company’s policies in order, you’re not alone. This phase gets into the nitty-gritty of security practices—including PHI access, privacy practices, encryption, and data breach notification—which is complicated territory.

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In 2014 alone, the Department of Health and Human Services was notified of 282 data breaches affecting 500 or more individuals, which compromised the data of more than 12 million people. According to the Ponemon Institute, 90 percent of healthcare organizations have experienced a data breach, and 40 percent have had five or more in the last two years. These numbers really speak for themselves: Data breaches in the healthcare industry are a major problem, so it’s high time that the OCR is auditing organizations to assess—and remediate—risks. Notably, both covered entities and their business associates will be audited this time around, an acknowledgment that it isn’t only healthcare organizations that need to be careful.

The audits are no doubt a daunting process. But the wakeup call audit preparation can bring shouldn’t be limited to only the organizations that get tapped by OCR. After all, HIPAA compliance is a complicated undertaking with many moving parts.

RELATED TOPIC: 7 HIPAA security risk myths debunked

We’ve put together some tips for healthcare organizations to prepare for this second round of OCR audits—and implement some best practices for securing PHI. Even if you don’t end up being audited, heeding these tips puts your organization on the right road to HIPAA compliance.

1. Encrypt sensitive data. Encryption is key to preventing data breaches, and while it’s not the only thing that contributes to compliance, it’s perhaps the most important place to start. To prepare for the HIPAA audits, make sure you know exactly which of your organization’s files are being encrypted and how—and which are not. Tools like data-loss prevention scanners can help give a portrait of this in your organization.

But from there, it’s essential to take strides to encrypt everything that’s sensitive. When it comes to complying with HIPAA, file-level encryption is paramount: Encrypting the content itself—rather than just its storage place—ensures that the encryption is maintained wherever the files are synced, shared, and emailed or if the cloud provider falls victim to a data breach. ePHI demands the highest levels of protection, and getting into the practice of securing data at the file level will make complying with HIPAA—and passing the audits—that much easier.

RELATED TOPIC: How to defend your hospital against IT security breaches

2. Review and update all security and privacy practices. You know by now that HIPAA is about more than the day-to-day operations and handling of PHI. Often, HIPAA is oriented around policies. With that in mind, know that the HIPAA auditors will be taking a close look at security and privacy practices, so it’s a good time to become familiar with your company’s. Pay particular attention to BYOD policies and integrity control. As more and more healthcare providers use mobile devices to store and share patient records and other sensitive data, it’s critical to have up-to-date policies governing device use. Keep in mind that even if the cloud isn’t officially sanctioned at your workplace, employees are likely using it anyway, and likely in an unsafe manner, especially on their phones.

More than 1.4 million smartphones were stolen just last year. Add to that stolen laptops, tablets, and flash drives, and lost devices of any kind, and you can see that there’s a lot of unsecured data ripe for the picking out there. In fact, misplaced mobile devices and other inadvertent employee negligence is often cited as the number-one cause of data breaches.  A smart policy will not only endorse the cloud, but also provide appropriate additional levels of encryption that protect files in transit and on mobile devices. By the same token, HIPAA mandates that ePHI security is never compromised, and maintaining audit trails for sensitive files—and knowing who is accessing files when—is an excellent practice for integrity control and privacy assurance.

RELATED TOPIC: Why the cloud is the safest place to store medical records

3. Don’t just know your policies—know how you’ll respond to a data breach. Data breaches happen all the time, to companies big and small. Having strong security measures in place is a must, but it doesn’t mean you can assume your files will never be breached. Rather, savvy companies will expect a breach—and know exactly what they should do if one happens. Make sure you have a comprehensive procedure in place for data breach notification that reflects HHS’ Breach Notification Requirements. There are also certain steps a company can take to stop a breach in practice, including remotely blocking a device or activating an automatic logoff.

4. Understand how your PHI gets shared. We saw from the Target breach of 20TK that the retail giant came down in part because of a business associate’s practices. That’s a good thing to bear in mind here: The organizations with which you share information can often be your weakest link. Phase 2 of the HIPAA audits expects compliance from business associates as well as covered entities. That means any lawyers, accountants, translators, documentation storage companies, transcription services, or others who work with you and disclose PHI in any capacity must comply with HIPAA, too. That falls on them to execute, but it also means you’re in it together to ensure compliance for the data you both touch.

RELATED TOPIC: How Premera Blue's breach reveals weaknesses in healthcare security

5. Have a third-party auditor check your HIPAA compliance. We already know it’s essential to have an audit trail to help sniff out odd behaviors and get routine updates on how your data is being accessed in order to detect any worrying patterns. Better still might be to contract a third party to do a preliminary audit and fix any issues that might arise from their examination. HIPAA compliance isn’t a one-time event; it’s a process. So it’s wise to do a regular check-in to make sure all systems are up to date and all policies are HIPAA compliant, especially as technology habits are constantly changing.

The Phase 2 HIPAA audits should be taken as a sign that the OCR is beginning to crack down harder on compliance, in particular when it comes to electronic records. Despite the fear the audits have struck in healthcare providers scrambling to make sure everything’s in shape, they’re ultimately a good thing. Preparing for the audits—whether you end up being audited or not—will ensure maximum security for your PHI, allowing you and your staff to focus on what really matters: providing excellent care.

Asaf Cidon is CEO and co-founder of Sookasa, a cloud security and encryption company that enables safe adoption of popular cloud services such as Dropbox and Google Drive to store sensitive information. 

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Jun 13, 2021

How healthcare can safeguard itself against cyberthreats

Jonathan Miles
6 min
Jonathan Miles, Head of Strategic Intelligence and Security Research at Mimecast, tells us how the healthcare sector can protect itself from attacks

One of the most fundamental lessons from the COVID crisis is that health should always be a priority.  In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.

The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics. 

From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world. 

Going digital 

The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years. 

This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate. 

Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.

To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care. 

Strengthening defences

Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change. 

It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device. 

These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.

Despite this, there are fundamentals that any organisation should implement: 
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.

In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.

Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents. 

Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.

This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents. 
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.

Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.

As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.  

Fighting future threats

With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.

To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced. 

This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.

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