The Health Information Technology for Economic & Clinical Health (HITECH) act really does ‘up the ante’ for HIPAA enforcement.
In theory Health organizations have had to comply with the Health Insurance Portability and Accountability Act (HIPAA) since its introduction in 1996. Originally HIPAA was introduced by congress to protect the health insurance rights of employees made redundant. Additional ‘Titles’ to the act were introduced including ‘Title 2’ which was designed to protect electronically stored data relating to patient health information – often referred to as ‘Protected Health Information’ (PHI)
The problem with HIPAA has been the broad interpretation adopted by many healthcare providers and insurers. In fact, many providers require the waiver of HIPPA rights as a condition of service. This has undoubtedly resulted in a varying degree of adoption among providers leaving many unsure as to whether they are or are not considered compliant. But how could you blame them? The requirements aren’t specific and there has been little enforcement to speak of.
The HITECH act as part of the American Recovery and Reinvestment Act aims to change all that with increased penalties for non compliance.
A breach that exposes a patient’s confidential data could have serious and lasting consequences. Unlike credit cards for example, which can be cancelled and changed if they are exposed – health care records can’t just be changed or re-set. According to data from Forrester Research criminals are increasingly targeting health care organizations. For security teams within health organizations HITECH’s increased penalties may well assist in the justification of funding needed to sure up security and compliance projects that may otherwise have languished under the previously ambivalent and poorly defined HIPAA enforcement.
It is open to debate as to how the federal government will audit compliance with HIPAA’s security requirements from here on in, but it widens the number of enforcers by giving State Attorney General’s the ability to file federal civil action for harmful disclosures of protected health information (PHI).
There are already cases of lawsuits underway for alleged HIPAA violations due to exposed or breached PHI, likely to end with heavy financial compensation payments being ordered.
Some Good News…
Like all things in life there’s usually a process to follow and HIPAA and HITECH are no different. The main headings that will need to be addressed are:
Administrative Safeguards – specifically written evidence of measures adopted to ensure compliance. Internal auditing in particular change management processes, approvals and documentation to provide evidence that systems and process is properly governed.
Physical Safeguards – including access controls, restrict and control access to equipment containing PHI information. This will include the use of Firewalls, Intrusion Protection technology and with particular focus on workstation, mobile/remote worker security
Technical Safeguards – Configuration ‘hardening’, to ensure that known threats and vulnerabilities are eliminated from all systems, with a zealous patch management process combined with anti-virus technology, regularly tested and verified as secure. Strong Monitoring for security incidents and events, with all event logs being securely retained is also a key measure to safeguard IT system security.
In fact, the scope of the standard is quite similar in respect of its approach and its measures to the PCI DSS (The Payment Card Industry Data Security Standard), which is another security standard all healthcare providers will now be familiar with. The PCI DSS is concerned with the secure governance of Payment Card data, and any ‘card merchant’ i.e. an organization handling payment card transactions.
Therefore it makes sense to consider measures for HIPAA compliance in the context of PCI DSS also, since the same technology that helps deliver HIPAA compliance should be relevant for PCI DSS. Or to put it another way – compliance with one will significantly assist compliance with the other.
What do you need to do as an IT Service Provider to your Organization?
A number of automated ‘compliance auditing’ solutions are available that typically provide the following functions
Compliance Auditing (AKA Device Hardening) – typically, ‘out of the box’ as well as ‘made to order’ reports allow you quickly test critical security settings for servers & desktops, network devices and firewalls. The best solutions will provide details on your administrative procedures, technical data security services, and technical security mechanisms. Generally, these reports will probably identify some security gaps to begin with. Once repaired though, you can generate these reports again to prove to auditors that your servers are compliant. Using inbuilt change tracking you can ensure systems remain compliant.
Change Tracking – once your firewalls, servers, workstations, switches, routers etc are all in a compliant state you need to ensure they remain so. The only way to do this is to routinely verify the configuration settings have not changed because unplanned, undocumented changes will always be made while somebody has the admin rights to do so! We will alert when any unplanned changes are detected to the firewall, and any other network device within your ‘Compliant Infrastructure’
Planned Change Audit Trail – when changes do need to be made to a device then you need to ensure that changes are approved and documented – we make this easy and straightforward, reconciling all changes made with the RFC or Change Approval record
Device ‘Hardening’ must be enforced and audited. A good compliance auditing solution will provide automated templates for a hardened (secured & compliant) configuration for servers and desktops and network devices to show where work is needed to get compliant, and thereafter, will track all planned and unplanned changes that affect the hardened status of your infrastructure. The state of the art in compliance auditing software covers registry keys and values, file integrity, service and process whitelisting/blacklisting, user accounts, installed software, patches, access rights, password ageing and much more.
Event Log Management – All event logs from all devices must be analyzed, filtered, correlated and escalated appropriately. Event log messages must be stored in a secure, integrity-assured, repository for the required retention period for any governance policy.
Correlation of Security Information & Audit Logs – in addition you should implement Log Gathering from all devices with correlation capabilities for security event signature identification and powerful ‘mining’ and analysis capabilities. This provides a complete ‘compliance safety net’ to ensure, for example to name just a few, virus updates complete successfully, host intrusion protection is enabled at all times, firewall rules are not changed, user accounts, rights and permissions are not changed without permission.