HIPAA vs. PCI DSS for Healthcare Organizations

Why Is HIPAA Important for Healthcare Organizations?

HIPAA facilitated the secure transition of the healthcare industry from paper to electronic records of health information. Healthcare institutions use HIPAA to streamline healthcare administration functions, ensure protected healthcare information is securely shared, and improve security and compliance.

HIPAA provides standards for maintaining healthcare and electronic transaction records, ensuring all parties apply the same practices. All entities covered by HIPAA must use nationally-recognized identifiers and code sets. As a result, it standardizes the transfer of electronic health data between various entities, including healthcare and health plan providers.

HIPAA not only helps transform the practices of healthcare institutions. It also helps secure patients’ data. It requires health plan providers, healthcare providers, medical clearinghouses, and all business associates of entities subject to HIPAA to implement several safeguards that protect health and other personal information. These practices are regulated, and violating entities face repercussions.

HIPAA regulations require organizations in the healthcare industry to control access to sensitive health data and restrict actions like viewing and sharing health information with specific parties. It helps ensure the information disclosed to health plan and healthcare providers and the information created, stored, or transmitted by these entities is subject to stringent security regulations. It also gives patients control over with whom the entity can share their information.

Why Is PCI DSS Compliance Important in Healthcare?

The Payment Card Industry Data Security Standard (PCI DSS) helps secure credit and payment card data. While the healthcare industry has been hard at work implementing HIPAA standards, it is lagging when it comes to PCI DSS.

PCI DSS compliance is mandated by the Payment Card Industry Security Council, formed by major credit card brands, such as Visa and American Express. PCI DSS compliance applies to all healthcare providers that accept payment cards, including small office practitioners and large third-party administrators of medical claims.

HIPAA compliance relates to a different set of confidential data—it does not secure credit card information. Achieving compliance with one does not mean you are covered by both. You must achieve compliance separately with each regulation.

HIPAA vs. PCI Compliance in Healthcare: Differences and Similarities

Both HIPAA and PCI DSS are essential for the industry. However, each standard has a different focus. The key differences between these two compliance standards are:

• Covered entities—HIPAA applies to healthcare organizations or practitioners and their business partners in the US only. PCI DSS applies to all businesses that process credit card transactions worldwide.
• Structure—HIPAA has a broader structure that provides fewer details on how to implement security measures. PCI DSS provides detailed implementation instructions, which make it clearer how to comply, but can also present a larger organizational effort.
• Focus—HIPAA focuses on a wide range of issues affecting an entire organization, such as patient safety, eliminating fraud, protecting privacy, and reducing waste and abuse. PCI DSS has a more narrow focus on the protection of cardholder data and related systems.
• Meaningful Use program—HIPAA’s Omnibus Rule relates to requirements set by the Medicare and Medicaid EHR Incentive Programs (known as Meaningful Use). These are programs that give health providers incentive payments for integrating EHR. HIPAA compliance may be required to be eligible for the Meaningful Use incentives. PCI DSS compliance is not required as part of Meaningful Use.

There are also several similarities between HIPAA and PCI DSS for healthcare organizations:

• Controls—many of the controls required by HIPAA and PCI DSS overlap.
• Infrastructure—many infrastructure components recommended by HIPAA, such as Active Directory, antivirus, and log monitoring, are also needed in PCI DSS.
• Maintenance—both HIPAA and PCI DSS requires periodic vulnerability scanning and remediation, risk analysis, incident response, self-auditing according to security protocols, and overall maintenance of security controls.

Bottom Line: What Healthcare Organizations Need to Do to Comply with HIPAA, PCI DSS, or Both

In short, here are the key requirements for each compliance standard:

HIPAA compliance requires conducting regular security risk analyses and employee training and implementing technical safeguards that prevent unauthorized access to PHI. Additionally, HIPAA requires organizations to create an incident response plan, enter into business associate agreements (BAAs) with third-party vendors, and conduct third-party risk assessments.

PCI compliance requires recording and tracking all card data across the organization’s network. It often involves implementing zero trust to mitigate data breach risks. Zero trust incorporates many PCI DSS standards, including access management, encryption, segmentation, and isolation. However, zero trust extends to all sensitive information instead of covering only payment card data.

While each compliance standard presents unique challenges, there is also significant overlap between them. If your organization is required to comply with both PCI and HIPAA, it is possible to create one organizational framework that can address both standards. This can save a great deal of time and effort. HIPAA/PCI framework mappings are available which can help you plan the effort and understand how to prepare for both standards with a single initiative.