What should you look for in a good healthcare host? Healthcare hosting providers must comply with HIPAA, the Health Insurance Portability and Accountability Act of 1996, which means they must protect and secure patient records. When you look at healthcare hosting providers, you want to know how HIPAA audit-ready the healthcare host is. The first step is reviewing components of compliance with this handy 16-piece HIPAA Hosting Checklist (which covers the basics but is obviously not substantive enough for a comprehensive evaluation):
Healthcare Hosting Checklist
Full data security, management, and training strategies, on file
“A system of developing unique user IDs and passwords and procedures for login, logout, decryption and emergencies” (Blankenspoor)
Policies developed to control access to physical buildings and electronic systems containing PHI (protected health information)
Guidelines for how data is stored, transferred, trashed, and reimplemented
Audits and logs of system use (SSAE 18 and SOC audited infrastructure)
Rules for data transmission in all possible scenarios (email, cloud, etc.)
Quality control for all data (destroyed, changed, backed-up, etc.)
Dynamic data availability
A distinction between web, database, and production servers
Antivirus and Multifactor Authentication
Management of OS (operating system) patching
Private IP (internet protocol) addresses and private hosted environment
SSL certificate encryption of all PHI
Disaster recovery and backup plans (Offsite backup)
First-class Healthcare HIPAA hosting vs. economy-class hosting: what’s the difference?
A hard fact of the Internet is that you need machines to be part of it – either on your own or as a service. If you are in the healthcare field and don’t want to set up servers for your website or other services in your own datacenter, you need HIPAA hosting.
All hosting is not created equal. Because there is a disparity between security and other checks and balances from one system to another, standards were created to guide oversight of infrastructure and maintain proper protection of patient data. Those standards were developed by the US Health and Human Services Department (HHS), as directed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Hence, beyond simple web hosting, anyone who is aiming to secure healthcare records in a healthcare hosting environment needs HIPAA compliant hosting, sometimes called simply HIPAA hosting.
“HIPAA recognizes all health care providers and their business associates as covered entities (CEs) and makes them responsible to safeguard the privacy and security of identifying information.” “Some CEs, particularly smaller sized CEs, don’t have the resources necessary to implement a system to handle and safeguard health data on their own, so they rely upon the services of HIPAA hosting.”
Any hosting provider can offer a service that is HIPAA compliant as determined by its own understanding of the healthcare law; in other words, there is no official federal certification process for these business associates. The vetting of the quality of HIPAA infrastructure that backs any hosted services must be determined by the healthcare covered entities that use their services.
The government also doesn’t recognize any third-party certification bodies. That allows free competition in developing credibility and proving it through legitimate independent parties. However, it also means it’s your responsibility to know the quality of the certification body and what exactly is included in their auditing process.
HIPAA final rule reshuffles the deck for healthcare hosting
Given the surrounding a lack of standards for what qualifies as “HIPAA compliant hosting,” there is a positive for covered entities: Business associates (BAs) are now responsible for data in the same manner as covered entities (healthcare providers, plans, and data clearinghouses) are – after implementation of the Omnibus HIPAA Final Rule (often called just the Final Rule or Omnibus Rule; activated March 26, 2013).
Following passage of the rule, business associates “are liable for PHI uses and disclosures and HIPAA Security Rule compliance.” “Additionally, BAs with their subcontractors, while BAs – not covered entities – are also now responsible for responding to any noncompliant subcontractors.”
Health and Human Services additionally created a process through which randomly chosen covered entities would be audited for adherence to the all-important Security, Privacy, and Breach Notification Rules.
HIPAA & HITECH
HITECH (the Health Information Technology for Economic and Clinical Health Act of 2009) was an effort to keep the transition to digital health data as safe as possible. While HITECH describes how electronic health records can be shared, HIPAA assigns responsibility for data security to any organization or individual that accesses and uses electronic protected health information (ePHI).
Specific security methods are at your discretion, though, to an extent. “[T]he HHS allows entities to implement their own chosen methods,” said Blankenspoor. “However, there are best practices used in the industry that the HHS would expect entities to make use of, or show that they are able to implement a comparable or better system.”
What are examples of covered entities & business associates?
The term covered entity specifically includes all healthcare providers, plans, and data clearinghouses operating in the United States. Like their business associates – contracted through a business associate agreement, per HIPAA – covered entities have to independently meet all compliance rules.
Essentially, the covered entities are healthcare companies and agencies that are more directly healthcare-related. What are business associates? HIPAA hosting providers are one example. Others include medical billing services and shredding companies.
Jail possible for HIPAA violations in healthcare hosting
Like anything in business, a company might look at HIPAA and decide they are not going to invest in meeting its guidelines. Within the law, that refusal to comply is called willful neglect. Fines for this violation are $10,000-$50,000. The total a single company can be fined per year is $1.5 million. It’s also possible to be sentenced to jail time for willful neglect of HIPAA that results in sensitive data being exposed.
Neglect isn’t always considered willful. It is sometimes categorized as reasonable cause. In these situations, 500 or more individual pieces of medical data have become exposed – resulting in $100-$50,000 fines for each violation. Note that these types of violations are never accompanied by jail time.
Top 10 HIPAA Fines by Settlement
Sources: http://www.beckershospitalreview.com/healthcare-information-technology/10-largest-hipaa-settlement-fines.html and https://www.beckershospitalreview.com/cybersecurity/9-hipaa-settlement-fines-in-2017.html
Note that 7 of the 10 largest HIPAA fines occurred in 2016 or 2017.
The HHS audit program
The random audits began with a pilot program that included 113 companies and other organizations. This pilot process allowed Health and Human Services to better understand best practices both for compliance and for non-compliance (i.e. how they should respond to violations).
“[Atlantic.Net’s] financial strength and proven track record are something we view with great confidence.”
What is the HIPAA Security Rule?
In a nutshell, the Privacy Rule safeguards electronic health records. The Security Rule, however, is the especially pertinent one to HIPAA hosting because it sets more specific expectations for health data storage and transmission – i.e., the realm of ePHI (electronic Protected Health Information).
The HIPAA Security Rule is sectioned into Administrative Safeguards, Physical Safeguards, and Technological Safeguards. It has gradually become more prominent because of adaptations in the digital world and expansion of different, newer technological methods.
“The same standards for the privacy and confidentiality of healthcare data apply to PHI and ePHI,” advised Blankenspoor, “but the processes used to keep data private are much more complex and technical for electronic data files and ePHI than they are for paper files.”
“The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.1 To fulfill this requirement, HHS published what are commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. The Privacy Rule, or Standards for Privacy of Individually Identifiable Health Information, establishes national standards for the protection of certain health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.”[iii]
How Can You Get Healthcare Hosting That’s HIPAA-Compliant Right Now?
Are you evaluating HIPAA compliant cloud hosting and storage providers for your business, but not sure where to start? Atlantic.Net is HIPAA-Audited, HITECH-Audited, and backed by SSAE 16 SOC 1 Type II and SOC 2 Type I reports. We can assist from design to deployment, so that you can continue to focus on your core business. Contact us today for a free consultation.