How to Achieve HIPAA Compliance?

Hari Mahesh

“Healthcare is becoming part of information technology.” – Bill Maris

One area where we can see a vast advancement in technology is hospital management. A few years back, most of the management operations, including handling the patient data, were done through the paper medium. But if you look closely now, it’s digitized everywhere. You just need to mention your name or mobile number, and your health history will be populated.

Even the old paper medium has migrated to digital formats, and software applications are everywhere. At the same time, patients register, and doctor’s examination data or lab results are updated in the software.

Not only that, all these data are also synced to the cloud. So, you go to any other branch of that particular hospital, and they can pull all your data from the cloud. Everything is handled by third-party vendor software, and the data is stored in the cloud. However, with this technological advancement comes the need for data security. So, to protect patients’ data, HIPAA (Health Insurance Portability and Accountability Act) was introduced.

HIPAA ensures that patient data remains secure and that Protected Health Information (PHI) is not shared with anyone else without the patient’s consent.

So, let’s discuss HIPAA more, its importance, and how to ensure its compliance through testing.

What is HIPAA Compliance?

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law created in 1996 to safeguard patients’ privacy. This law protects the patient’s health information by ensuring it is not shared with others without the patient’s consent. This rule applies to all healthcare providers, health plans, and clearinghouses. Department of Health and Human Services (HHS) regulates HIPAA compliance, which the Office for Civil Rights (OCR) enforces.

HIPAA compliance is essential for healthcare organizations to maintain. It protects sensitive patient information’s privacy, security, and integrity and is also crucial for avoiding legal and financial penalties.

What is Protected Health Information?

PHI stands for Protected Health Information. It’s any identifiable information about a person’s health created, used, or shared by a healthcare provider or business associate. This includes information in electronic format (e.g., electronic health records), paper records (e.g., medical charts), and even spoken communication. PHI covers many details, including medical history, treatment plans, lab results, billing information, and anything related to a patient’s physical or mental health.

Why is HIPAA Compliance important?

HIPAA compliance is crucial for several reasons that impact patients, healthcare providers, and the overall healthcare industry. Let’s understand why FIPAA compliance is important:

For Patients

• Privacy and Trust: Compliance with HIPAA protects the patient’s personal health information, which promotes trust between them and their healthcare providers. Making patients comfortable enough to share data about their personal lives can lead to a better diagnosis and treatment plan.
• Control Over Information: HIPAA also gives people the right to access, amend, and demand an accounting of their protected health information. This authorization grant ensures the patient has control over the health information and can decide on the best course of action based on the information at their disposal.
• Reduced Risk of Identity Theft and Discrimination: Breaches of unsecured PHI can lead to identity theft and discrimination based on health conditions. HIPAA compliance minimizes these risks by mandating strong data security measures.

For Healthcare Providers

• Reduced Risk of Financial Penalties: Non-compliance with HIPAA regulations can result in significant fines. Compliance helps healthcare providers avoid these hefty financial burdens.
• Enhanced Reputation: Demonstrating HIPAA compliance shows a commitment to patient privacy and data security, leading to a positive reputation within the healthcare community and thereby attracting patients who value their privacy.
• Improved Efficiency and Streamlined Processes: HIPAA compliance often involves implementing standardized data formats and secure communication channels. This can improve data exchange efficiency and streamline workflows for healthcare providers.

For the Healthcare Industry

• Standardized Data Practices: HIPAA establishes a national standard for handling PHI, ensuring consistent and secure data practices across the healthcare industry. This facilitates smoother data exchange between providers and organizations involved in patient care.
• Reduced Risk of Large-Scale Breaches: Widespread adoption of HIPAA compliance strengthens the overall security of the healthcare industry. This reduces the risk of large-scale data breaches affecting millions of patients.
• Increased Patient Confidence: Stronger data security and patient privacy protections encouraged by HIPAA compliance increase public trust in the healthcare system. This enables patients to seek timely and necessary medical care.

Who needs to be HIPAA Compliant?

The Health Insurance Portability and Accountability Act (HIPAA) applies to specific entities in the healthcare industry that handle patient information. These entities are known as “covered entities,” and they must comply with the HIPAA Privacy Rule to safeguard patient privacy.

Covered Entities

• Healthcare Providers: This includes any healthcare professional, regardless of practice size, who transmits patient health information electronically for specific transactions. These transactions typically involve claims processing, eligibility verification, referral requests, and others defined by the HIPAA Transactions Rule.
• Health Plans: This broad category encompasses various health insurance providers, including health, dental, vision, and prescription drug plans. It also includes HMOs, Medicare/Medicaid programs, long-term care insurers (excluding specific fixed-indemnity policies), employer-sponsored group plans, and government/church-sponsored health plans. However, small employer-sponsored group plans with fewer than 50 participants solely administered by the employer are exempt.
• Healthcare Clearinghouses: These entities specialize in transforming non-standard health information received from other entities into a standardized format (data or content). They typically handle individually identifiable health information only when providing services to covered entities (health plans or providers) as business associates.

Business Associates

The HIPAA regulations extend beyond covered entities to include “business associates.” These are individuals or organizations (except covered entity employees) that access or disclose patient information while performing services for a covered entity. Examples include companies in claims processing, data analysis, utilization review, or billing activities for a healthcare provider or health plan.

This revised version simplifies the text while maintaining critical information:

• Clear title highlighting the topic.
• Bullet points for easier understanding of covered entity categories.
• Defined “business associates” and their role in nonentities.

Roadmap to HIPAA Compliance

There isn’t a formal “HIPAA certification” process. However, HIPAA compliance is essential for covered entities (healthcare providers, health plans, and clearinghouses) and their business associates. Here’s a seven-step road map, so let’s get started.

Step 1: Understand the Rules

HIPAA compliance requires covered entities and, in some cases, their business associates to follow a set of regulations established by the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy and security of a patient’s protected health information (PHI). Here’s a breakdown of the essential requirements:

Privacy Rule

• Patient Rights: This grants patients specific rights regarding their PHI, including:
  • Access: Patients can request to see and obtain a copy of their medical records.
  • Amendment: Patients have the right to request corrections to any inaccuracies in their PHI.
  • Accounting of Disclosures: Patients can request a report detailing who their PHI has been disclosed to.
• Permitted Uses and Disclosures: The Privacy Rule outlines when and how healthcare providers can use and disclose PHI for treatment, payment, and healthcare operations. It also requires patient authorization for most other disclosures.
• Minimum Necessary Standard: Covered entities can only use or disclose the minimum amount of PHI necessary to accomplish the intended purpose.

Security Rule

• Safeguards: This rule mandates the implementation of safeguards to ensure the confidentiality, integrity, and availability of electronic protected health information (ePHI). These safeguards fall into three categories:
  • Administrative: Policies and procedures for managing ePHI security risks.
  • Physical: Physical measures to protect ePHI access include secure facilities and devices.
  • Technical: Technical security measures to protect ePHI, including encryption and access controls.
• Risk Assessment: Covered entities must conduct periodic risk assessments to identify and address potential security risks to ePHI.

Breach Notification Rule

• Reporting: This rule mandates covered entities to notify patients, the Department of Health and Human Services (HHS), and potentially the media in case of a breach of unsecured PHI. The notification timeframe and content depend on the severity of the violation.

Step 2: Conduct a Gap Analysis

Assess your existing practices to identify areas that might not align with HIPAA regulations. This helps you prioritize efforts and resources.

Step 3: Develop Procedures and Protocols

Create comprehensive policies and procedures that address all aspects of HIPAA compliance, including:

• Access Controls: Who can access PHI and how?
• Risk Management: Identifying and mitigating potential security risks to patient data.
• Incident Response: Procedures for handling PHI breaches.

Step 4: Implement Safeguards

Implement administrative, physical, and technical safeguards to protect ePHI depending on the Security Rule requirements. This could involve:

• Administrative: Security awareness training, data encryption protocols, and transparent data disposal procedures.
• Physical: Secured access controls to devices and facilities storing PHI.
• Technical: Firewalls, intrusion detection systems, and secure communication methods for transmitting PHI.

Step 5: Train Your Workforce

Train your staff on HIPAA requirements and their roles and responsibilities in protecting patient privacy and data security. Regular training helps maintain awareness and best practices.

Step 6: Risk Assessment and Monitoring

Regularly evaluate your security posture by conducting risk assessments. Update policies and procedures based on identified gaps or changes in regulations or technology.

Step 7: Business Associate Agreements

If you work with business associates who access PHI on your behalf, ensure you have signed agreements requiring their HIPAA compliance. These agreements hold them accountable for protecting patient information.

Role of Testing in HIPAA Compliance

HIPAA compliance demands robust safeguards for sensitive patient information. Testing plays a crucial role in verifying the effectiveness of these safeguards and identifying potential vulnerabilities. Read this article to know how to perfrom Healthcare Software Testing.

Here’s a breakdown of key testing types and their contribution to HIPAA compliance:

Vulnerability Testing

This testing identifies security weaknesses in systems that could potentially be exploited. It involves automated scanning of networks and systems to detect vulnerabilities. Nessus, Qualys, and OpenVAS are popular tools used for this purpose. They provide comprehensive reports that help understand a system’s security weaknesses.

Penetration Testing

Penetration testing simulates an attack on the system to evaluate the effectiveness of existing security measures. It helps in understanding how an actual attack could impact the system. Tools like Metasploit, Core Impact, and Immunity Canvas are commonly used for penetration testing, offering real-time attack simulations and analysis.

Risk Assessment

Risk assessments are crucial to identifying and mitigating risks associated with PHI. They evaluate risks’ potential impact and likelihood of occurrence. Archer and LogicManager are examples of GRC platforms that facilitate risk assessments by providing templates and tools to analyze and document risks systematically.

Compliance Auditing

Compliance audits verify that all HIPAA regulations are followed, involving a thorough review of processes, controls, and policies. Tools like HIPAA One and Compliancy Group help streamline this process, offering automated checklists and documentation capabilities to ensure adherence to HIPAA guidelines.

Security Incident Response Testing

This type of testing assesses an organization’s preparedness in responding to security breaches. It evaluates incident response plans and team effectiveness under simulated attack scenarios. Tools like Splunk and IBM QRadar support incident response testing by monitoring and managing the response processes.

Web Application Testing

Web automation testing is also crucial in HIPAA compliance, particularly for healthcare applications and systems accessed through web interfaces. It ensures that web applications are robust against unauthorized access and vulnerabilities that could lead to data breaches. Automation testing can help consistently test web applications for security flaws, functional errors, and compliance with HIPAA’s privacy and security rules. Selenium and testRigor are commonly used for automated web testing, enabling thorough and repeatable testing processes. Read this Test Automation Playbook to get started with automation testing.

testRigor for HIPAA Compliance Testing

testRigor, being HIPAA compliant, is the best option for performing web application testing. With its latest AI technologies like generative AI, NLP, and ML, testRigor makes automation as straightforward as manual testing. Read: Test Automation Tool For Manual Testers.

With generative AI, testRigor can create test steps and test data just with test description. With the support of NLP, users can create test scripts in plain English, and there is no need to create scripts in any programming language.

testRigor specializes in end-to-end testing, ensuring that every aspect of an application, from front-end user interactions to back-end processing and integrations, works as expected. Read here how to perform end-to-end testing with testRigor.

login as customer
click "Verify Your KYC"
enter stored value "FirstName" into "First Name"
enter stored value "LastName" into "Last Name"
enter stored value "DOB" into "Date Of Birth"
enter stored value "address" into "Address"
enter stored value "email" into "Email ID"
enter stored value "phone" into "Mobile"
click "Save" roughly to the left of "Submit"
check the page contains "KYC Application Pending"

This sample test script demonstrates that it contains simple English steps. Additionally, with testRigor, we can create reusable functions and save them for future use. This eliminates the need to write all steps repeatedly; instead, we can simply invoke the function, such as “login as customer.” Read: How to use reusable rules or subroutines in testRigor?

Furthermore, we can store values with identifiers and easily reference them in the script, as seen in the command “enter stored value ‘FirstName’ into ‘First Name‘.” Read: How to use variables in testRigor?

With testRigor, you can also perform mobile testing to validate the UI of applications with UI testing. Also, healthcare applications are accessed on different devices, platforms, and browsers, so testing them on all browsers across platforms is crucial. testRigor seamlessly supports cross-platform testing.

testRigor helps you validate files, audio, 2FA, video, email, SMS, phone calls, mathematical validations/calculations of formulas, APIs, Chrome extensions, and many more complex scenarios. Access testRigor documentation and top testRigor’s features to learn about more valuable capabilities.

Conclusion

HIPAA compliance is not a one-time process. It’s an ongoing one. We need to conduct risk assessments and update the safeguards and employee training at regular intervals. When there is an update in process, the team needs to be trained in those areas. To evaluate and ensure there are no loopholes in the risk, we can rely on different types of testing like penetration testing, vulnerability scanning, and simulated attacks.

Also, using the latest AI-enabled tools like testRigor, we can test the web applications and ensure they comply with HIPAA standards. This proactive approach, coupled with employee training and ongoing monitoring, exhibits a commitment to data security and minimizes the risk of breaches, promoting trust with patients and regulators.

Frequently Asked Questions (FAQs)

testRigor is SOC2 and HIPAA compliant and supports FDA 21 CFR Part 11 reporting. You can efficiently perform accessibility testing through testRigor. Read here how to build an ADA-compliant app.

HIPAA compliance should be an ongoing effort with regular assessments. Formal audits should be conducted annually or whenever significant changes to the healthcare environment or IT systems occur.

Penalties can range from minor fines for accidental breaches to significant fines for willful neglect of compliance, which can escalate to criminal charges for severe violations. Fines can reach up to $50,000 per violation, with a maximum of $1.5 million annually.

“We spent so much time on maintenance when using Selenium, and we spend nearly zero time with maintenance using testRigor.”

Keith Powe VP Of Engineering - IDT