‍

Many organizations in the healthcare industry are adopting cloud-based solutions for handling data, including protected health information (PHI). While these services help with scalability and convenience, they introduce new security threats and vulnerabilities, expanding your attack surface and HIPAA compliance risks.

‍

The use of cloud computing can heighten these concerns through risks like misconfigurations, rogue administrators, or unclear shared responsibilities.

‍

“

The core danger of operating in a cloud-native healthcare environment is that patient privacy, safety, and trust are put at risk when a cloud service provider fails to meet HIPAA requirements. Without proper safeguards, sensitive health data becomes vulnerable to exposure or misuse.”

Faisal Khan

GRC Solutions Expert, Vanta

|

LinkedIn

‍

Whether you’re a covered entity or a business associate providing cloud services, a compliance-based approach is necessary in a cloud-native healthcare environment to avoid HIPAA violations and penalties.

‍

This guide will help you leverage cloud-based services while remaining HIPAA-compliant. We’ll cover:

‍

• Whether HIPAA permits the use of cloud services
• How to use the cloud in adherence to HIPAA
• What potential challenges to expect

‍

Why is the healthcare ecosystem moving to the cloud?

The healthcare industry is increasingly adopting cloud solutions to modernize operations. Cloud infrastructure enhances interoperability between different systems and platforms, enabling faster, better-coordinated patient services.

‍

For instance, CSPs provide critical infrastructure for telehealth clinics offering remote services like video consultations and chat-based care. This expands healthcare service scope and can become a major differentiator among competing clinics.

‍

The benefits CSPs provide to covered entities are summarized below:

‍

• Resilience against data loss: Cloud services often have data backup and disaster recovery procedures to prevent permanent data loss due to outages or security incidents
• Lower infrastructure costs: Organizations can reduce the cost of servers, maintenance, and corresponding IT support by shifting to cloud services
• Easier scalability: Cloud resources enable you to scale storage depending on business goals or patient needs

‍

Does HIPAA permit the use of a cloud service to store or process ePHI?

The HIPAA Privacy and Security rules do not explicitly mention cloud services. However, the U.S. Department of Health and Human Services (HHS) provides clear guidance on HIPAA in the cloud computing context. The guidance states that both covered entities and business associates can use cloud services to store or process ePHI as long as there’s a business associate agreement (BAA) outlining the permitted and required uses and disclosures.

‍

CSPs are considered business associates due to the nature of their services, which is storing, maintaining, or transmitting ePHI on behalf of a covered entity. A signed BAA ensures compliance with mandatory safeguards, including but not limited to:

‍

• Encryption
• Access control
• Access logging

‍

Takeaway: You can meet HIPAA requirements in a cloud-native environment if you and your CSPs ensure the confidentiality, integrity, and availability of ePHI.

‍

{{cta_withimage13="/cta-blocks"}}   | HIPAA compliance checklist

‍

How to remain HIPAA compliant while leveraging cloud services?

The HHS Office for Civil Rights (OCR), which is the main enforcement body for HIPAA, defines clear guidelines that covered entities and their business associates can follow to ensure their use of the cloud aligns with HIPAA. The guidance can be broken down into eight steps:

‍

1. Sign a business associate agreement (BAA)
2. Establish access control policies for cloud access
3. Set up strong encryption protocols
4. Implement audit controls to record ePHI access
5. Enable continuous monitoring
6. Create incident response and notification procedures
7. Conduct regular audits
8. Review and update measures and systems

‍

Step 1: Sign a business associate agreement (BAA)

Covered entities under HIPAA must sign a BAA with any organization that stores, maintains, or transmits PHI on their behalf. The BAA establishes each party’s responsibilities and makes the business associate—here, the cloud service provider—accountable for PHI breaches.

‍

The agreement must include provisions that address:

‍

• Permitted uses and disclosures of PHI
• Destruction or returning of PHI after the contract period ends
• Contract termination clauses for violations
• HIPAA compliance for subcontractors

‍

Step 2: Establish access control policies for cloud access

For your cloud environment, setting up comprehensive access control policies is imperative to mitigate unauthorized access risks. Expect to implement safeguards such as:

‍

• Unique user IDs
• Strong password requirements
• Multi-factor authentication

‍

A critical principle here is the Minimum Necessary Rule, which mandates that your staff can only use the minimum ePHI needed to perform their role. A scalable way to enforce this is to implement role-based access control (RBAC) for controlled permissions.

‍

You can reduce the possibility of unauthorized ePHI access with auto-logout, which ensures users get logged off their devices after a set period of inactivity. You can further strengthen compliance oversight by regularly monitoring access logs and flagging suspicious activities.

‍

Step 3: Set up strong encryption protocols

Under the HIPAA Security Rule, all ePHI must be encrypted both at rest and in transit (aligns with the standards outlined by NIST). HIPAA classifies encryption as an “addressable” implementation specification, which means organizations must do one of the following:

‍

• Implement the specified encryption protocols 
• Do something equivalent that achieves the same purpose
• Justify and document a rationale if it’s not implemented

‍

When working with a CSP, most covered entities outline applicable encryption methods in the BAA. This includes clarifying whether the covered entity or business associate is responsible for encrypting ePHI using a particular protocol. You must also ensure all devices that can access or send ePHI from outside your organization’s firewall are able to both encrypt and decrypt ePHI.

‍

{{cta_withimage39="/cta-blocks"}} | The Healthcare compliance checklist

‍

Step 4: Implement audit controls to record ePHI access

Under the Security Rule’s technical safeguards, organizations are required to implement audit controls that log ePHI access events and store data, including who accessed the data, when, and from what device.

‍

To ensure the confidentiality and integrity of this information, store these logs in a tamper-resistant, access-controlled system, such as a centralized logging service or SIEM. That way, the logs remain confidential and can be reviewed during periodic information-system activity reviews and audits.

‍

This documentation responsibility should be twofold; both the covered entity and the CSP should document and maintain ePHI access across their network environments. Logging on both ends ensures full visibility into who is interacting with sensitive data and may help identify unauthorized access.

‍

Step 5: Enable continuous monitoring

Continuous monitoring is an essential yet challenging requirement of maintaining HIPAA compliance while leveraging cloud computing.

‍

Without continuous input, your security and compliance teams would rely on point-in-time reports, which may lead to undetected data compromises or a delayed response to security incidents. Such gaps only increase the risk of HIPAA violations and regulatory scrutiny.

‍

Some important aspects of a continuous monitoring solution for cloud systems include:

‍

• Systems that can verify the integrity of your ePHI and generate automated alerts for unauthorized ePHI access or modifications
• Logging capabilities to track user activity and maintain a trail of audit-friendly data

‍

To support your efforts, consider compliance automation tools like Vanta that integrate with your cloud architecture and enable real-time tracking on a centralized dashboard.

‍

Step 6: Create incident response and notification procedures

The HIPAA Breach Notification Rule requires CSPs to adhere to strict notification timeframes for any breach involving ePHI.

‍

While the rule outlines a 60-day notification timeframe, covered entities may be recommended a stricter reporting window to support faster incident response and resolution.

‍

If you’re working with CSPs, your incident response plan should also address business continuity. The Security Rule requires ePHI to maintain high availability, meaning that CSPs must have processes in place that ensure high levels of uptime.

‍

Step 7: Conduct regular audits

Both covered entities and business associates must periodically review their security practices to ensure they continue to align with HIPAA requirements.

‍

While HIPAA doesn’t demand a particular audit frequency when CSPs are involved, industry best practices recommend conducting them at least annually. Audits can also be triggered by PHI breaches, regulatory updates, and operational changes.

‍

From the perspective of a covered entity, audits can expand externally to CSPs. Depending on the terms of your BAA, you may be able to investigate your business associates’ security practices to obtain satisfactory evidence of HIPAA compliance.

‍

{{cta_withimage13="/cta-blocks"}}   | HIPAA compliance checklist

‍

Step 8: Review and update measures and systems

Since HIPAA requirements evolve with the threat landscape, both covered entities and business associates must regularly update existing controls and best practices to stay compliant. The micro-processes can include the following:

‍

• Upgrading encryption standards
• Adjusting access controls for offboarded CSPs
• Patching vulnerabilities across cloud systems handling ePHI

‍

Whenever HIPAA regulation requirements are updated, you should review your BAAs and ensure the shared security responsibilities and other contractual obligations remain aligned.

‍

Keep transparent records of all updates and remediations to ensure their demonstrability to OCR and your stakeholders.

‍

Common challenges of HIPAA-compliant cloud computing

HIPAA’s broad scope and lack of prescriptive guidance can make achieving compliance challenging in a cloud environment. Here’s what you can look out for:

‍

• Third-party risk management: Partnering with CSPs expands an organization’s risk exposure, but the accountability for protecting ePHI still rests with the covered entity. Conduct regular assessments to identify and address threats early.
• Complexity of managing multiple cloud environments: Using more than one CSP streamlines operations but increases complexity. Maintaining visibility into controls and policies can get challenging unless you invest in a capable HIPAA compliance solution.
• Collecting evidence and documentation: Organizations must collect and maintain all PHI-related documentation, training records, and BAAs, which can be an administrative burden at scale. You’d also need a systemized approach to ensure the records are readily available for auditors.

‍

You can mitigate many of these challenges by implementing dedicated HIPAA compliance software like Vanta, which can automate repetitive compliance workflows.

‍

Support HIPAA compliance in cloud-based environments with Vanta

Vanta is a trust management platform that supports HIPAA compliance by offering organizations clear guidance and resources for implementing requirements across policies, documentation, and controls. Vanta can automate many time-consuming HIPAA compliance tasks in a cloud environment, including evidence management and continuous monitoring.

‍

The platform offers a dedicated HIPAA product that comes with various helpful features such as:

‍

• A unified dashboard for streamlined compliance tracking
• Pre-built policies and an in-app editor
• Built-in training and governance solution
• Automated evidence collection powered by 375+ integrations
• HIPAA training videos developed by Vanta’s compliance and security experts

‍

The platform is designed to help you keep up with changes, whether you’re onboarding new vendors, team members, or auditors. Besides HIPAA, Vanta can also support other compliance standards for healthcare organizations, including SOC 2, HITRUST, and ISO 27001.

‍

Schedule a custom demo to have a Vanta expert walk you through the HIPAA support features.

‍

{{cta_simple18="/cta-blocks"}} | HIPAA product page

‍

A note from Vanta: Vanta is not a law firm, and this article does not constitute or contain legal advice or create an attorney-client relationship. When determining your obligations and compliance with respect to relevant laws and regulations, you should consult a licensed attorney.

‍