May 9

HIPAA and Cloud Computing: Protecting Patient Data in the Digital Age

As healthcare providers turn to cloud computing for storing and managing EHRs, HIPAA and cloud computing compliance has become a growing concern. In this blog, we’ll outline key considerations to maintain compliance and protect patient privacy and security.

Evaluating Cloud Service Providers for HIPAA Compliance

As healthcare organizations continue to adopt cloud computing, it is important to consider the security implications of this move.  When dealing with sensitive patient data, it is crucial to evaluate cloud service providers for HIPAA compliance.

HIPAA sets national standards for protecting the privacy, security, and integrity of PHI.  Any cloud service provider that handles PHI must comply with the HIPAA Security Rule, which establishes a series of administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of electronic PHI.

To ensure that a cloud service provider is HIPAA compliant, organizations must evaluate their cybersecurity and HIPAA security practices.  Cybersecurity refers to the technologies, processes, and practices designed to protect networks, devices, and data from unauthorized access, use, disclosure, modification, or destruction.  HIPAA security refers to the specific requirements for handling PHI, as established by the HIPAA Security Rule.

To evaluate cloud service providers for HIPAA compliance, organizations can use several methods, including conducting an audit or review of the vendor’s policies, procedures, and technical controls.  They can also request proof of third-party audits or certifications, such as SOC 2 or HITRUST.  Additionally, they can review the vendor’s contracts and service level agreements (SLAs) to ensure that they comply with HIPAA requirements.  Performing this due diligence, while a crucial part of an organization’s overall cloud strategy, is only part of the equation.  The organization is still required to ensure that how they operate in the cloud adheres to HIPAA standards.

Cloud Providers as Business Associates

There is one more critical component to HIPAA and cloud computing for CEs or BAs.  A cloud provider such as Microsoft is considered a BA under HIPAA since they store and process ePHI.  As such, a CE or BA must enter into a Business Associate Agreement (BAA) with the cloud provider.  A BAA is a legal contract that outlines the responsibilities of the cloud provider in safeguarding ePHI and complying with HIPAA regulations.

By entering into a BAA with the cloud provider, the organization can ensure that the cloud provider is held accountable for any breaches or violations of HIPAA regulations.  Without a BAA, the CE could be held liable for any non-compliance or data breaches that occur within the cloud environment.  Indeed, according to 45 CFR § 164.308(b)(1) and § 164.502(e), if you do not have a BAA in place with your cloud provider, you are noncompliant with these rules.

Implementing Safeguards to Protect Patient Data in the Cloud

Organizations are responsible for ensuring that the patient data they store in the cloud is properly protected, even if they are using a cloud service provider that is HIPAA-compliant.  While it is important to evaluate cloud service providers for HIPAA compliance, it is equally important for the covered entity to establish and maintain its own policies and procedures for using cloud technology.  This includes implementing safeguards such as access controls, encryption, and monitoring to protect patient data.  Ultimately, the responsibility for HIPAA compliance rests with the covered entity, and they must take all necessary steps to protect patient data in the cloud.

There are several safeguards that healthcare providers should consider implementing to ensure the safety and security of patient data in the cloud.  These safeguards can be divided into technical and administrative measures.

Technical safeguards include access controls, encryption, and firewalls.  Access controls ensure that only authorized users can access patient data.  Encryption ensures that the data remains secure, even if it is accessed by unauthorized users.  Firewalls provide an extra layer of security to prevent unauthorized access.

Administrative safeguards include policies and procedures, workforce training, and risk management.  Policies and procedures should be in place to ensure that all employees know how to handle patient data in the cloud.  Workforce training ensures that employees are aware of their responsibilities regarding the handling of patient data.  Risk management ensures that the healthcare provider is aware of the risks associated with cloud computing and takes appropriate steps to mitigate those risks.

One example of a technical safeguard is the use of two-factor authentication.  This ensures that even if an unauthorized user gains access to a username and password, they still cannot access patient data without a second factor, such as a fingerprint or code sent to a phone.

Another example of an administrative safeguard is conducting regular risk assessments.  This ensures that healthcare providers are aware of the risks associated with cloud computing and can take appropriate steps to mitigate those risks.  In short, while using a HIPAA-compliant cloud service provider such as Microsoft Azure does offload the burden of maintaining a costly on-premises IT infrastructure, a CE or BA must still enact safeguards wherever appropriate to ensure ongoing HIPAA compliance.

Training Employees to Ensure Adherence to HIPAA Regulations

One of the most important steps in protecting patient data in the cloud (or anywhere else) is training employees on HIPAA regulations.  Employees play a crucial role in safeguarding sensitive patient information, and they must understand their responsibilities when handling such data.

HIPAA training should cover a range of topics, including the importance of patient confidentiality, how to identify and report potential security breaches, the proper use of technology, and the legal consequences of violating HIPAA regulations.  It is also essential to teach employees about the specific policies and procedures that are in place for your organization, such as the use of encrypted messaging or secure cloud storage.

There are myriad methods that you can use to ensure that employees adhere to HIPAA regulations.  First, it is essential to conduct regular training sessions to reinforce the importance of protecting patient data.  These sessions can take the form of online courses, in-person seminars, or interactive workshops.  A separate, dedicated section discussing cloud computing should be made a part of the training.

Second, it is crucial to provide ongoing feedback and support to employees.  This may include regular audits of data security practices, personalized coaching on areas that need improvement, and recognition for exemplary behavior.  It is also important to establish a system for reporting and addressing any security breaches or violations of HIPAA regulations promptly.

Third, it is helpful to create a culture of accountability and responsibility among employees.  This can be accomplished by providing clear expectations for behavior and outlining consequences for non-compliance.  When employees understand that their actions can have serious consequences, they are more likely to take the necessary steps to protect patient data.

Developing a Contingency Plan for Data Breaches

Even with proper safeguards in place, data breaches can still occur in the cloud.  That’s why CEs and BAs must have a well-developed contingency plan in place.  A contingency plan ensures that a quick and effective response can be launched if a data breach occurs, which can reduce the overall damage to patient data and business operations.

A comprehensive contingency plan should cover a range of scenarios and include key elements such as:

  • Identifying the team responsible for managing the response to a data breach, including designated individuals who are authorized to communicate with affected parties, law enforcement, and other relevant organizations.
  • Detailing the specific steps that need to be taken in the event of a data breach.  This should include a checklist of actions to be taken immediately, such as contacting the cloud service provider, launching an internal investigation, and assessing the scope and extent of the breach.
  • Defining the communication protocols for informing affected parties, such as patients, partners, and regulators, about the breach and the steps that are being taken to manage it.  This should also include providing guidance on what individuals should do if they suspect their data has been compromised.
  • Identifying the necessary legal and regulatory compliance steps that need to be taken.  This includes notifying relevant authorities, providing necessary reports and documentation, and fulfilling HIPAA breach notification requirements.
  • Creating a framework for continuous improvement by including procedures for post-incident review and assessment.

Some examples of incident response procedures that could be included in a contingency plan include:

  • Determining the extent of the data breach and isolating affected systems or data.
  • Identifying the potential cause of the breach and working to remediate vulnerabilities or gaps.
  • Activating emergency response procedures and assembling the response team.
  • Notifying relevant parties, including patients, partners, and regulatory agencies.
  • Conducting a thorough investigation to understand how the breach occurred and implementing corrective actions.
  • Maintaining documentation of the breach, response procedures, and remediation actions.

Developing a contingency plan for data breaches can be a complex undertaking, but it’s an essential component of operating in the cloud.  It ensures that organizations are prepared to respond quickly and effectively in the event of a breach and that they can minimize the damage to patient data and their reputation.


In conclusion, utilizing cloud services can bring many benefits to CEs and BAs, but it’s crucial to keep patient data safe and secure.  By following key considerations, such as evaluating cloud service providers for HIPAA compliance, implementing safeguards, training employees, and developing contingency plans, you can ensure that your organization is staying compliant with HIPAA regulations. 

It’s also essential to regularly review and update your HIPAA compliance strategies to stay ahead of potential threats.  As healthcare continues to move into the digital age, it’s clear that cloud computing will continue to play an increasingly critical role in healthcare delivery.  Staying up-to-date on HIPAA regulations and ensuring your organization’s compliance will help ensure the safety and security of patient data in the cloud for years to come.

Is your healthcare organization struggling to maintain HIPAA compliance in the cloud?  Axeleos can help! Our MediGuard service offering includes a HIPAA privacy and security assessment, as well as ongoing security protection services to help you safeguard patient data in the cloud.  Don’t risk costly HIPAA violations or data breaches – contact us today to learn more about how we can help you ensure compliance and protect patient privacy.


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