AWS HIPAA compliance checklist


March 12, 2024 • 5 min read

In an era where healthcare data security is paramount, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) is a critical undertaking for organizations utilizing cloud services. Among the leading cloud service providers, Amazon Web Services (AWS) stands out for its robust infrastructure and comprehensive security measures with the correct configurations, as part of AWS’ Shared Responsibility Model. Healthcare needs to adhere to HIPAA to safeguard the privacy and security of patient’s sensitive health information, ensuring trust and compliance with regulatory standards. HIPAA compliance relies on the security of your cloud infrastructure, as well as the policies you follow as a team day-to-day. In this article, we’ll delve straight into the AWS HIPAA compliance checklist, identifying the key cloud requirements and explaining how you can simplify achieving and maintaining AWS HIPAA compliance. 

What is HIPAA?

HIPAA, or the Health Insurance Portability and Accountability Act, is a U.S. legislation enacted to protect the privacy and security of individuals’ health information, setting standards for the electronic exchange of healthcare data and outlining rules for healthcare providers and organizations handling sensitive patient information. It is made up of a set of regulations that aims to ensure the confidentiality and integrity of personal health information while allowing for the secure and efficient sharing of necessary data within the healthcare system. HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates who handle PHI. 

Why does healthcare data need to be regulated through HIPAA? 

Patient data refers to information related to an individual’s medical history, diagnoses, treatments, medications, and any other details relevant to their health and well-being. This information is highly confidential and in need of robust protection because cybercriminals target healthcare data for its high market value on the dark web, as it includes valuable personally identifiable information, medical histories, and insurance details that can be exploited for identity theft, fraud, or ransom attacks. 

Does using AWS as your cloud provider automatically make you compliant with HIPAA? 

Just using AWS services doesn’t mean you unlock HIPAA compliance instantly because configuration mistakes can jeopardize healthcare data protection and enable your cloud environment to not meet HIPAA standards. AWS uses a Shared Responsibility Model which outlines the distribution of security responsibilities between Amazon Web Services (AWS) and its customers. AWS is responsible for the security “of” the cloud infrastructure, while customers are responsible for the security “in” the cloud, managing aspects like data protection, access control, and configuration. AWS offers services and features that help you reach the standards of HIPAA. It’s your responsibility to ensure you complete each step of the AWS HIPAA compliance checklist. 

The AWS HIPAA compliance checklist 

We will identify each of the key components of the AWS HIPAA compliance checklist and explain how you can simplify cloud compliance with the intelligent AWS management, StackZone.  

1. Ensure your data is encrypted 

HIPAA requires covered entities and business associates to encrypt PHI both at rest and in transit. In the cloud, this means using strong encryption to protect data that is stored in the cloud and data that is transmitted to and from the cloud. Data encryption can be monitored by implementing AWS config rules and ensured by implementing auto-remediation. 

2. Use robust access controls 

To comply with HIPAA, you need to implement appropriate access controls to ensure that only authorized individuals have access to PHI. In the cloud, this means implementing strong authentication measures everywhere, such as multi-factor authentication, and ensuring that access controls are properly configured and monitored. Regularly audit user access, review logs, and conduct access reviews to promptly detect and address any unauthorized or unnecessary permissions, thereby enhancing overall AWS HIPAA compliance.

A way to transform the security of your cloud environment is through a zero trust architecture. A zero trust approach helps you with access control by assuming that no user or system should be inherently trusted, requiring continuous verification of identity and authorization for every access attempt, thereby reducing the risk of unauthorized access and potential security breaches. 

You should always grant a principle of least privilege across your cloud environment. This ensures that individuals have the minimum necessary access rights to perform their specific tasks, minimizing the risk of unauthorized access and potential exposure of sensitive healthcare information, thereby enhancing overall data security and compliance. Analyse who actually needs access to what and only grant access to users who complete MFA and who require access for their tasks. Regularly audit user access, review logs, and conduct access reviews to promptly detect and address any unauthorized or unnecessary permissions, thereby enhancing overall AWS HIPAA compliance. By regularly rotating credentials, you can determine whether the same users still require the same access, and if they don’t, reduce or remove it!  

3. Conduct regular risk assessments 

HIPAA requires covered entities and business associates to conduct regular risk assessments to identify potential risks to the confidentiality, integrity, and availability of PHI. In the cloud, this means identifying potential risks associated with cloud computing and taking steps to mitigate those risks. These risk assessments need to be documented, and ready for a HIPAA audit. The risk assessments ensure you’re covering all bases and show you what you need to work on as a priority. 

4. Prepare your incident response; be proactive, not reactive 

Effective incident response is essential for minimizing the impact of security breaches and ensuring business continuity. HIPAA requires covered entities and business associates to have an incident response plan in place and to conduct regular testing of that plan. This needs to be perfectly configured to not lose any PHI. In the cloud, this means ensuring that incident response plans are updated to account for cloud-specific risks and that testing includes scenarios that involve cloud computing. An effective incident response plan will rely on the automation of AWS features such as AWS CloudWatch Events and AWS Lambda. Automation helps you to be one step ahead of attacks so your cloud environment works hard in the background to protect your data. 

5. Ensure your data will be backed up in the event of a disaster 

HIPAA requires covered entities and business associates to have a data backup plan in place to ensure the availability of PHI in the event of a disaster or other event that results in data loss. This is not limited to cybersecurity incidents like data breaches; you need to be prepared for incidents such as equipment malfunctions such as server crashes and even natural disasters that could disrupt your operations and damage your infrastructure leading to system outages.  

In the cloud, this means ensuring that data is backed up regularly and that backups are stored in a secure location that is separate from the primary data storage location. To ensure this backup plan is adequate, you’ll need to regularly test it and provide records of the outcomes of the tests. There are many services such as Amazon S3 that help you obtain secure and durable storage. Using Amazon S3 offers various choices to safeguard the privacy and security of PHI records, including client-side encryption for data in transit and supplementary server-side encryption to secure data when it is stored.  

6. Establish controls for audit logging and monitoring 

Audit logging and monitoring in the HIPAA AWS compliance checklist involve the implementation of robust systems to track and analyze activities within the AWS environment. This stage is crucial for identifying and responding to potential security incidents promptly. By enabling services such as AWS CloudTrail and CloudWatch, organizations can maintain detailed logs, set up alerts, and continuously monitor for any suspicious or unauthorized access, ensuring timely detection and mitigation of security threats to protected health information (PHI). This proactive approach aligns with HIPAA requirements for maintaining the integrity and confidentiality of healthcare data.

The importance of data protection for healthcare 

The healthcare industry has experienced a rapid digital acceleration towards cloud-powered services, driven by the increasing adoption of electronic health records (EHRs), telemedicine platforms, and data analytics solutions. This shift has not only enhanced the efficiency and accessibility of healthcare information but has also raised concerns regarding the security and privacy of sensitive patient data. As organizations strive to harness the benefits of cloud technologies for improved patient care and operational efficiency, the importance of robust cybersecurity measures become paramount to safeguard against potential cyber threats and ensure the integrity of healthcare data in this digitally transformed landscape. 

There have been countless horrific cyber attacks on the healthcare industry which have unfortunately had devastating consequences. This was evident in 2019 with the American Medical Collection Agency (AMCA) breach where there was theft of personal and financial information of millions of patients. This included addresses, payment card information, social security numbers, medical data, and more. This data was then sold. This attack revealed the vulnerability of third-party service providers in the healthcare sector as well as the critical importance of stringent data security measures. 

Limitations in healthcare cybersecurity reduce both client and patient trust. AMCA experienced termination of agreements from their four largest clients, which contributed to AMCA’s bankruptcy. 

Common cyber attacks on healthcare 

It has been predicted by Cybersecurity Ventures, that the global healthcare cybersecurity market is projected to reach $28.31 billion by 2027. This money is needed to protect the healthcare industry from: 

  • Ransomware attacks – Malicious software that encrypts healthcare systems’ data, demanding payment for its release.
  • Phishing – Deceptive emails or messages aiming to trick healthcare staff into divulging sensitive information or clicking on malicious links.
  • Insider threats: Malicious activities from within healthcare organizations, either by employees or contractors.
  • Distributed Denial of Service (DDoS) – Overloading healthcare systems with traffic to disrupt normal operations.
  • Credential theft – Unauthorized access to healthcare networks by stealing login credentials.
  • IoT exploitation – Exploiting vulnerabilities in connected medical devices and Internet of Things (IoT) infrastructure.
  • Data interception – Unauthorized access to sensitive healthcare data during transmission.
  • Supply chain attacks: Targeting vulnerabilities in the healthcare supply chain, affecting the integrity of medical products and services.
  • Data Breaches – Unauthorized access or disclosure of patient information, leading to potential identity theft or fraud.
  • Man-in-the-middle attacks – Intercepting and potentially altering communication between healthcare systems and devices.

Who needs to be HIPAA compliant? 

Entities that need to be HIPAA compliant include healthcare providers, health plans, and healthcare clearinghouses that handle and transmit protected health information (PHI). Additionally, business associates, such as third-party service providers, that have access to PHI in the course of providing services to covered entities must also adhere to HIPAA regulations.

What are the common misconfigurations of HIPAA that reduce compliance?

Common misconfigurations in HIPAA compliance often involve lapses in security measures and data handling practices. One frequent issue is inadequate access controls, where organizations fail to implement the principle of least privilege, granting excessive permissions to users. Another common misconfiguration is related to encryption, as failing to encrypt sensitive data both at rest and in transit can lead to violations. Additionally, poor audit logging and monitoring practices, such as insufficiently reviewing logs or neglecting real-time alerts, can compromise the ability to detect and respond promptly to security incidents. Inconsistent or insufficient employee training on HIPAA regulations also contributes to misconfigurations, as staff may unintentionally mishandle protected health information. Addressing these misconfigurations is essential for organizations to enhance their HIPAA compliance efforts and ensure the robust protection of healthcare data.

It’s important to keep awareness of the fact that if you lack confidence in your configurations, your compliance will be reduced. Visibility is needed to ensure you have a perfectly configured cloud environment. 

How to achieve AWS HIPAA compliance in days? 

StackZone’s blueprint for healthcare streamlines and automates the AWS HIPAA compliance checklist. StackZone is a powerful tool for all aspects of your cloud management such as security, cost optimization, and compliance. Our mission is to make it easy for businesses to manage their AWS cloud, so they can focus on running their business. You’re equipped to simplify HIPAA compliance in hours. By using StackZone, you have the full monitoring abilities to ensure not only do you achieve HIPAA compliance for AWS straight away by fixing misconfigurations, but with automation and remediations, you never lose compliance. 

What is a HIPAA cloud blueprint?

StackZone’s configuration blueprints are a set of predefined set of design settings for specific industries. The healthcare blueprint sets you up with a complaint framework so any improvements you need to make are efficiently sorted so you’re on the right track for maintaining HIPAA compliance. It means you achieve the AWS HIPAA compliance checklist in a superfast timescale of 6 working hours. Implementing all these compliance settings yourself manually through the AWS console can not only be time-consuming (often taking months) but it can involve mistake-making which comes at a cost. Compliance can’t be compromised for PHI. 

Here’s what StackZone achieves for you: 

  • Ensures the security of your PHI with the highest level of security standards through encryption and automated access controls. 
  • Provides simplicity through the user-friendly dashboard to implement security assessments so you understand how secure your cloud environment is
  • Achieves HIPAA compliance in hours, not weeks or days
  • Ensures protection and recovery from disasters through automation

How StackZone achieves the AWS HIPAA compliance checklist 

StackZone is the all-in-one powerful cloud tool that enables you to deploy and manage your AWS workload in a HIPAA-compliant framework. It speeds up the process of completing the AWS HIPAA compliance checklist. Here are a few examples:

  • Using the StackZone Console, you can effortlessly implement AWS Config Rules across your resources from a central point, eliminating the requirement for manual intervention or coding when encrypting your data. AWS Config Rules aids in achieving encryption compliance by continuously monitoring and enforcing predefined or custom rules related to encryption settings across AWS resources. 
  • Robust access controls are achieved with each deployment of StackZone with the 6 principles of a zero trust security model – Verify every user and device, implement least principle privilege access, achieve micro-segmentation, always assume breach, continuously monitor and assess, and encrypt and protect all data.  
  • You can activate vulnerability assessments on the StackZone console. StackZone uses Prowler and you can configure what groups to use as a compliance set of checks for Prowler to perform against all AWS Accounts in your AWS Organization.
  • The StackZone AWS Backup functionality enables you to automatically schedule backups for your EC2 Instances, EBS/EFS Volumes, RDS/Aurora Instances, and DynamoDB tables. Simply assign the tags “daily,” “weekly,” or “monthly” to your AWS resource, and the AWS Backup feature will handle the backup process according to your selected timeframe.
  • To establish controls for audit logging and monitoring, StackZone can provide multi-region CouldTrail which helps log all AWS API Calls, which can be enhanced with AWS CloudWatch Alarms, ensuring a variety of calls you want to be notified about are sent to your chosen security contact.  

Final thoughts 

When it comes to using the cloud in healthcare, simple mistakes and forgetful behavior can lead to serious consequences. Hackers are always watching for opportunities to gain access and this is why there are strict standards to comply with the Health Insurance Portability and Accountability Act (HIPAA).  We hope the AWS HIPAA compliance checklist that we’ve provided is something you can keep returning to, to help you determine your compliance level with HIPAA. To achieve full visibility and control over your compliance, try the StackZone console and watch how you streamline HIPAA compliance in hours. 

This article was written by Fernando Hönig, Founder of StackZone

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