The Health Insurance Portability and Accountability Act, best known as HIPAA, is one of the most well-known healthcare privacy laws in the United States. The primary objective of HIPAA is to safeguard patients' Personal Health Information (PHI). HIPAA's Security and Privacy rules establish guidelines for protecting Electronically Protected Health Information (EPHI), and Trustwave DbProtect is a powerful tool to help achieve this goal.

As all healthcare facilities are aware, Title II of HIPAA encompasses the Privacy Rule, which governs the use and disclosure of PHI held by healthcare clearinghouses, employer-sponsored health plans, health insurers, and medical service providers. The HIPAA Security Rules detail the technical requirements for implementing the Privacy Rule effectively that all healthcare facilities must follow.

These technical requirements include:

• Controlling and monitoring access to equipment that contains health information
• Restricting access to authorized individuals for both hardware and software
• Safeguarding information systems housing PHI from unauthorized intrusion
• Ensuring that data within systems remains unaltered and protected against unauthorized changes or erasure
• Documenting risk analysis and risk management programs.

The Significance of a Data-Centric Approach to HIPAA Compliance

Many organizations initially adopted a network-centric approach focusing on securing endpoints and implementing perimeter defenses. This focus has been the standard practice, and while it is essential to establish robust perimeter defenses, these measures often prove ineffective against modern attacks, such as:

• SQL injection vulnerabilities that grant direct access to the database
• Malware introduced through phishing or other means, compromising employee workstations and providing access to the database and PHI
• Insider attacks.

However, information security teams can use a data-centric approach to counter these threats. This methodology prioritizes data protection at its source, which is the database. Securing databases requires implementing a comprehensive framework that guides security processes affecting Personal Health Information. Trustwave collaborates with numerous healthcare organizations to enhance PHI security through a seven-step continuous protection approach used as part of the database security solution.

Trustwave DbProtect is an enterprise-class database security risk and compliance solution that facilitates data-centric security implementation. It assists organizations in promptly identifying and mitigating risks, enforcing the Principle of Least Privilege, and protecting sensitive data across on-premises and cloud-based databases. DbProtect offers features such as identifying all known and unknown databases (including rogue and unsecured ones) and ensuring PHI resides only in authorized and secured databases.

Let's review the path to securing data.

Step 1: Inventory Databases

HIPAA mandates healthcare organizations to establish policies and procedures to prevent, detect, contain, and rectify network security violations. The first crucial step toward HIPAA compliance involves creating an inventory of all databases containing Personal Health Information. This activity entails discovering, classifying, and prioritizing known databases within the network and the cloud. It also involves identifying unknown databases that may pose security risks and compliance issues.

Trustwave DbProtect aids organizations in protecting their PHI by ensuring authorized and secured database usage, restricting access, and removing any unauthorized databases from their networks.

Step 2: Test

To align with the latest HIPAA policies and standards, one must verify that your database security strategy, configurations, and settings meet the required criteria. Once policies are in place, conducting an analysis allows you to associate risk scores with the findings of vulnerability assessments. This approach helps concentrate efforts on mitigating the most critical risks.

Trustwave DbProtect automates and accelerates this process, facilitating the discovery, classification, and prioritization of an organization's databases containing sensitive information, whether stored in the cloud or on-premises.

Step 3: Eliminate Vulnerabilities

Complying with the HIPAA Security Rules can be a daunting task for healthcare organizations of all sizes. The healthcare industry remains a prime target for cybercriminals seeking to steal patients' personal information for identity theft purposes. Data from the U.S. Department of Health and Human Services (HHS) found that healthcare data breaches have doubled in three years, with over 700 breaches in 2022.

Attackers can exploit weak passwords, misconfigurations, missing security patches, and vulnerabilities to gain unauthorized access to personal health information (PHI). HIPAA mandates the implementation of policies and procedures to prevent, detect, contain, and correct security violations. It also requires healthcare organizations to regularly evaluate their technical systems to address any changes that may impact the security of PHI.

Once security teams have identified and scanned the databases, the next step is to mitigate risks and ensure compliance at the database level.

Trustwave DbProtect Vulnerability Management offers powerful scanning capabilities to identify and eliminate vulnerabilities and misconfigurations that put PHI at risk. With built-in policies and Trustwave SpiderLabs threat intelligence, organizations can access up-to-date information on vulnerabilities and threats. The comprehensive reporting provided by DbProtect facilitates risk analysis, mapping vulnerabilities to risk levels and business impact. This analysis helps organizations and cloud providers prioritize their remediation efforts, ensuring the most critical threats to sensitive data are promptly addressed.

Step 4: Enforce Least Privileges

In addition to assessing technical vulnerabilities and misconfigurations, evaluating user access rights and their data-related actions is crucial. Over time, users may accumulate more privileges than necessary, leading to segregation of duties violations and increasing the risk of fraudulent activities or PHI theft. HIPAA requires implementing policies and procedures to ensure appropriate access to PHI for all workforce members, limiting access to only authorized individuals.

Trustwave DbProtect Rights Management provides a comprehensive view of an organization's data ownership, access controls, and rights to sensitive information. By enforcing the Principle of Least Privileges, organizations can grant users only the privileges necessary for their roles, restricting database access to a need-to-know basis and mitigating shared accounts. Rights Management also offers an audit trail to track the granting of privileges, helping prevent future privilege escalations.

Step 5: Monitor for Anomalies

HIPAA mandates the implementation of mechanisms to record and examine activity within information systems containing PHI. Regularly testing security systems and processes, including database activity monitoring, is essential for mitigating breaches and meeting HIPAA requirements.

Trustwave DbProtect Activity Monitoring enables organizations to meet HIPAA requirements, reduce risk, and prevent data loss by validating remediated vulnerabilities, monitoring unremediated vulnerabilities to prevent exploitation, and tracking privileged user activity to identify unauthorized behavior.

Step 6: Protect

As a best practice for database security, it is recommended to define a policy-based monitoring methodology that aligns with your specific security and audit requirements. Such a methodology provides compensating controls for known vulnerabilities, utilizing vulnerability, configuration, user data, and comprehensive vulnerability and threat intelligence knowledgebase. This approach ensures accurate and efficient monitoring policies, resulting in a manageable set of actionable security and compliance alerts.

Trustwave DbProtect detects, alerts, and takes corrective action against suspicious activities, intrusions, and policy violations, providing robust database protection.

Step 7: Respond to Suspicious Behavior

Timely response to breaches is critical to minimize damage. The average cost of a data breach is significant, and the breach lifecycle can extend for several months. Therefore, healthcare organizations should seek a database security solution that enables immediate action when detecting suspicious activity or policy violations.

Trustwave DbProtect Active Response offers an additional layer of protection for sensitive data in the cloud. It allows organizations to take action when unauthorized and suspicious database activity is detected.

Customizable actions include:

• Sending alerts to IT Security
• Notifying the SIEM system for correlation with web application logs
• Initiating malware scans
• Executing scripted actions like locking an account or blocking suspicious activity.

To bring this all together, attackers are increasingly targeting personal healthcare data, making rigorous database security measures essential. A comprehensive defense-in-depth approach is crucial, with a focus on protecting data at the database level. Establishing an effective database security program requires commitment, discipline, and a proven methodology across the organization. By implementing the outlined steps and identifying individuals responsible for program objectives, healthcare organizations can establish robust security controls for their most valuable asset—their data.