As the health care industry continues reeling from the recent Change Healthcare ransomware attack that crippled large portions of the U.S. health care system, health care providers are naturally reminded of the importance of their cybersecurity safeguards. The HIPAA Security Rule requires that regulated entities maintain reasonable and appropriate administrative, technical, and physical safeguards for electronic protected health information (ePHI), including:

• Ensuring the confidentiality, integrity, and availability of all ePHI they create, receive, maintain or transmit;
• Identifying and protecting against reasonably anticipated threats to the security or integrity of the information;
• Protecting against reasonably anticipated, impermissible uses or disclosures; and
• Ensuring compliance by their workforce.

These security measures require review and modification as threats change.

Based on the Change Healthcare attack, covered entities should consider:

1. Taking a closer look at the recent cybersecurity guidance prepared by the National Institute of Standards and Technology. The 122-page guide offers practical guidance and resources that regulated entities can use to better understand Security Rule requirements and safeguard ePHI. The first step in this process is a risk assessment to identify potential risks and vulnerabilities where ePHI can be improperly disclosed, modified, or made unavailable. The cybersecurity guide recommends the following steps:
   1. Understand where ePHI is created, received, maintained, processed, and transmitted.
   2. Identify potential threat events, sources, and vulnerabilities based on the operating environment and any knowledge acquired from analyzing where ePHI flows (e.g., ransomware, phishing, insider threats).
   3. Determine the level of risk (e.g., low, moderate, or high) based on the likelihood that a reasonably anticipated threat will exploit a vulnerability and the impact that would result.
   4. Document the results.
2. Based on this risk assessment, evaluate options for implementing security measures and policies/procedures to reduce potential risks and vulnerabilities. The cybersecurity guide provides a table of key activities to consider when implementing Security Rule requirements, including actionable steps to take and sample questions to consider when determining the adequacy of cybersecurity measures. Key activities may include technical safeguards, employee training, vendor audits, and data minimization.
3. Preparing for the worst. As reported last month by the U.S. Department of Health and Human Services’ Office for Civil Rights, there have been significant increases in HIPAA complaints and large breaches, and hacking/IT incidents continue to comprise the majority of reported breaches. With cyberattacks on the rise, and all eyes on the health care industry’s cybersecurity, health care providers can expect an increased focus on their preparedness. For this reason, covered entities should consider:
   1. Refreshing their incident response and business continuity plans;
   2. Simulating their response to such events via a tabletop exercise; and
   3. Reviewing relevant contracts and insurance coverages to ensure adequate protection.