5 Principles to Keep in Mind When Starting Your Security Risk Assessment

Healthcare organizations in the United States have been the most compromised by data breaches for several years, and that’s not likely to stop anytime soon.1 

That’s why organizations in the healthcare industry, regardless of size, must conduct an annual security risk assessment (SRA) to identify vulnerabilities, remediate risk, prevent dangerous cybersecurity incidents, and avoid penalties for non-compliance.
But because of its time-consuming and complex nature, many entities view the security risk assessment process as a heavy burden and wait until the end of the year to get started, even knowing the financial and reputational risks that not having a compliance remediation plan in place carries.
That’s a mistake.
Read on for five things to keep in mind when starting your SRA to understand the necessity of starting early, building a HIPAA compliance remediation plan, and thinking beyond the basic requirements of the annual assessment.

Your Security Risk Assessment Checklist 

A security risk assessment (SRA) systematically evaluates potential vulnerabilities and threats to the security of electronic protected health information (PHI) and patient data. 

The primary purpose of an SRA is to assess the security measures and controls in place within healthcare organizations to safeguard patient information. It helps HIPAA-covered entities understand their security posture, determine areas of weakness, develop risk management principles and practices, and meet compliance requirements.  

When starting your SRA, it’s critical to keep the following five principles in mind: 

1. Regulatory Compliance 

Before starting your SRA, become educated in relevant federal and state healthcare regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. 

Familiarize yourself with the specific security requirements and standards outlined in these regulations. They change frequently and form the foundation for safeguarding sensitive patient information, so they’re must-knows for completing a risk assessment. 

You can stay up-to-date on regulations by habitually visiting regulatory websites, subscribing to compliance newsletters, setting up Google Alerts, and attending relevant webinars. 

2. Risk Identification and Assessment  

At its core, your SRA should be used to comprehensively identify and assess potential risks to patient data’s confidentiality, integrity, and availability.  

This involves conducting a complete analysis of your organization’s IT systems, networks, and data storage to identify vulnerabilities and potential threats. Consider internal and external risks and prioritize them based on their potential impact on patient information. 

By taking the time to identify all hazards and not skipping out on any relevant areas, you’ll ensure that nothing falls through the cracks. This will help you prove a culture of compliance to regulatory bodies in the event of a breach and make it easier to mitigate risk. 

3. Year-Round Remediation 

The security risk assessment isn’t a one-and-done task. The most pragmatic path to compliance comes from taking a series of steps to correct security gaps over time… A journey begins with the first step. 

That might include implementing robust data protection measures, including encryption, to safeguard electronic and physical patient records. It may also look like limiting access to sensitive data to authorized personnel and establishing role-based access controls to ensure that employees can only access the information necessary for their job functions.  

Deciding on and implementing precautions is one of the most important things to remember to maintain full compliance throughout the year. 

4. Employee Training and Awareness  

61% of healthcare cybersecurity breaches come about because of employee negligence.2 Your SRA is not just there to fix issues; it should also help you find ways to establish a preventative maintenance process that helps prevent accidental non-compliance within the organizations. 

Train all staff members on the importance of data security and the best practices to maintain it, and especially emphasize areas of weakness you found in your SRA. Make security awareness training a regular part of onboarding and ongoing professional development and highlight the significance of recognizing and reporting security incidents promptly. 

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 5. Incident Response and Recovery Planning  

Even if you  think you’re doing everything right, breaches are always a risk, and you need to be ready. Use your assessment results to develop a detailed incident response plan outlining the steps you’ll take in case of a security or data breach.   

Assign clear roles and responsibilities to team members involved in handling incidents, and regularly test the incident response plan through simulations to ensure its effectiveness and make any necessary adjustments. Additionally, create a comprehensive data backup and recovery strategy to minimize the impact of potential data loss or system disruptions. 

As you mitigate risk and plan your incident response, document your processes so you can prove to the Officer for Civil Rights (OCR) that you took the measures necessary to remain compliant and prevent breaches. 

How to Assess Cybersecurity Risk: The Conclusion  

By adhering to these principles, small to medium-sized healthcare organizations can lay a strong foundation for maintaining the security and privacy of patient information throughout their operations. 

But even knowing the importance of the SRA and its role in year-long compliance doesn’t make it any less work to complete. That’s why many healthcare organizations invest in automated compliance software or the help of certified assessors to streamline the SRA and make it easier to navigate, understand, and manage.   

Intraprise Health’s HIPAA One combines the best of both worlds with a hybrid approach: you can complete your assessment through a fully self-guided approach, enlist the support of expert assessors, or both. This way, you can complete the SRA on your terms and guarantee your organization remains compliant. 

Make your SRA a priority, not an afterthought. Get in touch with Intraprise Health’s team of HIPAA experts and learn how HIPAA One can ensure compliance in your organization.

1. https://www.healthcarecompliancepros.com/blog/the-security-risk-analysis-sra-designed-for-healthcare

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