In compliance with the Health Insurance Portability and Accountability Act (HIPAA), our organization conducts periodic technical and nontechnical evaluations. These evaluations, initially based on the standards implemented under this rule, and subsequently in response to environmental or operational changes, aim to assess the extent to which our security policies and procedures meet the requirements of this subpart. Conducting regular technical and nontechnical evaluations as part of an ongoing commitment to the security of electronic protected health information (ePHI). Ensuring that the evaluations are initially based on the standards implemented under the HIPAA rule to establish a foundational assessment framework. Adapting the evaluation process in response to environmental or operational changes that may impact the security landscape of ePHI. Reviewing security policies and procedures comprehensively to ascertain their alignment with the evolving requirements of this subpart.

Priority: High

Category: Security Management and Evaluation

Services Associated with AWS:

- AWS Security Hub: Leveraging AWS Security Hub to centralize and automate security findings from various AWS services, facilitating a comprehensive evaluation.

- AWS Config: Utilizing AWS Config to assess, audit, and evaluate the configurations of AWS resources against established policies.

Services Associated with Azure:

- Azure Security Center: Implementing Azure Security Center to gain insights into the security posture of Azure resources and ensure compliance with established standards.

- Azure Policy: Using Azure Policy to define, enforce, and assess policies that govern security and compliance across Azure resources.

Objective Evidence:

- Evaluation Reports: Documentation of reports generated from periodic evaluations, showcasing the findings and assessments of security policies and procedures.

- Policy and Procedure Documentation: Comprehensive documentation of security policies and procedures, highlighting their alignment with the requirements of this subpart.

- Response to Changes: Records demonstrating the organization's responsiveness to environmental or operational changes and corresponding adjustments to security measures.

Possible Technology Considerations:

- Security Information and Event Management (SIEM): Implementation of SIEM solutions to collect, analyze, and respond to security events, enhancing the technical aspect of evaluations.

- Automated Compliance Tools: Deployment of automated tools that assess and ensure compliance with security policies and procedures.

- Continuous Monitoring Solutions: Use of continuous monitoring solutions to track and evaluate security controls and configurations in real-time.

What Needs to Be Answered:

- How effective are the periodic technical and nontechnical evaluations in assessing the alignment of security policies and procedures with HIPAA requirements?

- How well does the evaluation process adapt to changes in the environment or operations that may impact the security of ePHI?

- How is technology utilized to enhance the technical aspects of evaluations, ensuring a comprehensive assessment of security controls?

- How are the findings of evaluations documented and reported, and what mechanisms are in place to track and address identified gaps?