HIPAA Expert Determination: Everything You Need to Know

For 13 years and counting, the healthcare industry has topped the list for the most frequent and expensive data breaches. According to IBM’s 2023 Cost of a Data Breach Report, the cost of healthcare data breaches has risen more than 53% since 2020, reaching an average of $10.93M per incident.

In spite of the size and profitability of the healthcare and life sciences industry, the price of these violations can be crippling – not to mention the reputational damages and loss of patient trust that are likely to follow a breach.

The Health Insurance Portability and Accountability Act (HIPAA) is the leading data compliance regulation protecting sensitive health data, and adhering to its standards is essential for avoiding such penalties and fines. But doing so can be complicated, and its Expert Determination method – a key consideration for HIPAA security compliance – is not well understood.

In this blog, we’ll clarify the key aspects of HIPAA Expert Determination and best practices for implementing it in a way that doesn’t delay speed to data and insights.

What is HIPAA Expert Determination?

The HIPAA Expert Determination method is a process by which qualified experts with requisite knowledge and skills evaluate a healthcare organization’s security measures in order to assess potential risks to protected health information (PHI). These experts analyze policies, procedures, and technical safeguards to identify vulnerabilities, assess compliance with HIPAA standards, and propose risk mitigation strategies.

Given the overall complexity of HIPAA’s requirements, the expert determination method provides an additional line of defense against threats to PHI. It also provides patients and customers with the assurance that healthcare companies are upholding data security and privacy standards.

5 Challenges to Achieving HIPAA Compliance

Achieving compliance with HIPAA’s standards is essential, but not necessarily straightforward. It requires a combination of legal and technical expertise that must be built into organizational structures, in addition to training for all employees on expectations for handling data and protecting patients’ privacy.

Five common challenges to integrating the HIPAA Expert Determination method and achieving compliance are:

1. Resource Constraints – Engaging qualified experts and dedicating sufficient resources to conducting thorough risk assessments is resource-intensive and often expensive, especially for smaller healthcare organizations.
2. Technological Advancements – Rapid technological developments, including new types of AI models, are changing the data landscape every day, and in doing so, introducing novel security risks. Keeping up with these emerging tools and evolving threats requires continuous attention, education, and investment.
3. Interoperability Issues – Data sharing across organizations is key to painting a full picture of patients’ health or developing the next breakthrough drug. But integrating disparate systems while enforcing consistent privacy controls can be slow and dubious.
4. Human Error – Despite technical safeguards and awareness training, humans are liable to make mistakes, whether intentional or not. Mitigating the possibility of human error from data practices is an evasive task for healthcare organizations.
5. Third Party Risks – Sharing PHI with third parties, such as external researchers, public health officials, or insurance companies, requires healthcare companies to ensure that data is being adequately protected in transit and used appropriately on the receiving end.

In spite of these challenges, the right preparation and structure make implementing the HIPAA Expert Determination method and meeting data privacy compliance requirements a more seamless and straightforward process.

Best Practices for HIPAA Expert Determination

Effectively integrating HIPAA Expert Determination requires a comprehensive approach. Best practices for doing so include:

Enlist Qualified Experts

It may go without saying, but deep subject matter expertise in healthcare data security, privacy law, and HIPAA requirements is critical to getting Expert Determination right. A qualified expert must demonstrate an understanding of your organization’s systems and processes, tech stack, departmental structure, and use cases, and be able to bridge the gap between legal stipulations and technical solutions.

Look for someone who has experience in healthcare, the legal system, and conducting risk assessments, so they can form a holistic view of your ecosystem, its gaps, and how to realistically mitigate risks. Read more from the Department of Health and Human Services here.

Go Beyond Risk Assessments

Periodically conducting risk assessments is table stakes – putting indicators in place for the interim periods, however, is a best practice. While this sounds like a time- and resource-intensive approach, incorporating a data monitoring tool that provides access behavior analytics, risk severity scoring, sensitive data views, and anomaly alerts gives your team an always-on backup that allows you to proactively address abnormalities.

The ability to investigate audit logs and generate reports on-demand is a secondary benefit of continuous security monitoring that eases the burden of proving compliance at any moment.

Adopt Technical Safeguards for Security

The specificity of HIPAA’s security and privacy requirements – for instance, that PHI usage should be limited to the minimum necessary degree – make them difficult to account for when using homegrown safeguards. This is particularly true as operations scale, as is often the case in large healthcare organizations.

To ensure that data security and compliance are achieved, adopting a data security platform that offers an all-in-one suite of tools which can be deployed across any platform is a best practice for mature and growing organizations. Curious what to look for in such a tool? Skip to the next section to find out.

Establish an Incident Response Plan

The HIPAA Expert Determination method directs designated experts to propose mitigation strategies targeting data breaches and noncompliance. Realistically, such strategies are not foolproof. Putting a data breach response plan in place ensures that you won’t be caught flat-footed in the event of a compromising incident, allowing you to minimize any harm.

Create your response plan with input from your HIPAA expert(s), data platform and security teams, and in-house legal counsel, and share it with employees who regularly handle data.

Mandate Training and Awareness

The best way to ensure your entire organization is equipped to manage data appropriately and respond to incidents effectively is to provide periodic training. Educating employees about their role in protecting PHI and complying with HIPAA reinforces a culture of responsibility, while raising awareness about emerging threats.

Since data security and HIPAA compliance may not be top of mind across all functions, mandating training is a best practice for ensuring it is completed in a holistic and timely manner.

Stay Up-To-Date on Regulatory Changes

HIPAA has been enforced since 1996, but it is by no means static. Since being enacted, there have been a number of updates to strengthen its requirements and respond to changing environmental, behavioral, and technological factors. It is safe to assume that HIPAA will continue to evolve and expand, so staying abreast of modifications and how best to incorporate them will minimize change management complexity and lapses in compliance.

What to Look for in a Tool for HIPAA Compliance

Achieving compliance with HIPAA does not have to be a manual process. In fact, given the aforementioned challenges, it should not be. Adopting a tool that addresses HIPAA’s requirements and helps inform the Expert Determination method is the most straightforward and effective way to meet compliance standards.

Here are the key capabilities to look for in a tool for HIPAA compliance:

• Automation – When it comes to data use in the healthcare and life sciences sector, time is of the essence. Incorporating automation into your workflows (for instance, via automated policy enforcement) helps reduce delays, lag time, and room for human error, so data moves efficiently throughout your ecosystem.
• Data Discovery & Classification – How much PHI exists in your data platforms and where exactly does it live? Without a data discovery solution that also provides automated data classification, it’s significantly more difficult to ensure that all of your PHI is accounted for and appropriately tagged for policy enforcement.
• Scalable Access Control – If there’s one feature not to overlook when choosing a tool for HIPAA compliance, it’s data access control. However, legacy role-based approaches no longer cut it. In today’s world, where rates of data use and sharing are increasing exponentially, attribute-based access control is the gold standard for ensuring only the right people can access the right data at the right time, and – importantly under HIPAA – for the right reasons. Read more about role-based access control vs. attribute-based access control for the full explanation.
• Advanced Data Masking – Expert Determination is one of two methods to satisfy the HIPAA Privacy Rule’s de-identification standard. The other, Safe Harbor, defines 18 types of sensitive data that must be removed from data sets. Regardless of which method you use, enlisting a tool that offers dynamic data masking and advanced privacy enhancing technologies (PETs) safeguards PHI with mathematical guarantees.
• Centralized Policy Management – According to the 2024 State of Data Security Report, 33% of data professionals cited a lack of visibility into data usage and sharing as their biggest data security challenge. Managing and enforcing policies from a single platform increases visibility and ensures that policies are applied consistently across platforms.
• Data Monitoring – The best data breach response is the one that never has to happen in the first place. Having a data monitoring tool in your stack is the most surefire way to make this a reality and improve data security posture management. The ability to analyze data access, usage, and sharing, and identify anomalies in real time allows you to proactively respond to threats and simplify HIPAA compliance.

The most secure, resilient tool is one that combines all of these capabilities into a single platform. This removes the need to coordinate various disparate solutions across all of your platforms and users, so you can seamlessly establish secure workflows that don’t inhibit data analytics or compromise HIPAA compliance.

To see how Immuta protects sensitive healthcare data in Snowflake, check out this demo.