HIPAA Backup Requirements

HIPAA, the 1996 Health Insurance Portability and Accountability Act, established national requirements for safeguarding protracted health information (PHI). HIPAA’s Security Rule provides certain requirements for data backup and storage of ePHI, all of which are mandatory. These requirements are intended to ensure that healthcare organizations will be able to protect PHI from unauthorized access, corruption, or loss while also maintaining the integrity and availability of such information. In this article, we dive deeper into HIPAA backup requirements and learn core backup principles for HIPAA compliance.

The Importance of Data Backup in Healthcare

Data backup is essential for ensuring the protection, availability, and integrity of critical information. Healthcare organizations manage vast amounts of sensitive data, including electronic health records (EHRs), test results, and billing information, which are critical for providing accurate and timely patient care. In the event of data loss due to cyberattacks, human error, system failure, or natural disasters, regular backups ensure that this information can be quickly restored, minimizing downtime and preventing operational disruptions.

Backups help recover quickly from ransomware

The ransomware attack on Ascension Health in mid-2024, an extensive healthcare system in the US, underscores the importance of robust data backup and recovery strategies. The attack severely disrupted the operations of numerous hospitals, forcing them to divert ambulances, close pharmacies, and resort to manual record-keeping. Roughly 5.6 million individuals fell victim to the hack, having their medical, insurance, identification, and payment information disclosed. While sensitive data disclosure posed significant financial and legal ramifications, Ascension successfully restored full operations within a few weeks, demonstrating the effectiveness of its backup and recovery measures.

Backups help minimize human error

Data backups play a critical role in minimizing the impact of human error in healthcare by ensuring that vital patient information remains accessible and secure. Errors such as accidental file deletion, incorrect data entry, or overwriting records can compromise patient care and operational efficiency. With regular backups, healthcare providers can quickly restore lost or corrupted data, ensuring continuity of care and compliance with HIPAA and other regulations. By providing an additional layer of security, backups help mitigate risks associated with human mistakes, safeguard sensitive information and maintain trust in healthcare systems.

Backups ensure business continuity amid natural disasters

California wildfires highlight the critical importance of robust data backups amid unforeseen natural events. Disasters like these can disrupt operations, forcing closures of clinics and potentially compromising patient data. In the face of wildfires, reliable data backups enable healthcare providers to recover critical data quickly and resume operations, ensuring patient safety and continuity of care.

HIPAA Requirements for Data Backup and Recovery

A complete understanding of all HIPAA backup requirements is essential to maintain compliance. Meanwhile, it also ensures a respectable level of security for sensitive patient information. The HIPAA Security Rule requires all covered entities to implement a detailed data backup plan. Part 45 CFR 164.308(a)(7)(Ii)(A) of the HIPAA Security Rule requires establishing and implementing procedures to create and maintain retrievable exact copies of PHI. Most backup attributes, including their frequency, depend on the organization's environment. However, there are common recommendations of what data backup plan should include:

• procedures for recovering data that has been lost;
• procedures that ensure that the exact copies of existing ePHI are always available;
• protocols for maintaining critical business functions during emergencies;
• regular testing and updates to security measures to ensure continued compliance with HIPAA standards.

Core Backup Principles for HIPAA Compliance

Classify ePHI based on sensitivity

Effective data classification during backups is a cornerstone of robust data management. Classifying PHI may include the following:

• Restricted/Confidential Data: This category includes data that, if disclosed, altered, or destroyed unauthorizedly, could result in significant harm. Such data demands the highest security measures and controlled access, adhering to the principle of least privilege.
• Internal Data: Data in this category could cause low to moderate damage if disclosed, altered, or destroyed without authorization. Although not intended for public release, it requires adequate security controls.
• Public Data: While public data does not require protection from unauthorized access, it still needs safeguards against unauthorized modification or destruction.

Organizations can optimize backup processes, prioritize critical information, and ensure HIPAA compliance by categorizing data based on its sensitivity and importance. For instance, highly sensitive ePHI may require encryption and frequent backups in geographically diverse locations, while less sensitive data might be backed up less frequently. This targeted approach also reduces storage costs by allocating resources more efficiently, focusing advanced protections on sensitive data while using simpler solutions for less critical information.

Adopt the 3-2-1 backup rule to HIPAA context

When doing data backups, technical experts recommend following the 3-2-1 rule. In HIPAA-related context, the rule looks like the following:

• 3 copies of ePHI
• 2 different storage media
• 1 off-site copy in a secure location

Storing backups on at least two different media types ensures greater reliability, as one medium can compensate for the failure of another. Meanwhile, keeping one backup copy offsite protects against localized disasters like floods, fires, or theft, ensuring data recovery is possible even in extreme scenarios. While the rule’s benefits are obvious, a survey revealed that fewer than one in five organizations follow the 3-2-1 rule, leading to multiple data recovery and restoration issues. Consider applying it for a simple yet highly effective framework for comprehensive data protection.

Encrypt backups

​​The HIPAA encryption requirements occupy a section of the Technical Safeguards in the HIPAA Security Rule (45 CFR §164.312). The purpose of the requirement is to ensure ePHI is unreadable, undecipherable, and unusable to any person or software program that has not been granted access rights. While HIPAA does not provide specific data encryption requirements, best practices recommend following the guidelines of NIST SP 800-111 for data at rest and NIST SP 800-52 for data in transit. The most widely used data encryption method for data at rest today is AES-256. This encryption algorithm converts readable data into an unreadable format, which can only be deciphered with a specific decryption key. TLS 1.2 or higher is the right method for encrypting data in transit. When combined with strong key management practices—such as storing keys in secure hardware modules and implementing regular key rotation—both AES-256 and TLS 1.2 provide a robust defense against data compromise.

Restrict access to healthcare backup to authorized individuals only

Maintaining robust access control is critical for safeguarding PHI backups, ensuring that only authorized individuals can view or manage sensitive data. Under HIPAA technical safeguards, organizations must implement role-based access controls, unique user identification, and robust authentication methods to restrict backup access. This includes multi-factor authentication (MFA), activity monitoring, and automatic session timeouts to prevent unauthorized access and misuse. These controls not only enhance security but also help maintain compliance. Read more about access controls in one of our articles, Reinforce the Weakest Security Link with Access Controls.

HIPAA Data Retention Policies

HIPAA data retention policies generally fall into two categories – HIPAA medical records retention and HIPAA records retention requirements. The distinction between the two categories is that there are no HIPAA medical records retention requirements (these are preempted by state laws), but requirements exist for other documentation. HIPAA states that covered entities and business associates must record any policies, procedures, actions, or training attestations carried out to comply with HIPAA standards. The HIPAA subsection 45 CFR §164.316(b)(2)(i) says that such records must be kept for a minimum of 6 years after their creation or, if the document outlined a policy, 6 years from when the policy was last implemented. The 6-year retention period refers to the date of creation or termination of the following documents:

• documentation of HIPAA policies and procedures;
• access logs and security incident records;
• BAAs (Business Associate Agreements);
• other HIPAA-related documentation.

Of course, these requirements represent only the bare minimum and are often fine-tuned or expanded, depending on the circumstances. These circumstances include specific medical record types, state-specific requirements with longer retention requirements, risk management considerations, clinical research needs, legal defense purposes, and more.

Regular testing and validation of data backup and recovery practices

HIPAA requires regular testing and validation of data backup and recovery processes to ensure the integrity and availability of ePHI. This involves conducting periodic backup restorations to verify that data can be successfully recovered in case of a system failure or data breach. Testing should cover all aspects of the backup system, including file integrity, recovery times, and compatibility with current systems. Failure to validate backups could make critical data inaccessible during emergencies, leading to potential compliance violations and operational disruptions. Proactive testing demonstrates due diligence, enhances system reliability, and ensures that ePHI remains protected and recoverable.

Meeting HIPAA Backup Requirements with Planet 9

Meeting HIPAA backup and retention requirements is highly important, yet it is not the only task of HIPAA-covered entities and business associates. Ensuring compliance with HIPAA involves a comprehensive approach that extends to regular risk assessments, employee training and awareness programs, and developing thorough policies and procedures to manage and respond to security incidents effectively. Planet 9 HIPAA-compliance services offer a comprehensive approach to ensuring and maintaining HIPAA compliance and include:

• Conducting a discovery to understand the client’s organization, business processes, and technologies.
• Performing a HIPAA evaluation to identify safeguards in place and compliance gaps.
• Performing a risk assessment to identify risks to PHI.
• Developing a roadmap for addressing the identified compliance gaps and risks
• Assisting the client in executing the roadmap.

You can also utilize the Planet 9 HIPAA Vitals application to assess your HIPAA compliance. The HIPAA Vitals assessment is based on several reputable sources, including the Office of Civil Rights (OCR) Audit Protocol, NIST 800-66 Rev. 1, HIPAA Security Series issued by the Department of Health and Human Services (DHHS), and years of experience implementing HIPAA requirements in different organizations by our professionals. Feel free to contact the Planet 9 team for help with your security and compliance challenges. We’ll be happy to assist!