HIPAA Audit Logs: What Are the Requirements for Compliance?

HIPAA audit log requirements are not difficult to follow, and they can help bolster your company’s overall security posture.

What are HIPAA audit logs?HIPAA audit logs are records of who accessed the network, at what time, what actions they took, and what documents or data they viewed in order to create a log of activities. Audit logs are a requirement for HIPAA compliance.

What Is the Purpose of an Audit Log?

IT systems process thousands of individual events each day: security incident events, user access events, configuration adjustment events, and so on. Understanding these events, recorded as audit logs, is critical for administrators and security experts because they show when and how things happen and whether they went wrong. They are a critical component of security risk management.

To maintain records of these events in a useful way, a secure system keeps audit logs that provide a log of evidence that can be used for compliance reporting and forensics in cases of a HIPAA breach.

What Are HIPAA Audit Log Requirements?

The Health Insurance Portability and Accountability Act (HIPAA) is a critical piece of legislation that aims to protect the privacy and security of patients’ protected health information (PHI). To maintain compliance with HIPAA, healthcare organizations and their business associates must adhere to specific requirements, including implementing audit logs. These audit logs serve as a mechanism to monitor and record electronic PHI (ePHI) activities and help detect unauthorized access or potential security breaches.

HIPAA audit logging requirements mandate that healthcare organizations and their partners maintain comprehensive logs of all activities related to ePHI. This includes tracking access, modifications, deletions, and data movements. The audit logs must capture sufficient information to identify the individual or entity responsible for the action, the date and time of the activity, and the specific data affected. The information must be stored securely and be tamper-proof, ensuring its integrity and availability for review in case of security incidents or investigations. Additionally, healthcare organizations must periodically review and analyze the audit log data to identify and address potential risks to the security and privacy of ePHI. By maintaining an adequate audit logging system and routinely assessing its data, organizations can meet HIPAA compliance requirements and improve their overall cybersecurity posture, safeguarding sensitive patient information from potential threats.

Uses of Audit Logs

Typical uses of audit logs include the following:

• Audit Logs for Compliance: Most security regulations (including HIPAA) require audit logs. These logs serve the dual purpose of ensuring that an organization can investigate data breaches and provide evidence of compliance during audits.
• Audit Logs for Forensics: Once a data breach occurs, an organization must work fast to mitigate the issue and understand it to remediate security problems. This process is impossible in large IT infrastructures without reliable audit logs.
• Audit Logs for Disaster Recovery: If a non-security issue occurs, which results in data loss or system interoperability, enterprises must move fast to get things back up and running. Automated and manual recovery efforts will rely on audit logs to ensure that they understood and solved the problem and avoid it in the future.

Features of Audit Logs

A proper audit log system for modern enterprise infrastructure typically includes at least some, if not all, of the following features:

• Automation: Logs must register in a system automatically upon the occurrence of an event. This can include attempts to log into a system, monitor access to specific resources, and track changes to files, folders, and databases. Furthermore, administrators should be able to streamline system audits in quick workflows with little or no overhead.
• Immutability: An audit log isn’t worth much if it isn’t reliable, and hacks or data corruption related to audit logs can render a chain of evidence worthless. A natural audit log system must include some way to guarantee that a record is accurate, untouched, and trustworthy.
• Robust Information: Audit logs can track almost any piece of information you want, but some information is more valuable than others. A complete audit log system should store key information about any event, including data and time stamps, descriptions of events, affected systems, and any errors or warnings.

It’s important to note that cybersecurity and IT audit logs aren’t necessarily the same as financial audit logs, although they often overlap.

HIPAA Laws and Audit Logs

HIPAA regulations define specific HIPAA security requirements for all electronic protected health information (PHI) and the systems that contain it, as well as maintaining logs of system activity.

The Privacy and Security Rules designate that all healthcare providers and insurance companies (Covered Entities) and their business partners (Business Associates) must maintain physical, technical, and administrative controls over confidentiality, integrity, and availability of patient information. This includes maintaining critical audit logs around the access and processing of that data.

Per HIPAA regulations, a compliant system will include the following types of audit logs:

• Application Audit Logs: Audit logs must monitor user activity for people using any applications, including workstation and cloud applications. These logs will monitor how files are opened and closed, created, edited, and deleted.
• System-level Audit Logs: System audit logs will record system-wide events, including system shutdowns or reboots, user authentication and authorization, and resource access by specific users.
• User Audit Logs: These audit logs might seem similar to system-level logs, but they focus more specifically on user activity, including access to PHI and any system commands executed by that user.

HIPAA Audit Log Requirements

Following these requirements, a CE or BA must track the following events through audit logs:

• User login attempts, successful or unsuccessful
• Changes to databases storing PHI
• Adding, removing, or changing permissions and roles for users in the system
• Access to files, databases, or directories by users
• Firewall logs tracking attempted connections into and out of the security perimeter of the system
• Logs of anti-malware software
• Access to paper records

Additionally, because HIPAA regulations are so widespread and prioritized, the National Institute of Standards and Technology (NIST) released Special Publication 800-66, a document that outlines how organizations can meet HIPAA security requirements. This publication includes guidelines on how organizations can think about implementing audit logs, including questions that guide organizations to implementing audit logs.

These questions include the following:

• Where is ePHI within IT systems, and where is it vulnerable?
• What activities, applications, or processes render ePHI vulnerable, including locations where it is available to access by internal or external stakeholders?
• What activities inside and outside an IT system should be monitored for specific or potential interaction with ePHI?
• How will logs be reviewed? By whom, on what schedule, and through what mechanisms?
• How will reporting work, who will handle reports, and how will they be processed?
• How will suspect activity, confirmed breaches, and security investigations operate, and how will they utilize existing logs?
• How can the system administrators protect the integrity of these logs within HIPAA standards?

A full rundown of HIPAA audit log suggestions can be found in NIST SP 800-66.

It becomes apparent after reviewing such questions that audit logs cover several practices, media, and processes. For example, an employee checking out a tablet might complete a paper sign-out sheet and log into the device, both of which provide a record of procurement (one a relatively accurate paper record with a date and time and the other a digital user event).

Common Elements in HIPAA Audit Logs

In order to effectively understand and implement HIPAA audit logs, it is crucial to familiarize ourselves with the common elements that comprise these logs. The table presented below outlines the key components typically found in HIPAA audit logs. With a better understanding of these elements, healthcare organizations and their business associates can gain valuable insights into user actions, resource access, and the overall security of PHI. This table serves as a reference guide, shedding light on the essential details that should be included within audit logs to ensure compliance with HIPAA regulations.

By employing these elements in their audit logging practices, organizations can strengthen their HIPAA compliance efforts and bolster the security of sensitive patient information.

HIPAA Audit Log Requirements for Cloud Service Providers

There are specific requirements under HIPAA that apply to cloud service providers and the use of audit logs, which, once again, are an essential component of HIPAA compliance.

When using a cloud solution for storing or sharing PHI, covered entities and their business associates must ensure that the cloud service provider has implemented appropriate measures in accordance with HIPAA. Here are some key considerations for cloud service providers regarding audit logs:

1. Access Controls: The cloud service provider must maintain audit logs to track and monitor access to electronic protected health information (ePHI). This includes recording user activities such as logins, logouts, and any modifications made to ePHI.
2. Timestamps: Audit logs should include accurate timestamps indicating when events occurred. These timestamps help establish an audit trail and enable the reconstruction of events if necessary.
3. User Identification: Audit logs should capture unique user identification information, allowing the association of specific actions with individual users. This helps in tracking any unauthorized access or activity.
4. Integrity: Audit logs must be protected against unauthorized alteration or deletion. They should be tamper-evident, ensuring that any modifications or attempts to tamper with the logs are detectable.
5. Retention and Availability: HIPAA requires the retention of audit logs for a specified period (at least six years). Cloud service providers must ensure that audit logs are securely stored and available for review when needed.
6. Review and Analysis: Covered entities and business associates should regularly review and analyze the audit logs to identify any potential security incidents or breaches. This helps in detecting and responding to unauthorized access or activities promptly.

It is important to note that the specific implementation details and requirements may vary depending on the cloud service provider and the services being utilized. Covered entities and business associates should establish appropriate agreements and conduct due diligence to ensure that their chosen cloud service provider complies with all HIPAA regulations regarding audit logs and overall data security.

HIPAA Log Retention Requirements

There is some debate over whether or not audit logs fall under the six-year rule for document retention under HIPAA. On the one hand, audit logs in IT systems handling PHI seem to be a clear candidate for audit log retention. On the other hand, audit logs don’t always contain or disclose PHI. Requiring mandatory retention could unintentionally expose business secrets or cause undue burden on organizations.

HIPAA rules and the Department of Health and Human Services don’t specify 100% what information must be logged and thus what should be maintained for six years. The short answer that many experts give is that if risk analysis and clear justifications are given to why some logs are retained and others or not, HHS can make a supportive ruling for compliance requirements.

It is nevertheless a best practice to retain the logs and secure them from unauthorized access, and be available for review by the entity’s designated privacy officer or security personnel. The retention period begins on the date the log is created and continues for preferably six years, even if the covered entity goes out of business or is acquired by another entity. Compliance with the retention requirements is crucial for avoiding potential HIPAA violations, as well as maintaining the privacy and security of patients’ PHI.

Consequences of Noncompliance With HIPAA Audit Log Requirements

Failure to comply with HIPAA audit log requirements can result in the following consequences:

1. Penalties and Fines: Noncompliance with HIPAA audit log requirements can lead to penalties and fines imposed by the Office for Civil Rights (OCR), which enforces HIPAA regulations. The fines can range from $100 to $50,000 per violation, depending on the severity and willfulness of the noncompliance. In some cases, organizations may face multiple violations, leading to substantial financial penalties.
2. Legal Liability: Noncompliance can expose organizations to legal liability, including potential lawsuits from affected individuals or entities. If patient data is compromised or misused due to inadequate audit log controls, organizations may be held accountable for any resulting harm or privacy breaches. Legal actions can result in significant financial damages and reputational harm.
3. Loss of Trust and Reputation: Failing to comply with HIPAA audit log requirements can damage an organization’s reputation and erode trust among patients, partners, and stakeholders. Breaches of patient privacy and security can lead to negative publicity, loss of customers, and a diminished standing within the healthcare industry.
4. Increased Scrutiny and Audits: Noncompliance may trigger increased scrutiny from regulatory bodies, such as OCR. Organizations may face audits, investigations, or compliance reviews, which can consume significant time, resources, and cause disruptions to normal operations. These audits may assess an organization’s overall compliance with HIPAA regulations, including the audit log requirements.
5. Corrective Action Plans: In cases of noncompliance, OCR may require organizations to develop and implement corrective action plans to address deficiencies and prevent future violations. These plans often involve implementing additional security measures, improving policies and procedures, conducting staff training, and demonstrating ongoing compliance efforts.
6. Exclusion From Federal Programs: Noncompliance with HIPAA audit log requirements can result in exclusion from participating in federal healthcare programs, such as Medicare and Medicaid. Being excluded from these programs can have severe financial consequences for healthcare providers and organizations.

It is important for covered entities and business associates to understand and comply with HIPAA audit log requirements to protect patient privacy and security and avoid these potential consequences. Organizations should establish robust audit log systems, regularly review and analyze logs, and maintain documentation to demonstrate compliance with HIPAA regulations.

Common Challenges in Collecting and Managing HIPAA Audit Logs

One major challenge presented by HIPAA audit logs is the sheer volume of data that needs to be captured and stored. As organizations increasingly embrace technologies that generate, process, and store PHI, including cloud computing and Internet of Things (IoT), the amount of data generated can quickly become overwhelming.

Another challenge is ensuring that the audit logs are complete and accurate. Any gaps or errors in the data can compromise the effectiveness of the logging system and make it difficult to identify security incidents or other issues. Additionally, it can be challenging to ensure that the logs are accessible and secure, while also complying with regulatory requirements and data protection laws. Finally, developing an effective strategy for analyzing and interpreting audit logs can be a complex task, requiring specialized skills and tools to extract meaningful insights from the data.

What Is an Internal HIPAA Audit Checklist?

An Internal HIPAA Audit Checklist is a tool CEs and BAs use to verify that they comply with the Health Insurance Portability and Accountability Act (HIPAA). It provides a systematic way for these firms to review and update their HIPAA policies and procedures. It typically includes sections covering team member training, computer systems, data storage, and physical security.

CEs and BAs benefit from using an Internal HIPAA Audit Checklist by detecting errors and vulnerabilities compromising the security and privacy of protected health information (PHI). This helps them avoid accidental noncompliance with HIPAA regulations, which could lead to financial penalties, lawsuits, and damage to the company’s reputation.

How Does Kiteworks Help With HIPAA Audit Log Compliance?

Using a centralized platform to handle documents and files can support HIPAA compliance by bringing together the tools necessary to maintain that compliance, including comprehensive audit logging.

The Kiteworks platform brings together several key features for HIPAA compliance:

• Security and Compliance: Kiteworks utilizes AES-256 encryption for data at rest and TLS 1.2+ for data in transit. Its hardened virtual appliance, granular controls, authentication, other security stack integrations, and comprehensive logging and audit reporting enable organizations to easily and quickly demonstrate compliance with security standards. It has out-of-the-box compliance reporting for industry and government regulations and standards, such as HIPAA, the Payment Card Industry Data Security Standard (PCI DSS), SOC 2, and the General Data Protection Regulation (GDPR).

In addition, Kiteworks touts certification and compliance with various standards that include, but are not limited to, the Federal Risk and Authorization Management Program (FedRAMP), Federal Information Processing Standards (FIPS), the Federal Information Security Management Act (FISMA), Cybersecurity Maturity Model Certification (CMMC), and the Information Security Registered Assessors Program (IRAP).

• Audit Logging: With the Kiteworks platform’s immutable audit logs, organizations can trust that attacks are detected sooner and maintain the correct chain of evidence to perform forensics. Since the system merges and standardizes entries from all the components, its unified Syslog and alerts save security operations center teams crucial time and help compliance teams to prepare for audits.
• SIEM Integration: Kiteworks supports integration with major SIEM solutions, including IBM QRadar, ArcSight, FireEye Helix, LogRhythm, and others. It also has the Splunk Forwarder and includes a Splunk App.
• Visibility and Management: The CISO Dashboard in Kiteworks gives organizations an overview of their information: where it is, who is accessing it, how it is being used, and if sends, shares, and transfers of data comply with regulations and standards. The CISO Dashboard enables business leaders to make informed decisions while providing a detailed view of compliance.
• Single-tenant Cloud Environment: File transfers, file storage, and user access occur on a dedicated Kiteworks instance, deployed on-premises, on an organization’s Infrastructure-as-a-Service (IaaS) resources, or hosted as a private single-tenant instance by Kiteworks in the cloud by the Kiteworks Cloud server. This means no shared runtime, shared databases or repositories, shared resources, or potential for cross-cloud breaches or attacks.

To learn more about how Kiteworks enables custom HTML audit logs, schedule a custom demo of Kiteworks today.

Additional Resources

• Blog Post Everything You Need to Know About HIPAA Compliance [Complete Checklist]
• Blog Post Managed File Transfer & HIPAA-compliant Solutions
• Blog Post Top HIPAA-compliant Forms
• Blog Post HIPAA Encryption: Requirements, Best Practices & Software
• Blog Post Send HIPAA-compliant Email