HIPAA Compliance on Microsoft Azure: How to Achieve and Maintain

| Author , tagged in azure, hipaa
Cloudticity, L.L.C.

Moving the patient data of large healthcare organizations to the cloud simply makes sense. The reliability, redundancy, speed, and scalability of cloud platforms make them vastly superior to antiquated on-premises systems for the data-intensive needs of the healthcare industry.

While this is true, there’s so much at stake in terms of regulatory compliance and data security that you need to be aware of. Nearly every business entity in the healthcare industry is required to abide by the Health Insurance Portability and Accountability Act, first signed into law in 1996. 

While the bulk of the law deals with insurance, it also sets out specific regulations for dealing with Protected Health Information.

All organizations are wise to spend time on making sure they are fully HIPAA compliant. Managing protected health information is a task that should never be taken lightly.

Patients place their trust in healthcare providers, and if individually identifiable health information is ever leaked or stolen, that trust is eroded, and may never return. Violations have a huge cost in both fines and the loss of business.

So where does an organization start to make sure HIPAA compliance on Azure is achieved at all levels and at all times?

In this article, we’ll explore how organizations that deal in large amounts of sensitive data can stay HIPAA compliant while utilizing Microsoft cloud services.

What Are the Risks to Health Care Data in the Cloud?

Risks are ever-present in the world of information technology. That’s why smart organizations adopt a posture of assuming failure in security measures so they can plan for redundant backups and lightning-quick responses.

When it comes to the cloud, there’s a perception that there may be a higher level of risk than on-premises servers. Following that logic dictates that since an organization maintains full physical control of its data center, they are in the best place to ensure access control, and deal with any problems as they arise.

The reality is that cloud-based data centers are probably more secure than any on-premises solution ever could hope to be. Companies like Amazon and Microsoft invest billions of dollars in keeping their facilities secure and limiting access to authorized users according to highly strict guidelines.

What Are the Ways That HIPAA Requires Covered Entities to be Compliant?

There are three major areas in which HIPAA and the associated “Health Information Technology for Economic and Clinical Health (HITECH) regulate healthcare entities.


First, privacy. This means that no private healthcare data can be disclosed without the explicit authorization of the patient. When a healthcare provider or insurance company has a relationship with a third party, this could create a situation where a privacy violation could occur. 

However, utilizing a cloud provider is fine, as long as certain steps are followed, which we’ll cover later in this article.


Second, is the important area of security. HIPAA and HITECH set out standards for how to safeguard data, so it isn’t accessed by any bad actors. Limiting access to data, using robust encryption and physical controls are all ways to ensure security.’


Finally, HIPAA and HITECH mandate that patients must be notified when a data breach occurs. Of course, companies can only make this notification if they know about a security incident. That’s why logs and audits are so important.

Why is it Essential to be Azure HIPAA Compliant?

Maintaining HIPAA compliance is the most important part of cloud architecture for healthcare providers and related businesses

The good news is that companies using Microsoft Azure as their cloud service provider will find it easy to achieve full compliance with the right configuration.

It is essential that HIPAA compliance be maintained both in-house and when outsourcing of protected health information (PHI) takes place.

This is because there are fairly severe penalties for failure to comply with regulations. Fines can run into tens of thousands of dollars. Fines can be issued daily, and rise steeply the longer they are not corrected.

There’s more to why it’s so important to have an adequate compliance program. When the trust between patients and providers or other HIPAA-covered entities is violated, they may be less likely to follow their healthcare provider's advice or return for follow-up care.

Can Microsoft Azure be HIPAA compliant?

The very design of HIPAA allows for cloud services to be compliant. Of course, it’s the way the services end up being used that determines if compliance is ultimately breached.

However, the selection of cloud service providers like Amazon Web Services (AWS), Google Cloud Platform, or Microsoft Azure can absolutely be successfully made compliant with all HIPAA regulations.

The First Step: the Business Associate Agreement

HIPAA regulates health care providers, health plans, etc. These are called “Covered Entities.” If covered entities outsource any portion of their business, they need to officially add them as a “Business Associate.” 

This requires signing a contract that the outsourced business entity will comply with all regulations concerning protected health information (PHI). This is what’s known as the HIPAA Business Associate Agreement or, BAA.

Thankfully, Microsoft, as a frequently used cloud environment in the healthcare sector, is very familiar with this agreement, and will be more than happy to sign it. In fact, the HIPAA business associate agreement is made available by default to all HIPAA-covered entities.

It is important to note that simply signing the Business Associate Agreement does not in itself make any company HIPAA compliant. This is simply the first step. The rest is up to you. So how do you make sure you are HIPAA compliant from the start? Here are some tips on the first steps to take.

Steps to Ensuring Full HIPAA Compliance

Once your HIPAA BAA is on the books, you can begin using Microsoft Azure to transmit and deal with personal health information. Of course, you must do so in a way that is fully compliant with HIPAA. 

The Office for Civil Rights (OCR) within the Department of Health and Human Services (HHS) is charged with investigating HIPAA violations, and carrying out enforcement actions. They perform periodic inspections and audits of covered entities.

You’ll want to make sure you have these important actions covered, so you are prepared in case you ever need to deal with the OCR. 

It can make the difference between a minor infraction and simply taking corrective action, paying massive fines, and facing a public relations disaster. Here are several steps to get started.

Decide On Access Controls

There’s a good principle to follow: limit access to PHI to the fewest number of people possible. This is called the “least privilege model.” While there’s good reason to trust your screened and trained employees, every person with access to confidential information is a potential risk.

It’s not just the number of employees that you need to limit. It’s also the level of access to information that each has. It should be limited to the bare minimum needed for them to perform their assigned task.

Develop a Contingency Plan

As stated above, assuming that failures and data breaches will take place put you in the driver's seat. You’ll be able to deal with those incidents in the minimum time, with minimal damage. While even minor violations should be avoided, it’s much better to catch them when they are in the hundreds of dollars, not the thousands.

Implement Audit Controls 

Using automation to make thorough and complete logs is essential to performing periodic security audits. When a data breach occurs, it will be much easier to track down the source when you have complete logs.

Ensure Data Security During Transmission

The good news for users of the Microsoft Azure Platform is that it already uses a highly encrypted VPN for the transmission of data. Anything that is sent to the cloud services through the VPN will be protected from prying eyes in accordance with the standards that HIPAA sets.

Care should be taken that data is never transmitted outside of that VPN. It’s far too easy to email protected information, so employees need to be reminded of this.

Ensure Data Security at Rest

Unlike the included Azure VPN, which is automatic, data stored on the cloud servers is not automatically encrypted at rest. If you simply signed a contract and started moving data, you’d violate HIPAA from the start.

Instead, make sure that you utilize your own set of encryption keys. These keys should take advantage of the latest security protocols, making them nearly impossible to break.

Stringent Authentication Protocols

One of the benefits of migrating to the cloud is the availability of data across the globe. Conversely, this increases the risk that unauthorized people will access the data. Making sure that users who access records are who they say they are, and possess the proper credentials is of huge importance to maintaining compliance.

There are more and more ways to achieve this. The days of weak passwords formed by pets' names or birthdays are long gone. Whether they are patients or employees, lengthy passwords that are well beyond the reach of a brute force crack or social engineering must be required.

Authentication no longer ends at passwords. Two-factor authentication through the use of third-party apps, or at the very least through phone verification, is highly advisable.

Centralized Control Of Security Policies

Ensuring security over a highly complex network of global data centers isn’t an easy task. It’s made even harder when there’s no clear leadership on policy. A security team and team leader are necessary to implement and adapt security guidelines, and ensure they are being followed.

Onboard Tools From Microsoft Azure

One of the first places to begin ensuring HIPAA compliance is on the Azure platform itself. 

Azure was built from the ground up to work with large, complex organizations that deal with sensitive information. It’s even trusted by the Department of Defense, along with other Federal, state, and local agencies.

Microsoft made available several tools and sources of information to make sure that agencies and organizations are in full compliance with HIPAA or other regulatory schemes.

Azure Compliance

Azure has already put in place the tools needed that comply with HIPAA, as long as you use them and configure them correctly. They have over 100 different applications that ensure and certify HIPAA compliance. This is one of the first places you should start.

It’s important to note that as some healthcare companies in the US maintain a global presence, Azure Compliance can also assist with similar privacy protection laws in other countries.

Azure Trust Center

All the information you need to maintain HIPAA compliance is available in the Azure Trust Center. It’s a one-stop shop for the latest information and advice you’ll need to make sure your cloud platform is correctly configured to stay compliant.

Azure Security Center

Visibility is at the core of the Security Center. It allows you to view the current security state at a glance. It prioritizes alerts, provides recommendations, and helps you respond quickly to any threats. It’s also engineered in a way to reduce false alarms, which is vital to maintaining a vigilant security posture.

HIPAA Compliance with Microsoft Azure is Highly Feasible

While the regulations may seem complex and intimidating at times, compliance is well within your grasp. Here are some final thoughts on how to make sure your organization gets started off on the right foot when you utilize Azure for protected health information.

Teamwork Makes the Process Easier

Having a dedicated compliance team is essential at all steps of your migration process. Make sure that all disciplines and departments are represented on the team. The compliance team can train and educate the entire organization on what needs to be done.

Take Advantage of Resources

Informational resources and training are abundant. Make sure your compliance team understands the issues inside and out, then have the entire organization follow their lead.

Recognize the Importance of HIPAA

Throughout the process of migrating to Azure and taking all the necessary steps to ensure compliance, it helps to have the right frame of mind. Healthcare is about much more than just profit and loss. It’s about prolonging and improving the quality of patient lives.

At the core of that is the idea of personal dignity and privacy. Protecting that is why HIPAA compliance is so important.

Want to learn more about how you can achieve and maintain HIPAA compliance on Azure? Download the full white paper.

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