Source: http://bluecoreresearch.com/education/compliance/hipaa/hipaa-detail/?pageno=all
Timestamp: 2019-04-19 10:51:06+00:00

Document:
HIPAA is the Health Insurance Portability and Accountability Act. HITECH is the Health Information Technology for Economic and Clinical Health Act. These are Federal Laws in the United States that requires, among other things, to protect individual’s health care information. Below is a detailed analysis of the laws and the regulation with relation to Oracle database auditing, and how this translates to practical requirements.
Title 42 of the United States Code is the Public Health and Welfare. Chapter 156 is Health Information Technology. Subchapter III is Privacy. Part A (§17931 – §17940) is Improved Privacy Provisions and Security Provisions.
In other words, we need to look at the regulation to see how HIPAA and HITECH should be implemented.
Title 45 of the Code of Federal Regulations is the Public Welfare and Human Services. Part 164 deals with Security and Privacy.
To help you understand how HIPAA relates to Oracle database auditing, we’ve included relevant portions of the regulations, with our interpretation of the requirements in practical technical terms.
(1) Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.
(2) Protect against any reasonably anticipated threats or hazards to the security or integrity of such information.
(3) Protect against any reasonably anticipated uses or disclosures of such information that are not permitted or required under subpart E of this part.
The “General Rules” are important as they explain the intention of the regulation. Don’t be dismayed by the generality of these paragraphs as HIPAA provides a lot more detail later on.
§ 164.308 (a)(1)(i) Standard: Security management process.
Implement policies and procedures to prevent, detect, contain, and correct security violations.
(A) Risk analysis (Required). Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity.
(B) Risk management (Required). Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with §164.306(a).
(C) Sanction policy (Required). Apply appropriate sanctions against workforce members who fail to comply with the security policies and procedures of the covered entity.
(D) Information system activity review (Required). Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.
§ 164.308 (a)(3)(i) Standard: Workforce security.
Implement policies and procedures to ensure that all members of its workforce have appropriate access to electronic protected health information, as provided under paragraph (a)(4) of this section, and to prevent those workforce members who do not have access under paragraph (a)(4) of this section from obtaining access to electronic protected health information.
(A) Authorization and/or supervision (Addressable). Implement procedures for the authorization and/or supervision of workforce members who work with electronic protected health information or in locations where it might be accessed.
(B) Workforce clearance procedure (Addressable). Implement procedures to determine that the access of a workforce member to electronic protected health information is appropriate.
An “Addressable” requirement can have different implementations depending on the environment, and alternate implementations could be acceptable given documentation of the justification.
Authorization – only employees that should have access to PHI should be granted such access. In most cases, only the application should access PHI.
§ 164.308 (a)(4)(i) Standard: Information access management.
Implement policies and procedures for authorizing access to electronic protected health information that are consistent with the applicable requirements of subpart E of this part.
(A) Isolating health care clearinghouse functions (Required).
If a health care clearinghouse is part of a larger organization, the clearinghouse must implement policies and procedures that protect the electronic protected health information of the clearinghouse from unauthorized access by the larger organization.
Implement policies and procedures for granting access to electronic protected health information, for example, through access to a workstation, transaction, program, process, or other mechanism.
(C) Access establishment and modification (Addressable).
Implement policies and procedures that, based upon the entity’s access authorization policies, establish, document, review, and modify a user’s right of access to a workstation, transaction, program, or process.
Establishment – the process for determining whether access should be granted, and the type of access needed.
Review – the method used to audit all the steps.
§ 164.308 (a)(5)(C) Log-in monitoring (Addressable).
The login monitoring requirement is very clear – HIPAA compliance requires monitoring of successful and failed logins to the Oracle database.
(a)(1) Standard: Access control. Implement technical policies and procedures for electronic information systems that maintain electronic protected health information to allow access only to those persons or software programs that have been granted access rights as specified in §164.308(a)(4).
Paragraph (a) clearly states that auditing is required. The likely implementation in Oracle databases is auditing of SQL activity in general, and one that accesses PHI in particular.
Limit access to PHI. Usually that would mean that only the application (and DBAs) could write to tables containing PHI.
§ 164.530 (c)(1) Standard: Safeguards.
A covered entity must have in place appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information.
A covered entity must reasonably safeguard protected health information from any intentional or unintentional use or disclosure that is in violation of the standards, implementation specifications or other requirements of this subpart.
(ii) A covered entity must reasonably safeguard protected health information to limit incidental uses or disclosures made pursuant to an otherwise permitted or required use or disclosure.
Least Privilege – make sure access to such information is as restricted as possible. In most cases, only the application (and DBAs) will have access.
Additional suggestions are available in the last section below.
High SQL Volume – report on unusually high frequency of particular SQLs, from particular accounts, machines etc.

References: §17940

§ 164
 §164

§ 164

§ 164

§ 164
 §164

§ 164