Privacy Investigations and User Access Monitoring: 5 Things Healthcare Leaders May Not Be Thinking About

User access monitoring is a critical component of a healthcare cybersecurity strategy, serving as a digital sentry guarding the gates to patient data and proprietary information. As the healthcare sector becomes increasingly interconnected, the potential risks associated with unauthorized access and data breaches loom. This is where user access monitoring acts as a watchful guardian to ensure that only authorized personnel gain access to patient records and confidential data.

What is User Access Monitoring?

User access monitoring refers to systematically tracking and analyzing the activities and behaviors of users who interact with digital systems, networks, applications, and data within an organization. It involves continuously surveilling user actions, such as logging in, accessing files or databases, making changes to settings, and other relevant activities, to ensure that only authorized individuals use the resources and that their actions are within acceptable boundaries.

The primary goal of user access monitoring is to enhance security by preventing unauthorized access, detecting suspicious or anomalous behavior, and responding promptly to potential security threats or breaches. By closely monitoring user activities, organizations can:

Prevent Unauthorized Access: User access monitoring ensures that only users with proper credentials and permissions can access sensitive data, applications, and systems. This helps prevent unauthorized users from gaining entry and potentially compromising sensitive information.

Detect Insider Threats: Monitoring user activities allows organizations to identify unusual or inappropriate behavior by authorized users, which could indicate insider threats or data breaches conducted by employees, contractors, or other individuals with legitimate access.

Mitigate Security Risks: Timely detection of abnormal user activities or unauthorized access attempts enables organizations to take immediate actions to mitigate potential security risks, such as locking accounts, disabling access, or initiating investigations.

Ensure Compliance: Many industries, including healthcare, are subject to strict regulatory requirements concerning data privacy and security. User access monitoring helps organizations demonstrate compliance with these regulations by maintaining a comprehensive record of user interactions and data access.

Enhance Incident Response: In the event of a security incident or breach, user access monitoring provides valuable insights into the scope and impact of the breach, facilitating a more effective incident response and recovery process.

Questions for Healthcare Leaders

Healthcare leaders have been employing user access monitoring for some time now, as it’s crucial for maintaining data privacy and security. Still, how and to what extent organizations leverage this as part of their cybersecurity strategies can vary. The following questions involve best practices around user access monitoring but aren’t discussed as frequently as they should be:

  1. Is the monitoring program and work plan (i.e., alert types, frequency of reviews, investigation, sanctions recommendations, etc.) included in the organization’s risk analysis? Regular risk analyses can and should support priorities for the organization’s user access monitoring and auditing function. In addition, user access monitoring contributes to the organization’s overall risk analysis by providing real-time insights into the security posture.
  2. Are you performing proactive monitoring? Proactive monitoring involves implementing measures to detect and prevent security incidents before they occur. The focus is on identifying potential risks and vulnerabilities and proactively mitigating them. On the other hand, reactive monitoring is generally a more passive approach, focusing on investigating and mitigating the consequences of incidents after they have already occurred.
  3. Are you monitoring privileged users? Monitoring access by privileged users, such as system administrators or executives, is essential. These users often have elevated permissions and can abuse their privileges for unauthorized activities, data theft, or misconduct.
    • Consider users with temporarily elevated privileges.
  4. Are you monitoring third parties? Organizations frequently grant access to third-party vendors, partners, affiliates, or contractors for various purposes. However, monitoring their activities can be challenging, especially if they are using their own systems or network connections.
    • Consider assessing your vendor risk program to confirm your organization has properly assessed risks, tiered vendors accordingly, and include assessing third-party access as part of the organization’s access monitoring program.
  5. Are you monitoring across platforms and applications? With the increasing adoption of cloud services, mobile devices, and remote work, user access monitoring must extend beyond traditional on-premises systems. Organizations need to ensure that user activities on various platforms, including cloud applications, virtual environments, and mobile devices, are adequately monitored to maintain data privacy and security. For example:
    • Consider systems maintaining data outside the EHR, such as research programs and legacy applications.
    • Consider Shadow IT risks. Shadow IT refers to unauthorized technology or software employees use without the IT department’s knowledge or approval. This can create blind spots in user access monitoring, as IT teams may not be aware of these systems or have visibility into user activities.

Addressing these lesser-known issues related to user access monitoring requires a comprehensive and proactive approach. Implementing monitoring tools, establishing clear policies and procedures, robust training, consistent application of sanctions and discipline, and of course, regular reviews of access logs and activity reports will help you identify and address these potential security vulnerabilities.

User Access Monitoring and Privacy Investigations

Office for Civil Rights (OCR) recently settled a case in which 23 hospital security guards were found to have been viewing patient records without a job-related purpose. This type of behavior and HIPAA violation is common in hospitals and health systems and can result from numerous motivations, like curiosity about a well-known or celebrity patient or the details surrounding a major event, etc. Regardless, without a job-related purpose in accessing patient records, healthcare organizations can easily find themselves facing an audit or investigation as a result of failing to assess risk, train employees, and monitor access adequately.

In the case of this settlement, the hospital will now be monitored for two years by OCR and has agreed to (1) conduct an accurate and thorough risk analysis within 60 days of OCR’s approval; (2) develop and implement a risk management plan; (3) develop, maintain, and revise, as necessary, its written HIPAA policies and procedures; (4) enhance its existing HIPAA and Security Training Program to provide workforce training on the updated HIPAA policies and procedures; (5) review all relationships with vendors and third-party service providers to identify business associates and obtain business associate agreements with business associates if not already in place.

Many organizations are still focused on monitoring only post-incidents and reports and are not effectively using technology or expertise to assess how records are being accessed. Healthcare leaders should design alerting and reporting strategies based on the organization’s overall risk assessment and consider the unique risks and situations. 


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