The U.S. Health Insurance Portability and Accountability Act (HIPAA) was introduced in 1996 to protect the privacy and security of health information. HIPAA’s Privacy, Security, and Breach Notification rules require healthcare providers and their partners to protect electronic protected health information (ePHI) through robust access controls, breach reporting, and documentation practices.
A critical part of this compliance effort involves maintaining detailed audit logs that track who accessed, modified, or disclosed PHI, and retaining HIPAA logs for at least six years.
This article describes the HIPAA logging requirements and provides best practices for implementing effective logging and auditing strategies.
Who needs to be HIPAA-compliant?
Entities that handle healthcare information, including those acting on behalf of another entity, are required to comply with HIPAA:
- Covered Entities
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They collect, create, or transmit PHI electronically. For instance, health care providers, health care clearinghouses, and health insurance providers.
- Business Associates
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They encounter PHI while performing contracted work on behalf of a Covered Entity. This is a broader category with examples including IT providers (cloud, MSSP, hosting, hardware maintenance services, etc.), business accounting services, third-party consultants, etc.
There is no formal HIPAA compliance certification from the federal government or subsidiary regulatory agencies. A HIPAA compliance assessment is an on-going process performed by a third party to assess an organization’s compliance with the HIPAA Privacy, Security, and Breach Notification rules.
What are the HIPAA audit log requirements?
Keeping track of who accesses, uses, modifies, or deletes PHI is crucial for healthcare providers and their partners. It helps them follow HIPAA’s Privacy Rule, which ensures that patients retain control over how their PHI is used and shared. Logging also supports compliance with HIPAA’s Security Rule, which requires healthcare providers and their partners to take reasonable steps to safeguard PHI. By keeping thorough records, healthcare providers and their partners can rest assured that they’re doing their part to protect patient’s privacy and security.
Within the Security Rule (text of the final regulation can be found at 45 CFR Part 160 and Part 164, subparts A and C), three types of safeguards are mentioned: Technical (§164.312), Administrative (§164.308), and Physical (§164.310). The following sections detail the HIPAA audit log requirements for each type of safeguard:
Technical safeguards
Log collection and management demands, as encompassed by §164.312(b), require Covered Entities and Business Associates to implement mechanisms that record and examine activity in information systems. This logging process is crucial to ensuring that PHI remains confidential, has integrity, and is always available:
| Section | Requirement |
|---|---|
"Implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information." |
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"Implement security measures to ensure that electronically transmitted electronic protected health information is not improperly modified without detection until disposed of." |
Administrative safeguards
The administrative safeguards from §164.308(a)(1)(ii)(D) requires reviewing collected data regularly to detect abnormal behavior, investigate incidents or breaches, and create reports or alerts.
| Section | Requirement |
|---|---|
"Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports." |
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"Implement procedures for monitoring log-in attempts and reporting discrepancies." |
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(i) "Implement policies and procedures to address security incidents." (ii) "Identify and respond to suspected or known security incidents; mitigate, to the extent practicable, harmful effects of security incidents that are known to the covered entity or business associate; and document security incidents and their outcomes." |
Policies, procedures, and documentation requirements
There are also policies and procedures requirements sections, like §164.316(b)(2)(i), which establishes a general baseline of six years retention period for related information.
| Section | Requirement |
|---|---|
(i) "Maintain the policies and procedures implemented to comply with this subpart in written (which may be electronic) form;" (ii) "If an action, activity or assessment is required by this subpart to be documented, maintain a written (which may be electronic) record of the action, activity, or assessment." |
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"Retain the documentation required by paragraph §164.316(b)(1) of this section for six years from the date of its creation or the date when it last was in effect, whichever is later." |
What are the audit logs to be collected?
When an event occurs, logging collects information such as the date and time of occurrence, what happened, who was involved, and why it happened. You then use this information to identify problems or security issues. There are different types of audit logging levels, each with a specific purpose. These include the application, system, and user audit logging levels:
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Application audit trails — Monitor and log user activities in the application. This includes the application data files opened and closed, and the creating, reading, editing, and deleting of application records associated with ePHI.
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System-level audit trails — Capture successful or unsuccessful log-on attempts, log-on ID/username, date and time of each log-on/off attempt, devices used to log-on, and the application the user successfully or unsuccessfully accessed.
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User audit trails — Monitor and log user activity in an ePHI system or application by recording events initiated by the user, such as all commands directly initiated by the user, log-on attempts with identification and authentication, and access to ePHI files and resources.
The following is a non-exhaustive list of examples of important security trails that have to be collected and processed across ePHI environments:
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Authentication events (logins, failed attempts)
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User accounts events (new users added, password changes)
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Access level changes (privilege escalations)
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Access to protected information (to files and databases)
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Security settings changes
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Software changes (installation and uninstallation)
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Anti-malware and firewall events
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Operating system events
Note that logs containing PHI must be secured (encrypted and access-controlled) to be HIPAA-compliant. Alternatively, avoid logging any PHI as it increases security risks, especially when logs are transferred to a third-party. In the case of logs centralization, consider appropriate data filtration for logs containing PHI and/or de-identification techniques as described in §164.154(a).
Robust logging and auditing can improve security and show compliance. Following these requirements is crucial for keeping healthcare data confidential, and maintaining integrity and availability.
What are the HIPAA log retention requirements?
The regulation does not explicitly specify an audit log retention period, but section §164.316(b)(2)(i), in conjunction with §164.316(b)(1), stipulates that documented actions and activity have to be retained for at least six years.
Still, it is a highly nuanced subject, and it’s always a question of what has to be retained for that amount of time and what can be omitted or retained for a significantly shorter period. The Security Rule is non-prescriptive, and it’s up to organization to scope critical activities and actions based on its own risk analysis. Having an audit log retention strategy explicitly considered within organization’s risk management framework demonstrates proper due diligence during a HIPAA assessment.
The safe way seems to be to retain logs for six years, but managing huge amounts of log data is costly. Systems storage capacity and budgets need to be considered to determine the retention period individually for each type of audit trail. It also pays to consult with legal experts - specific state laws or other side-regulations may impose extended retention periods.
How NXLog Platform helps you become HIPAA-compliant
The following capabilities help NXLog Platform support your organization in meeting HIPAA’s logging and compliance requirements:
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Unified log collection infrastructure — NXLog Platform supports both popular and advanced log collection methods and integrates with various data sources, including applications, databases, network devices, IoT systems, and SIEM or APM tools. This helps you maintain a unified and compliant log management and security process across your environment. Additionally, it also simplifies the routines and procedures that need to be communicated and implemented by staff.
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Important security events can be detected earlier — NXLog Platform’s observability features complement the continuous monitoring provided by SIEM/SOAR solutions. They allow you to track critical events at both the system and application level, even before those events trigger alerts in your security platforms.
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SIEM/APM cold storage cost savings — By filtering out noise from logs before forwarding them to your SIEM or APM tool, NXLog Platform helps reduce data storage costs (which are typically priced by events per second). It can also improve data ingestion speed and make ongoing security analysis more efficient.
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Cost-efficient audit log retention — The HIPAA Security Rule requires retaining audit trails for at least six years in general. NXLog Platform supports flexible log filtering, retention, and routing mechanisms, making it easier to design an efficient retention strategy, including cool-off periods.
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Masking or removal of sensitive data — This is essential when data must leave your HIPAA-compliant infrastructure and be transferred to external services, including those managed by third parties such as MSSPs.
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Protecting audit logs and system files against unauthorized changes — File Integrity Monitoring helps detect changes to the file system and trigger security events. This protects against unauthorized tampering of critical system files and retained logs.
As experts in log collection, centralization, and storage, we at NXLog are here to help. Get in touch with one of our experts today to see how we can aid in your HIPAA compliance quest.
