Patient Pattern Compliance

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1. Introduction

Patient Pattern, Inc (“Patient Pattern”) is committed to ensuring the confidentiality, privacy, integrity, and availability of all electronic protected health information (ePHI) it receives, maintains, processes and/or transmits on behalf of its Customers. As providers of compliant, hosted infrastructure used by health technology vendors, developers, designers, agencies, custom development shops, and enterprises, Patient Pattern strives to maintain compliance, proactively address information security, mitigate risk for its Customers, and assure known breaches are completely and effectively communicated in a timely manner. The following documents address core policies used by Patient Pattern to maintain compliance and assure the proper protections of infrastructure used to store, process, and transmit ePHI for Patient Pattern Customers.

Patient Pattern provides secure and compliant cloud-based software. This hosted software falls into two broad categories: 1) Platform as a Service (PaaS) and 2) Platform Add-ons. These Categories are cited throughout polices as Customers in each category inherit different policies, procedures, and obligations from Patient Pattern.

1.1 Software as a Service (SaaS)

SaaS Customers utilize hosted software and infrastructure from Patient Pattern to access Patient Pattern developed applications and configured databases. These customers are separated into compliant database schemas running securely connected to application systems secured and managed by Patient Pattern. Patient Pattern makes every effort to reduce the risk of unauthorized disclosure, access, and/or breach of SaaS Customer data through network (firewalls, dedicated IP spaces, etc) and server settings (encryption at rest and in transit, OSSEC throughout the Platform, etc).

1.2 Platform Add-ons

Add-ons are compliant API-driven services that are offered as part of the Patient Pattern Platform. These services currently include our secure file hosting, FTP file transfer and secure messaging services. With Add-ons, Patient Pattern has access to data models and manages all application level configurations and security.

In the future there may be 3rd party Add-on services available as part of the Patient Pattern Platform. These 3rd party, or Partner, Services will be fully reviewed by Patient Pattern to assure they do not have a negative impact on Patient Pattern’s information security and compliance posture.

1.3 Compliance Inheritance

Patient Pattern provides compliant hosted software for its Customers. Patient Pattern has been through a HIPAA compliance audit by a national, 3rd party compliance firm, to validate and map organizational policies and technical settings to HIPAA rules. Patient Pattern, as a company, and its technology, is HITRUST Certified. Patient Pattern’s infrastructure at Revion.com is HITRUST Certified.

Patient Pattern signs business associate agreements (BAAs) with its Customers. These BAAs outline Patient Pattern obligations and Customer obligations, as well as liability in the case of a breach. In providing software and managing security configurations that are a part of the technology requirements that exist in HIPAA and HITRUST, as well as future compliance frameworks, Patient Pattern manages various aspects of compliance for Customers. The aspects of compliance that Patient Pattern manages for Customers are inherited by Customers, and Patient Pattern assumes the risk associated with those aspects of compliance. In doing so, Patient Pattern helps Customers achieve and maintain compliance, as well as mitigates Customers risk.

Patient Pattern does not act as a covered entity. When Patient Pattern does operate as a business associate (not a subcontractor), Patient Pattern does not interface with users to obtain or provide access to ePHI. Access to ePHI is through our customers’ applications.

Certain aspects of compliance cannot be inherited. Because of this, Patient Pattern Customers, in order to achieve full compliance or HITRUST Certification, must implement certain organizational policies. These policies and aspects of compliance fall outside of the services and obligations of Patient Pattern.

Mappings of HIPAA Rules to Patient Pattern controls and a mapping of what Rules are inherited by Customers, both Platform Customers and Add-on Customers, are covered in §2.

1.4 Patient Pattern Organizational Concepts

The physical infrastructure environment is hosted at Revion.com. The network components and supporting network infrastructure are contained within the Revion.com infrastructure and managed by Revion.com. Patient Pattern does not have physical access into the network components. The Patient Pattern environment consists of Cisco firewalls; nginx web servers; Java, Python, and Go application servers; Percona and PostgreSQL database servers; Logstash logging servers; Linux Ubuntu monitoring servers; Windows Server virtual machines; Chef and Salt configuration management servers; OSSEC IDS services; Docker containers; and developer tool servers running on Linux Ubuntu.

Within the Patient Pattern Platform on Revion.com all data transmission is encrypted and all hard drives are encrypted so data at rest is also encrypted; this applies to all servers - those hosting Docker containers, databases, APIs, log servers, etc. Patient Pattern assumes all data may contain ePHI, even though our Risk Assessment does not indicate this is the case, and provides appropriate protections based on that assumption.

In the case of PaaS Customers, it is the responsibility of the Customer to restrict, secure, and assure the privacy of all ePHI data at the Application Level, as this is not under the control or purview of Patient Pattern.

The data and network segmentation mechanism differs depending on the primitives offered by the underlying cloud provider infrastructure:

The result of segmentation strategies employed by Patient Pattern effectively create RFC 1918, or dedicated, private segmented and separated networks and IP spaces, for each PaaS Customer and for Platform Add-ons.

Additionally, IPtables is used on each each server for logical segmentation. IPtables is configured to restrict access to only justified ports and protocols. Patient Pattern has implemented strict logical access controls so that only authorized personnel are given access to the internal management servers. The environment is configured so that data is transmitted from the load balancers to the application servers over an SSL encrypted session.

In the case of Platform Add-ons, once the data is received from the application server, a series of Application Programming Interface (API) calls is made to the database servers where the ePHI resides. The ePHI is separated into PostgreSQL and Percona databases through programming logic built, so that access to one database server will not present you with the full ePHI spectrum.

The bastion host, nginx web server, and application servers are externally facing and accessible via the Internet. The database servers, where the ePHI resides, are located on the internal Patient Pattern network and can only be accessed directly over an SSH connection through the bastion host. The access to the internal database is restricted to a limited number of personnel and strictly controlled to only those personnel with a business justified reason. Remote access to the internal servers is not accessible except through the load balancers and bastion host.

All Platform Add-ons and operating systems are tested end-to-end for usability, security and impact prior to deployment to production.

1.5 Requesting Audit and Compliance Reports

Patient Pattern, at its sole discretion, shares audit reports, including its HITRUST reports and Corrective Action Plans (CAPs), with customers on a case by case basis. All audit reports are shared under explicit NDA in Patient Pattern format between Patient Pattern and party to receive materials. Audit reports can be requested by Patient Pattern workforce members for Customers or directly by Patient Pattern Customers.

The following process is used to request audit reports:

  1. Email is sent to info@patientpattern.com In the email, please specify the type of report being requested and any required timelines for the report.
  2. Patient Pattern staff will log an Issue with the details of the request into the Patient Pattern Compliance Review Activities Project on JIRA. JIRA is used to track requests status and outcomes.
  3. Patient Pattern will confirm if a current NDA is in place with the party requesting the audit report. If there is no NDA in place, Patient Pattern will send one for execution.
  4. Once it has been confirmed that an NDA is executed, Patient Pattern staff will move the JIRA Issue to “Under Review”.
  5. The Patient Pattern Security Officer or Privacy Officer must Approve or Reject the Issue. If the Issue is rejected, Patient Pattern will notify the requesting party that we cannot share the requested report.
  6. If the Issue has been Approved, Patient Pattern will send the customer the requested audit report and complete the JIRA Issue for the request.

1.6 Version Control

Refer to the GitHub repository at https://github.com/patientpattern/policies/ for the full version history of these policies.

2. HIPAA Inheritance

2.1 HIPAA Inheritance for PaaS Customers

Administrative Controls HIPAA Rule Patient Pattern Control Inherited
Security Management Process - 164.308(a)(1)(i) Risk Management Policy Yes
Assigned Security Responsibility - 164.308(a)(2) Roles Policy Partially
Workforce Security - 164.308(a)(3)(i) Employee Policies Partially
Information Access Management - 164.308(a)(4)(i) System Access Policy Yes
Security Awareness and Training - 164.308(a)(5)(i) Employee Policy No
Security Incident Procedures - 164.308(a)(6)(i) IDS Policy Yes
Contingency Plan - 164.308(a)(7)(i) Disaster Recovery Policy Yes
Evaluation - 164.308(a)(8) Auditing Policy Yes
Physical Safeguards HIPAA Rule Patient Pattern Control Inherited
Facility Access Controls - 164.310(a)(1) Facility and Disaster Recovery Policies Yes
Workstation Use - 164.310(b) System Access, Approved Tools, and Employee Policies Partially
Workstation Security - 164.310(‘c’) System Access, Approved Tools, and Employee Policies Partially
Device and Media Controls - 164.310(d)(1) Disposable Media and Data Management Policies Yes
Technical Safeguards HIPAA Rule Patient Pattern Control Inherited
Access Control - 164.312(a)(1) System Access Policy Partially
Audit Controls - 164.312(b) Auditing Policy Yes (optional)
Integrity - 164.312('c’)(1) System Access, Auditing, and IDS Policies Yes (optional)
Person or Entity Authentication - 164.312(d) System Access Policy Yes
Transmission Security - 164.312(e)(1) System Access and Data Management Policy Yes
Organizational Requirements HIPAA Rule Patient Pattern Control Inherited
Business Associate Contracts or Other Arrangements - 164.314(a)(1)(i) Business Associate Agreements and 3rd Parties Policies Partially
Policies and Procedures and Documentation Requirements HIPAA Rule Patient Pattern Control Inherited
Policies and Procedures - 164.316(a) Policy Management Policy Partially
Documentation - 164.316(b)(1)(i) Policy Management Policy Partially
HITECH Act - Security Provisions HIPAA Rule Patient Pattern Control Inherited
Notification in the Case of Breach - 13402(a) and (b) Breach Policy Partially
Timelines of Notification - 13402(d)(1) Breach Policy Partially
Content of Notification - 13402(f)(1) Breach Policy Partially

2.2 HIPAA Inheritance for Platform Add-on Customers

Administrative Controls HIPAA Rule Patient Pattern Control Inherited
Security Management Process - 164.308(a)(1)(i) Risk Management Policy Yes
Assigned Security Responsibility - 164.308(a)(2) Roles Policy Partially
Workforce Security - 164.308(a)(3)(i) Employee Policies Partially
Information Access Management - 164.308(a)(4)(i) System Access Policy Yes
Security Awareness and Training - 164.308(a)(5)(i) Employee Policy No
Security Incident Procedures - 164.308(a)(6)(i) IDS Policy Yes
Contingency Plan - 164.308(a)(7)(i) Disaster Recovery Policy Yes
Evaluation - 164.308(a)(8) Auditing Policy Yes
Physical Safeguards HIPAA Rule Patient Pattern Control Inherited
Facility Access Controls - 164.310(a)(1) Facility and Disaster Recovery Policies Yes
Workstation Use - 164.310(b) System Access, Approved Tools, and Employee Policies Partially
Workstation Security - 164.310('c’) System Access, Approved Tools, and Employee Policies Partially
Device and Media Controls - 164.310(d)(1) Disposable Media and Data Management Policies Yes
Technical Safeguards HIPAA Rule Patient Pattern Control Inherited
Access Control - 164.312(a)(1) System Access Policy Yes
Audit Controls - 164.312(b) Auditing Policy Yes
Integrity - 164.312('c’)(1) System Access, Auditing, and IDS Policies Yes
Person or Entity Authentication - 164.312(d) System Access Policy Yes
Transmission Security - 164.312(e)(1) System Access and Data Management Policy Yes
Organizational Requirements HIPAA Rule Patient Pattern Control Inherited
Business Associate Contracts or Other Arrangements - 164.314(a)(1)(i) Business Associate Agreements and 3rd Parties Policies Partially
Policies and Procedures and Documentation Requirements HIPAA Rule Patient Pattern Control Inherited
Policies and Procedures - 164.316(a) Policy Management Policy Partially
Documentation - 164.316(b)(1)(i) Policy Management Policy Partially
HITECH Act - Security Provisions HIPAA Rule Patient Pattern Control Inherited
Notification in the Case of Breach - 13402(a) and (b) Breach Policy Yes
Timelines of Notification - 13402(d)(1) Breach Policy Yes
Content of Notification - 13402(f)(1) Breach Policy Yes

3. Policy Management Policy

Patient Pattern implements policies and procedures to maintain compliance and integrity of data. The Security Officer and Privacy Officer are responsible for maintaining policies and procedures and assuring all Patient Pattern workforce members, business associates, customers, and partners are adherent to all applicable policies. Previous versions of policies are retained to assure ease of finding policies at specific historic dates in time.

3.1 Applicable Standards

3.1.1 Applicable Standards from the HITRUST Common Security Framework

3.1.2 Applicable Standards from the HIPAA Security Rule

3.2 Maintenance of Policies

  1. All policies are stored and up to date to maintain Patient Pattern compliance with HIPAA, HITRUST, NIST, and other relevant standards. Updates and version control are done similar to source code control.
  2. Policy update requests can be made by any workforce member at any time. Furthermore, all policies are reviewed annually by both the Security and Privacy Officer to assure they are accurate and up-to-date.
  3. Patient Pattern employees may request changes to policies using the following process:
    1. The Patient Pattern employee initiates a policy change request by creating an Issue in the JIRA Compliance Review Activity (CRA) project. The change request may optionally include a GitHub pull request from a separate branch or repository containing the desired changes.
    2. The Security Officer or the Privacy Officer is assigned to review the policy change request.
    3. Once the review is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
    4. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
    5. If the policy change requires technical modifications to production systems, those changes are carried out by authorized personnel using Patient Pattern’s change management process (§9.4).
  4. All policies are made accessible to all Patient Pattern workforce members. The current master policies are published at https:/policy.
    • Changes are automatically communicated to all Patient Pattern team members through integrations between GitHub and Slack that log all GitHub policy channels to a dedicated Patient Pattern Slack Channel.
    • The Security Officer also communicates policy changes to all employees via email. These emails include a high-level description of the policy change using terminology appropriate for the target audience.
  5. All policies, and associated documentation, are retained for 6 years from the date of its creation or the date when it last was in effect, whichever is later
    1. Version history of all Patient Pattern policies is done via GitHub.
    2. Backup storage of all policies is done with Box.
  6. The policies and information security policies are reviewed and audited annually, or after significant changes occur to Patient Pattern’s organizational environment. Issues that come up as part of this process are reviewed by Patient Pattern management to assure all risks and potential gaps are mitigated and/or fully addressed. The process for reviewing polices is outlined below:
    1. The Security Officer initiates the policy review by creating an Issue in the JIRA Compliance Review Activity (CRA) project.
    2. The Security Officer or the Privacy Officer is assigned to review the current Patient Pattern policies (https:/policy/).
    3. If changes are made, the above process is used. All changes are documented in the Issue.
    4. Once the review is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
    5. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
    6. Policy review is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.
  7. Patient Pattern utilizes the HITRUST MyCSF framework to track compliance with the HITRUST CSF on an annual basis. Patient Pattern also tracks compliance with HIPAA and publishes results at https:/hipaa. In order to track and measure adherence on an annual basis, Patient Pattern uses the following process to track HITRUST audits, both full and interim:
    1. The Security Officer initiates the HITRUST audit activity by creating an Issue in the JIRA Compliance Review Activity (CRA) project.
    2. The Security Officer or the Privacy Officer is assigned to own and manage the HITRUST activity.
    3. Once the HITRUST activity is completed, the Security Officer approves or rejects the Issue.
    4. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
    5. Compliance with annual compliance assessments, utilizing the HITRUST CSF as a framework, is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.

Additional documentation related to maintenance of policies is outlined in §5.3.1.

4. Risk Management Policy

This policy establishes the scope, objectives, and procedures of Patient Pattern’s information security risk management process. The risk management process is intended to support and protect the organization and its ability to fulfill its mission.

4.1 Applicable Standards

4.1.1 Applicable Standards from the HITRUST Common Security Framework

4.1.2 Applicable Standards from the HIPAA Security Rule

4.2 Risk Management Policies

  1. It is the policy of Patient Pattern to conduct thorough and timely risk assessments of the potential threats and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information (ePHI) (and other confidential and proprietary electronic information) it stores, transmits, and/or processes for its Customers and to develop strategies to efficiently and effectively mitigate the risks identified in the assessment process as an integral part of the Patient Pattern’s information security program.
  2. Risk analysis and risk management are recognized as important components of Patient Pattern’s corporate compliance program and information security program in accordance with the Risk Analysis and Risk Management implementation specifications within the Security Management standard and the evaluation standards set forth in the HIPAA Security Rule, 45 CFR 164.308(a)(1)(ii)(A), 164.308(a)(1)(ii)(B), 164.308(a)(1)(i), and 164.308(a)(8).
    1. Risk assessments are done throughout product life cycles:
    2. Before the integration of new system technologies and before changes are made to Patient Pattern physical safeguards; and
      • These changes do not include routine updates to existing systems, deployments of new systems created based on previously configured systems, deployments of new Customers, or new code developed for operations and management of the Patient Pattern Platform.
    3. While making changes to Patient Pattern physical equipment and facilities that introduce new, untested configurations.
    4. Patient Pattern performs periodic technical and non-technical assessments of the security rule requirements as well as in response to environmental or operational changes affecting the security of ePHI.
  3. Patient Pattern implements security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to:
    1. Ensure the confidentiality, integrity, and availability of all ePHI Patient Pattern receives, maintains, processes, and/or transmits for its Customers;
    2. Protect against any reasonably anticipated threats or hazards to the security or integrity of Customer ePHI;
    3. Protect against any reasonably anticipated uses or disclosures of Customer ePHI that are not permitted or required; and
    4. Ensure compliance by all workforce members.
  4. Any risk remaining (residual) after other risk controls have been applied, requires sign off by the senior management and Patient Pattern’s Security Officer.
  5. All Patient Pattern workforce members are expected to fully cooperate with all persons charged with doing risk management work, including contractors and audit personnel. Any workforce member that violates this policy will be subject to disciplinary action based on the severity of the violation, as outlined in the Patient Pattern Roles Policy.
  6. The implementation, execution, and maintenance of the information security risk analysis and risk management process is the responsibility of Patient Pattern’s Security Officer (or other designated employee), and the identified Risk Management Team.
  7. All risk management efforts, including decisions made on what controls to put in place as well as those to not put into place, are documented and the documentation is maintained for six years.
  8. The details of the Risk Management Process, including risk assessment, discovery, and mitigation, are outlined in detail below. The process is tracked, measured, and monitored using the following procedures:
    1. The Security Officer or the Privacy Officer initiates the Risk Management Procedures by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
    2. The Security Officer or the Privacy Officer is assigned to carry out the Risk Management Procedures.
    3. All findings are documented in approved spreadsheet that is linked to the Issue.
    4. Once the Risk Management Procedures are complete, along with corresponding documentation, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
    5. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
  9. The Risk Management Procedure is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.

4.3 Risk Management Procedures

4.3.1 Risk Assessment

The intent of completing a risk assessment is to determine potential threats and vulnerabilities and the likelihood and impact should they occur. The output of this process helps to identify appropriate controls for reducing or eliminating risk.

4.3.2 Risk Mitigation

Risk mitigation involves prioritizing, evaluating, and implementing the appropriate risk-reducing controls recommended from the Risk Assessment process to ensure the confidentiality, integrity and availability of Patient Pattern Platform ePHI. Determination of appropriate controls to reduce risk is dependent upon the risk tolerance of the organization consistent with its goals and mission.

4.3.3 Risk Management Schedule

The two principle components of the risk management process - risk assessment and risk mitigation - will be carried out according to the following schedule to ensure the continued adequacy and continuous improvement of Patient Pattern’s information security program:

4.4 Process Documentation

Maintain documentation of all risk assessment, risk management, and risk mitigation efforts for a minimum of six years.

5. Roles Policy

Patient Pattern has a Security Officer [164.308(a)(2)] and Privacy Officer [164.308(a)(2)] appointed to assist in maintaining and enforcing safeguards towards compliance. The responsibilities associated with these roles are outlined below.

5.1 Applicable Standards

5.1.1 Applicable Standards from the HITRUST Common Security Framework

5.1.2 Applicable Standards from the HIPAA Security Rule

5.2 Privacy Officer

The Privacy Officer is responsible for assisting with compliance and security training for workforce members, assuring organization remains in compliance with evolving compliance rules, and helping the Security Officer in his responsibilities.

  1. Provides annual training to all workforce members of established policies and procedures as necessary and appropriate to carry out their job functions, and documents the training provided.
  2. Assists in the administration and oversight of business associate agreements.
  3. Manage relationships with customers and partners as those relationships affect security and compliance of ePHI.
  4. Assist Security Officer as needed.

The current Patient Pattern Privacy Officer is Brett Kellgren (brett@patientpattern.com).

5.2.1 Workforce Training Responsibilities

  1. The Privacy Officer facilitates the training of all workforce members as follows:
    1. New workforce members within their first month of employment;
    2. Existing workforce members annually;
    3. Existing workforce members whose functions are affected by a material change in the policies and procedures, within a month after the material change becomes effective;
    4. Existing workforce members as needed due to changes in security and risk posture of Patient Pattern.
  2. The Security Officer or designee maintains documentation of the training session materials and attendees for a minimum of six years.
  3. The training session focuses on, but is not limited to, the following subjects defined in Patient Pattern’s security policies and procedures:
    1. HIPAA Privacy, Security, and Breach notification rules;
    2. HITRUST Common Security Framework;
    3. NIST Security Rules;
    4. Risk Management procedures and documentation;
    5. Auditing. Patient Pattern may monitor access and activities of all users;
    6. Workstations may only be used to perform assigned job responsibilities;
    7. Users may not download software onto Patient Pattern’s workstations and/or systems without prior approval from the Security Officer;
    8. Users are required to report malicious software to the Security Officer immediately;
    9. Users are required to report unauthorized attempts, uses of, and theft of Patient Pattern’s systems and/or workstations;
    10. Users are required to report unauthorized access to facilities
    11. Users are required to report noted log-in discrepancies (i.e. application states users last log-in was on a date user was on vacation);
    12. Users may not alter ePHI maintained in a database, unless authorized to do so by a Patient Pattern Customer;
    13. Users are required to understand their role in Patient Pattern’s contingency plan;
    14. Users may not share their user names nor passwords with anyone;
    15. Requirements for users to create and change passwords;
    16. Users must set all applications that contain or transmit ePHI to automatically log off after 15 minutes of inactivity;
    17. Supervisors are required to report terminations of workforce members and other outside users;
    18. Supervisors are required to report a change in a users title, role, department, and/or location;
    19. Procedures to backup ePHI;
    20. Procedures to move and record movement of hardware and electronic media containing ePHI;
    21. Procedures to dispose of discs, CDs, hard drives, and other media containing ePHI;
    22. Procedures to re-use electronic media containing ePHI;
    23. SSH key and sensitive document encryption procedures.

5.3 Security Officer

The Security Officer is responsible for facilitating the training and supervision of all workforce members [164.308(a)(3)(ii)(A) and 164.308(a)(5)(ii)(A)], investigation and sanctioning of any workforce member that is in violation of Patient Pattern security policies and non-compliance with the security regulations [164.308(a)(1)(ii)(c)], and writing, implementing, and maintaining all polices, procedures, and documentation related to efforts toward security and compliance [164.316(a-b)].

The current Patient Pattern Security Officer is Brett Kellgren (brett@patientpattern.com).

5.3.1 Organizational Responsibilities

The Security Officer, in collaboration with the Privacy Officer, is responsible for facilitating the development, testing, implementation, training, and oversight of all activities pertaining to Patient Pattern’s efforts to be compliant with the HIPAA Security Regulations, HITRUST CSF, and any other security and compliance frameworks. The intent of the Security Officer Responsibilities is to maintain the confidentiality, integrity, and availability of ePHI. The Security Officer is appointed by and reports to the Board of Directors and the CEO.

These organizational responsibilities include, but are not limited to the following:

  1. Oversees and enforces all activities necessary to maintain compliance and verifies the activities are in alignment with the requirements.
  2. Helps to establish and maintain written policies and procedures to comply with the Security rule and maintains them for six years from the date of creation or date it was last in effect, whichever is later.
  3. Reviews and updates policies and procedures as necessary and appropriate to maintain compliance and maintains changes made for six years from the date of creation or date it was last in effect, whichever is later.
  4. Facilitates audits to validate compliance efforts throughout the organization.
  5. Documents all activities and assessments completed to maintain compliance and maintains documentation for six years from the date of creation or date it was last in effect, whichever is later.
  6. Provides copies of the policies and procedures to management, customers, and partners, and has them available to review by all other workforce members to which they apply.
  7. Annually, and as necessary, reviews and updates documentation to respond to environmental or operational changes affecting the security and risk posture of ePHI stored, transmitted, or processed within Patient Pattern infrastructure.
  8. Develops and provides periodic security updates and reminder communications for all workforce members.
  9. Implements procedures for the authorization and/or supervision of workforce members who work with ePHI or in locations where it may be accessed.
  10. Maintains a program promoting workforce members to report non-compliance with policies and procedures.
    • Promptly, properly, and consistently investigates and addresses reported violations and takes steps to prevent recurrence.
    • Applies consistent and appropriate sanctions against workforce members who fail to comply with the security policies and procedures of Patient Pattern.
    • Mitigates, to the extent practicable, any harmful effect known to Patient Pattern of a use or disclosure of ePHI in violation of Patient Pattern’s policies and procedures, even if effect is the result of actions of Patient Pattern business associates, customers, and/or partners.
  11. Reports security efforts and incidents to administration immediately upon discovery. Responsibilities in the case of a known ePHI breach are documented in the Patient Pattern Breach Policy.
  12. The Security Officer facilitates the communication of security updates and reminders to all workforce members to which it pertains. Examples of security updates and reminders include, but are not limited to:
    • Latest malicious software or virus alerts;
    • Patient Pattern’s requirement to report unauthorized attempts to access ePHI;
    • Changes in creating or changing passwords;
    • Additional security-focused training is provided to all workforce members by the Security Officer. This training includes, but is not limited to:
    • Data backup plans;
    • System auditing procedures;
    • Redundancy procedures;
    • Contingency plans;
    • Virus protection;
    • Patch management;
    • Media Disposal and/or Re-use;
    • Documentation requirements.
  13. The Security Officer works with the COO to ensure that any security objectives have appropriate consideration during the budgeting process.
    • In general, security and compliance are core to Patient Pattern’s technology and service offerings; in most cases this means security-related objectives cannot be split out to separate budget line items.
    • For cases that can be split out into discrete items, such as licenses for commercial tooling, the Security Officer follows Patient Pattern’s standard corporate budgeting process.
      • At the beginning of every fiscal year, the COO contacts the Security Officer to plan for the upcoming year’s expenses.
      • The Security Officer works with the COO to forecast spending needs based on the previous year’s level, along with changes for the upcoming year such as additional staff hires.
      • During the year, if an unforeseen security-related expense arises that was not in the budget forecast, the Security Officer works with the COO to reallocate any resources as necessary to cover this expense.

5.3.2 Supervision of Workforce Responsibilities

Although the Security Officer is responsible for implementing and overseeing all activities related to maintaining compliance, it is the responsibility of all workforce members (i.e. team leaders, supervisors, managers, directors, co-workers, etc.) to supervise all workforce members and any other user of Patient Pattern’s systems, applications, servers, workstations, etc. that contain ePHI.

  1. Monitor workstations and applications for unauthorized use, tampering, and theft and report non-compliance according to the Security Incident Response policy.
  2. Assist the Security and Privacy Officers to ensure appropriate role-based access is provided to all users.
  3. Take all reasonable steps to hire, retain, and promote workforce members and provide access to users who comply with the Security regulation and Patient Pattern’s security policies and procedures.

5.3.3 Sanctions of Workforce Responsibilities

All workforce members report non-compliance of Patient Pattern’s policies and procedures to the Security Officer or other individual as assigned by the Security Officer. Individuals that report violations in good faith may not be subjected to intimidation, threats, coercion, discrimination against, or any other retaliatory action as a consequence.

  1. The Security Officer promptly facilitates a thorough investigation of all reported violations of Patient Pattern’s security policies and procedures. The Security Officer may request the assistance from others.
    • Complete an audit trail/log to identify and verify the violation and sequence of events.
    • Interview any individual that may be aware of or involved in the incident.
    • All individuals are required to cooperate with the investigation process and provide factual information to those conducting the investigation.
    • Provide individuals suspected of non-compliance of the Security rule and/or Patient Pattern’s policies and procedures the opportunity to explain their actions.
    • The investigator thoroughly documents the investigation as the investigation occurs. This documentation must include a list of all employees involved in the violation.
  2. Violation of any security policy or procedure by workforce members may result in corrective disciplinary action, up to and including termination of employment. Violation of this policy and procedures by others, including business associates, customers, and partners may result in termination of the relationship and/or associated privileges. Violation may also result in civil and criminal penalties as determined by federal and state laws and regulations.
    • A violation resulting in a breach of confidentiality (i.e. release of PHI to an unauthorized individual), change of the integrity of any ePHI, or inability to access any ePHI by other users, requires immediate termination of the workforce member from Patient Pattern.
  3. The Security Officer facilitates taking appropriate steps to prevent recurrence of the violation (when possible and feasible).
  4. In the case of an insider threat, the Security Officer and Privacy Officer are to set up a team to investigate and mitigate the risk of insider malicious activity. Patient Pattern workforce members are encouraged to come forward with information about insider threats, and can do so anonymously.
  5. The Security Officer maintains all documentation of the investigation, sanctions provided, and actions taken to prevent reoccurrence for a minimum of six years after the conclusion of the investigation.

6. Data Management Policy

Patient Pattern has procedures to create and maintain retrievable exact copies of electronic protected health information (ePHI) stored in conjunction with Patient Pattern Add-ons and for PaaS Customers utilizing our Backup Service. This policy, and associated procedures for testing and restoring from backup data, do not apply to PaaS Customers that do not choose Patient Pattern Backup Service. The policy and procedures will assure that complete, accurate, retrievable, and tested backups are available for all systems used by Patient Pattern.

Data backup is an important part of the day-to-day operations of Patient Pattern. To protect the confidentiality, integrity, and availability of ePHI, both for Patient Pattern and Patient Pattern Customers, complete backups are done daily to assure that data remains available when it needed and in case of disaster.

Violation of this policy and its procedures by workforce members may result in corrective disciplinary action, up to and including termination of employment.

6.1 Applicable Standards

6.1.1 Applicable Standards from the HITRUST Common Security Framework

6.1.2 Applicable Standards from the HIPAA Security Rule

6.2 Backup Policy and Procedures

  1. Perform daily snapshot backups of all systems that process, store, or transmit ePHI for Patient Pattern Customers, including PaaS Customers that utilize the Patient Pattern Backup Service.
  2. Patient Pattern Ops Team, lead by VP of Engineering, is designated to be in charge of backups.
  3. Dev Ops Team members are trained and assigned to complete backups and manage the backup media.
  4. Document backups
    • Name of the system
    • Date & time of backup
    • Where backup stored (or to whom it was provided)
  5. Securely encrypt stored backups in a manner that protects them from loss or environmental damage.
  6. Test backups and document that files have been completely and accurately restored from the backup media.

7. System Access Policy

Access to Patient Pattern systems and application is limited for all users, including but not limited to workforce members, volunteers, business associates, contracted providers, consultants, and any other entity, is allowable only on a minimum necessary basis. All users are responsible for reporting an incident of unauthorized user or access of the organization’s information systems. These safeguards have been established to address the HIPAA Security regulations including the following:

7.1 Applicable Standards

7.1.1 Applicable Standards from the HITRUST Common Security Framework

7.1.2 Applicable Standards from the HIPAA Security Rule

7.2 Access Establishment and Modification

  1. Requests for access to Patient Pattern Platform systems and applications is made formally using the following process:
    1. The Patient Pattern workforce member, or their manager, initiates the access request by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
      • User identities must be verified prior to granting access to new accounts.
      • Identity verification must be done in person where possible; for remote employees, identities must be verified over the phone.
      • For new accounts, the method used to verify the user’s identity must be recorded on the Issue.
    2. The Security Officer will grant access to systems as dictated by the employee’s job title. If additional access is required outside of the minimum necessary to perform job functions, the requester must include a description of why the additional access is required as part of the access request.
    3. Once the review is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
    4. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required. The Security Officer then grants requested access.
      • New accounts will be created with a temporary secure password that meets all requirements from §7.12, which must be changed on the initial login.
      • All password exchanges must occur over an authenticated channel.
      • For production systems, access grants are accomplished by adding the appropriate user account to the corresponding LDAP group.
      • For non-production systems, access grants are accomplished by leveraging the access control mechanisms built into those systems. Account management for non-production systems may be delegated to a Patient Pattern employee at the discretion of the Security Officer.
  2. Access is not granted until receipt, review, and approval by the Patient Pattern Security Officer;
  3. The request for access is retained for future reference.
  4. All access to Patient Pattern systems and services are reviewed and updated on a bi-annual basis to ensure proper authorizations are in place commensurate with job functions. The process for conducting reviews is outlined below:
    1. The Security Officer initiates the review of user access by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
    2. The Security Officer, or a Privacy Officer, is assigned to review levels of access for each Patient Pattern workforce member.
    3. If user access is is found during review that is not in line with the least privilege principle, the process below is used to modify user access and notify the user of access changes. Once those steps are completed, the Issue is then reviewed again.
    4. Once the review is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
    5. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
    6. Review of user access is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.
  5. Any Patient Pattern workforce member can request change of access using the process outlined in §7.2 paragraph 1.
  6. Access to production systems is controlled using centralized user management and authentication.
  7. Temporary accounts are not used unless absolutely necessary for business purposes.
    • Accounts are reviewed every 90 days to ensure temporary accounts are not left unnecessarily.
    • Accounts that are inactive for over 90 days are removed.
  8. In the case of non-personal information, such as generic educational content, identification and authentication may not be required. This is the responsibility of Patient Pattern Customers to define, and not Patient Pattern.
  9. Privileged users must first access systems using standard, unique user accounts before switching to privileged users and performing privileged tasks.
    • For production systems, this is enforced by creating non-privileged user accounts that must invoke sudo to perform privileged tasks.
    • Rights for privileged accounts are granted by the Security Officer using the process outlined in §7.2 paragraph 1.
  10. All application to application communication using service accounts is restricted and not permitted unless absolutely needed. Automated tools are used to limit account access across applications and systems.
  11. Generic accounts are not allowed on Patient Pattern systems.
  12. Access is granted through encrypted, VPN tunnels that utilize two-factor authentication.
    • Two-factor authentication is accomplished using a Time-based One-Time Password (TOTP) as the second factor.
    • VPN connections use 256-bit AES 256 encryption, or equivalent.
    • VPN sessions are automatically disconnected after 30 minutes of inactivity.
  13. In cases of increased risk or known attempted unauthorized access, immediate steps are taken by the Security and Privacy Officer to limit access and reduce risk of unauthorized access.
  14. Direct system to system, system to application, and application to application authentication and authorization are limited and controlled to restrict access.

7.3 Workforce Clearance

  1. The level of security assigned to a user to the organization’s information systems is based on the minimum necessary amount of data access required to carry out legitimate job responsibilities assigned to a user’s job classification and/or to a user needing access to carry out treatment, payment, or healthcare operations.
  2. All access requests are treated on a “least-access principle.”
  3. Patient Pattern maintains a minimum necessary approach to access to Customer data. As such, Patient Pattern, including all workforce members, does not readily have access to any ePHI.

7.4 Access Authorization

  1. Role based access categories for each Patient Pattern system and application are pre-approved by the Security Officer or VP of Engineering.
  2. Patient Pattern utilizes hardware and software firewalls to segment data, prevent unauthorized access, and monitor traffic for denial of service attacks.

7.5 Person or Entity Authentication

  1. Each workforce member has and uses a unique user ID and password that identifies him/her as the user of the information system.
  2. Each Customer and Partner has and uses a unique user ID and password that identifies him/her as the user of the information system.
  3. All Customer support desk interactions must be verified before Patient Pattern support personnel will satisfy any request having information security implications.
    • Patient Pattern’s current support desk software, Zendesk, requires users to authenticate before submitting support tickets.
    • Support issues submitted via Patient Pattern’s dashboard require that users authenticate with their Patient Pattern account before submitting support tickets.
    • Support issues submitted by email must be verified by Patient Pattern personnel using a phone number that has been registered with the corresponding account.

7.6 Unique User Identification

  1. Access to the Patient Pattern Platform systems and applications is controlled by requiring unique User Login IDs and passwords for each individual user and developer.
  2. Passwords requirements mandate strong password controls (see below).
  3. Passwords are not displayed at any time and are not transmitted or stored in plain text.
  4. Default accounts on all production systems, including root, are disabled.
  5. Shared accounts are not allowed within Patient Pattern systems or networks.
  6. Automated log-on configurations that store user passwords or bypass password entry are not permitted for use with Patient Pattern workstations or production systems.

7.7 Automatic Logoff

  1. Users are required to make information systems inaccessible by any other individual when unattended by the users (ex. by using a password protected screen saver or logging off the system).
  2. Information systems automatically log users off the systems after 15 minutes of inactivity.
  3. The Security Officer pre-approves exceptions to automatic log off requirements.

7.8 Employee Workstation Use

All workstations at Patient Pattern are company owned, and all are laptop Apple products running Mac OSX or Linux.

  1. Workstations may not be used to engage in any activity that is illegal or is in violation of organization’s policies.
  2. Access may not be used for transmitting, retrieving, or storage of any communications of a discriminatory or harassing nature or materials that are obscene or “X-rated”. Harassment of any kind is prohibited. No messages with derogatory or inflammatory remarks about an individual’s race, age, disability, religion, national origin, physical attributes, sexual preference, or health condition shall be transmitted or maintained. No abusive, hostile, profane, or offensive language is to be transmitted through organization’s system.
  3. Information systems/applications also may not be used for any other purpose that is illegal, unethical, or against company policies or contrary to organization’s best interests. Messages containing information related to a lawsuit or investigation may not be sent without prior approval.
  4. Solicitation of non-company business, or any use of organization’s information systems/applications for personal gain is prohibited.
  5. Transmitted messages may not contain material that criticizes the organization, its providers, its employees, or others.
  6. Users may not misrepresent, obscure, suppress, or replace another user’s identity in transmitted or stored messages.
  7. Workstation hard drives will be encrypted using FileVault 2.0 or equivalent.
  8. All workstations have firewalls enabled to prevent unauthorized access unless explicitly granted.
  9. All workstations are to have the following messages added to the lock screen and login screen: This computer is owned by Patient Pattern, Inc. By logging in, unlocking, and/or using this computer you acknowledge you have seen, and follow, these policies (https:/policy) and have completed this training (https:/training/). Please contact us if you have problems with this - info@patientpattern.com.

7.9 Wireless Access Use

  1. Patient Pattern production systems are not accessible directly over wireless channels.
  2. Wireless access is disabled on all production systems.
  3. When accessing production systems via remote wireless connections, the same system access policies and procedures apply to wireless as all other connections, including wired.
  4. Wireless networks managed within Patient Pattern non-production facilities (offices, etc) are secured with the following configurations:
    • All data in transit over wireless is encrypted using WPA2 encryption;
    • Passwords are rotated on a regular basis, presently quarterly. This process is managed by the Patient Pattern Security Officer.

7.10 Employee Termination Procedures

  1. The Human Resources Department (or other designated department), users, and their supervisors are required to notify the Security Officer upon completion and/or termination of access needs and facilitating completion of the “Termination Checklist”.
  2. The Human Resources Department, users, and supervisors are required to notify the Security Officer to terminate a user’s access rights if there is evidence or reason to believe the following (these incidents are also reported on an incident report and is filed with the Privacy Officer):
    • The user has been using their access rights inappropriately;
    • A user’s password has been compromised (a new password may be provided to the user if the user is not identified as the individual compromising the original password);
    • An unauthorized individual is utilizing a user’s User Login ID and password (a new password may be provided to the user if the user is not identified as providing the unauthorized individual with the User Login ID and password).
  3. The Security Officer will terminate users’ access rights immediately upon notification, and will coordinate with the appropriate Patient Pattern employees to terminate access to any non-production systems managed by those employees.
  4. The Security Officer audits and may terminate access of users that have not logged into organization’s information systems/applications for an extended period of time.

7.11 Paper Records

Patient Pattern does not use paper records for any sensitive information. Use of paper for recording and storing sensitive data is against Patient Pattern policies.

7.12 Password Management

  1. User IDs and passwords are used to control access to Patient Pattern systems and may not be disclosed to anyone for any reason.
  2. Users may not allow anyone, for any reason, to have access to any information system using another user’s unique user ID and password.
  3. On all production systems and applications in the Patient Pattern environment, password configurations are set to require:
    • a minimum length of 8 characters;
    • a mix of upper case characters, lower case characters, and numbers or special characters;
    • a 90-day password expiration;
    • prevention of password reuse using a history of the last 6 passwords;
    • account lockout after 5 invalid attempts.
  4. All system and application passwords must be stored and transmitted securely.
    • Where possible, passwords should be stored in a hashed format using a salted cryptographic hash function (SHA-256 or equivalent).
    • Passwords that must be stored in non-hashed format must be encrypted at rest pursuant to the requirements in §17.8.
    • Transmitted passwords must be encrypted in flight pursuant to the requirements in §17.9.
  5. Each information system automatically requires users to change passwords at a pre-determined interval as determined by the organization, based on the criticality and sensitivity of the ePHI contained within the network, system, application, and/or database.
  6. Passwords are inactivated immediately upon an employee’s termination (refer to the Employee Termination Procedures in §7.10).
  7. All default system, application, and Partner passwords are changed before deployment to production.
  8. Upon initial login, users must change any passwords that were automatically generated for them.
  9. Password change methods must use a confirmation method to correct for user input errors.
  10. All passwords used in configuration scripts are secured and encrypted.
  11. If a user believes their user ID has been compromised, they are required to immediately report the incident to the Security Office.
  12. In cases where a user has forgotten their password, the following procedure is used to reset the password.
    • The user submits a password reset request to info@patientpattern.com. The request should include the system to which the user has lost access and needs the password reset.
    • An administrator with password reset privileges is notified and connects directly with the user requesting the password reset.
    • The administrator verifies the identity of the user either in-person or through a separate communication channel such as phone or Slack.
    • Once verified, the administrator resets the password.

The password-reset email inbox is used to track and store password reset requests. The Security Officer is the owner of this group and modifies membership as needed.

7.13 Access to ePHI

  1. Employees may not download ePHI to any workstations used to connect to production systems.
  2. Disallowing transfer of ePHI to workstations is enforced through technical measures.
    • All production access to systems is performed through a bastion/jump host accessed through a VPN. Direct access to production systems is disallowed by Patient Pattern’s VPN configuration.
    • On production Linux bastions, all file transfer services are disabled including file-transfer functionality of SSH services (SCP/SFTP).
    • On production Windows bastions, local drive mappings are disabled by Group Policy settings.
    • Configuration settings for enforcing these technical controls are managed by Patient Pattern’s configuration management tooling, Chef/Salt.

7.14 PaaS Customer Access to Systems

Patient Pattern grants PaaS customer secure system access via VPN connections. This access is only to Customer-specific systems, no other systems in the environment. These connections are setup at customer deployment. These connections are secured and encrypted and the only method for customers to connect to Patient Pattern hosted systems.

In the case of data migration, Patient Pattern does, on a case by case basis, support customers in importing data. In these cases Patient Pattern requires that all data is secured and encrypted in transit, such as by using SFTP or SCP for transferring files.

In the case of an investigation, Patient Pattern will assist customers, at Patient Pattern’s discretion, and law enforcement in forensics.

8. Auditing Policy

Patient Pattern shall audit access and activity of electronic protected health information (ePHI) applications and systems in order to ensure compliance. The Security Rule requires healthcare organizations to implement reasonable hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use ePHI. Audit activities may be limited by application, system, and/or network auditing capabilities and resources. Patient Pattern shall make reasonable and good-faith efforts to safeguard information privacy and security through a well-thought-out approach to auditing that is consistent with available resources.

It is the policy of Patient Pattern to safeguard the confidentiality, integrity, and availability of applications, systems, and networks. To ensure that appropriate safeguards are in place and effective, Patient Pattern shall audit access and activity to detect, report, and guard against:

This policy applies to all Patient Pattern Add-on systems, including BaaS, that store, transmit, or process ePHI. This policy, and associated procedures, do not apply to PaaS Customers that do not choose Patient Pattern Logging Service.

8.1 Applicable Standards

8.1.1 Applicable Standards from the HITRUST Common Security Framework

8.1.2 Applicable Standards from the HIPAA Security Rule

8.2 Auditing Policies

  1. Responsibility for auditing information system access and activity is assigned to Patient Pattern’s Security Officer. The Security Officer shall:
    • Assign the task of generating reports for audit activities to the workforce member responsible for the application, system, or network;
    • Assign the task of reviewing the audit reports to the workforce member responsible for the application, system, or network, the Privacy Officer, or any other individual determined to be appropriate for the task;
    • Organize and provide oversight to a team structure charged with audit compliance activities (e.g., parameters, frequency, sample sizes, report formats, evaluation, follow-up, etc.).
    • All connections to Patient Pattern are monitored. Access is limited to certain services, ports, and destinations. Exceptions to these rules, if created, are reviewed on an annual basis.
  2. Patient Pattern’s auditing processes shall address access and activity at the following levels listed below. In the case of PaaS Customers, Application and User level auditing is the responsibility of the Customer; Patient Pattern provides software to aggregate and view User and Application logs, but the log data collected is the responsibility of the PaaS Customer. Auditing processes may address date and time of each log-on attempt, date and time of each log-off attempt, devices used, functions performed, etc.
    • User: User level audit trails generally monitor and log all commands directly initiated by the user, all identification and authentication attempts, and data and services accessed.
    • Application: Application level audit trails generally monitor and log all user activities, including data accessed and modified and specific actions.
    • System: System level audit trails generally monitor and log user activities, applications accessed, and other system defined specific actions. Patient Pattern utilizes file system monitoring from OSSEC to assure the integrity of file system data.
    • Network: Network level audit trails generally monitor information on what is operating, penetrations, and vulnerabilities.
  3. Patient Pattern shall log all incoming and outgoing traffic to into and out of its environment. This includes all successful and failed attempts at data access and editing. Data associated with this data will include origin, destination, time, and other relevant details that are available to Patient Pattern.
  4. Patient Pattern utilizes OSSEC to scan all systems for malicious and unauthorized software every 2 hours and at reboot of systems.
  5. Patient Pattern leverages process monitoring tools throughout its environment.
  6. Patient Pattern treats its Dashboard as a Platform Add-on and, as such, it logs all activity associated with Dashboard Access.
  7. Patient Pattern uses OSSEC to monitor the integrity of log files by utilizing OSSEC System Integrity Checking capabilities.
  8. Patient Pattern shall identify “trigger events” or criteria that raise awareness of questionable conditions of viewing of confidential information. The “events” may be applied to the entire Patient Pattern Platform or may be specific to a Customer, partner, business associate, Platform Add-on or application (See Listing of Potential Trigger Events below).
  9. In addition to trigger events, Patient Pattern utilizes OSSEC log correlation functionality to proactively identify and enable alerts based on log data.
  10. Logs are reviewed weekly by the Security Officer.
  11. Patient Pattern’s Security Officer and Privacy Officer are authorized to select and use auditing tools that are designed to detect network vulnerabilities and intrusions. Such tools are explicitly prohibited by others, including Customers and Partners, without the explicit authorization of the Security Officer. These tools may include, but are not limited to:
    • Scanning tools and devices;
    • Password cracking utilities;
    • Network “sniffers.”
    • Passive and active intrusion detection systems.
  12. The process for review of audit logs, trails, and reports shall include:
    • Description of the activity as well as rationale for performing the audit.
    • Identification of which Patient Pattern workforce members will be responsible for review (workforce members shall not review audit logs that pertain to their own system activity).
    • Frequency of the auditing process.
    • Determination of significant events requiring further review and follow-up.
    • Identification of appropriate reporting channels for audit results and required follow-up.
  13. Vulnerability testing software may be used to probe the network to identify what is running (e.g., operating system or product versions in place), whether publicly-known vulnerabilities have been corrected, and evaluate whether the system can withstand attacks aimed at circumventing security controls.
    • Testing may be carried out internally or provided through an external third-party vendor. Whenever possible, a third party auditing vendor should not be providing the organization IT oversight services (e.g., vendors providing IT services should not be auditing their own services - separation of duties).
    • Testing shall be done on a routine basis, currently monthly.
  14. Software patches and updates will be applied to all systems in a timely manner.

8.3 Audit Requests

  1. A request may be made for an audit for a specific cause. The request may come from a variety of sources including, but not limited to, Privacy Officer, Security Officer, Customer, Partner, or an Application owner or application user.
  2. A request for an audit for specific cause must include time frame, frequency, and nature of the request. The request must be reviewed and approved by Patient Pattern’s Privacy or Security Officer.
  3. A request for an audit must be approved by Patient Pattern’s Privacy Officer and/or Security Officer before proceeding. Under no circumstances shall detailed audit information be shared with parties without proper permissions and access to see such data.
    • Should the audit disclose that a workforce member has accessed ePHI inappropriately, the minimum necessary/least privileged information shall be shared with Patient Pattern’s Security Officer to determine appropriate sanction/ corrective disciplinary action.
    • Only de-identified information shall be shared with Customer or Partner regarding the results of the investigative audit process. This information will be communicated to the appropriate personnel by Patient Pattern’s Privacy Officer or designee. Prior to communicating with customers and partners regarding an audit, it is recommended that Patient Pattern consider seeking risk management and/or legal counsel.

8.4 Review and Reporting of Audit Findings

  1. Audit information that is routinely gathered must be reviewed in a timely manner, currently monthly, by the responsible workforce member(s). On a quarterly basis, logs are reviewed to assure the proper data is being captured and retained. The following process details how log reviews are done at Patient Pattern:
    1. The Security Officer initiates the log review by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
    2. The Security Officer, or a Patient Pattern Security Engineer assigned by the Security Officer, is assigned to review the logs.
    3. Relevant audit log findings are added to the Issue; these findings are investigated in a later step. Once those steps are completed, the Issue is then reviewed again.
    4. Once the review is completed, the Security Officer approves or rejects the Issue. Relevant findings are reviewed at this stage. If the Issue is rejected, it goes back for further review and documentation. The communications protocol around specific findings are outlined below.
    5. If the Issue is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
  2. The reporting process shall allow for meaningful communication of the audit findings to those workforce members, Customers, or Partners requesting the audit.
    • Significant findings shall be reported immediately in a written format. Patient Pattern’s security incident response form may be utilized to report a single event.
    • Routine findings shall be reported to the sponsoring leadership structure in a written report format.
  3. Reports of audit results shall be limited to internal use on a minimum necessary/need-to-know basis. Audit results shall not be disclosed externally without administrative and/or legal counsel approval.
  4. Security audits constitute an internal, confidential monitoring practice that may be included in Patient Pattern’s performance improvement activities and reporting. Care shall be taken to ensure that the results of the audits are disclosed to administrative level oversight structures only and that information which may further expose organizational risk is shared with extreme caution. Generic security audit information may be included in organizational reports (individually-identifiable e PHI shall not be included in the reports).
  5. Whenever indicated through evaluation and reporting, appropriate corrective actions must be undertaken. These actions shall be documented and shared with the responsible workforce members, Customers, and/or Partners.
  6. Log review activity is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.

8.5 Auditing Customer and Partner Activity

  1. Periodic monitoring of Customer and Partner activity shall be carried out to ensure that access and activity is appropriate for privileges granted and necessary to the arrangement between Patient Pattern and the 3rd party. Patient Pattern will make every effort to assure Customers and Partners do not gain access to data outside of their own Environments.
  2. If it is determined that the Customer or Partner has exceeded the scope of access privileges, Patient Pattern’s leadership must remedy the problem immediately.
  3. If it is determined that a Customer or Partner has violated the terms of the HIPAA business associate agreement or any terms within the HIPAA regulations, Patient Pattern must take immediate action to remediate the situation. Continued violations may result in discontinuation of the business relationship.

8.6 Audit Log Security Controls and Backup

  1. Audit logs shall be protected from unauthorized access or modification, so the information they contain will be made available only if needed to evaluate a security incident or for routine audit activities as outlined in this policy.
  2. All audit logs are protected in transit and encrypted at rest to control access to the content of the logs.
  3. Audit logs shall be stored on a separate system to minimize the impact auditing may have on the privacy system and to prevent access to audit trails by those with system administrator privileges.
    • Separate systems are used to apply the security principle of “separation of duties” to protect audit trails from hackers.
    • Patient Pattern logging servers include Elasticsearch, Logstash, and Kibana (ELK) as part of their baseline configuration to ease reviewing of audit log data. The ELK toolkit provides message summarization, reduction, and reporting functionality.
  4. For PaaS Customers choosing to use Patient Pattern logging services, log data will be separated from the log data of other Patient Pattern Customers.

8.7 Workforce Training, Education, Awareness and Responsibilities

  1. Patient Pattern workforce members are provided training, education, and awareness on safeguarding the privacy and security of business and ePHI. Patient Pattern’s commitment to auditing access and activity of the information applications, systems, and networks is communicated through new employee orientation, ongoing training opportunities and events, and applicable policies. Patient Pattern workforce members are made aware of responsibilities with regard to privacy and security of information as well as applicable sanctions/corrective disciplinary actions should the auditing process detect a workforce member’s failure to comply with organizational policies.
  2. Patient Pattern Customers are provided with necessary information to understand Patient Pattern auditing capabilities, and PaaS Customers can choose the level of logging and auditing that Patient Pattern will implement on their behalf.

8.8 External Audits of Information Access and Activity

  1. Prior to contracting with an external audit firm, Patient Pattern shall:
    • Outline the audit responsibility, authority, and accountability;
    • Choose an audit firm that is independent of other organizational operations;
    • Ensure technical competence of the audit firm staff;
    • Require the audit firm’s adherence to applicable codes of professional ethics;
    • Obtain a signed HIPAA business associate agreement;
    • Assign organizational responsibility for supervision of the external audit firm.

8.9 Retention of Audit Data

  1. Audit logs shall be maintained based on organizational needs. There is no standard or law addressing the retention of audit log/trail information. Retention of this information shall be based on:
    • Organizational history and experience.
    • Available storage space.
  2. Reports summarizing audit activities shall be retained for a period of six years.
  3. Log data is currently retained and readily accessible for a 1-month period. Beyond that, log data is available via cold backup.
  4. For Paas Customers, they choose the length of backup retention and availability that Patient Pattern will implement and enforce.

8.10 Potential Trigger Events

9. Configuration Management Policy

Patient Pattern standardizes and automates configuration management through the use of Chef/Salt scripts as well as documentation of all changes to production systems and networks. Chef and Salt automatically configure all Patient Pattern systems according to established and tested policies, and are used as part of our Disaster Recovery plan and process.

9.1 Applicable Standards

9.1.1 Applicable Standards from the HITRUST Common Security Framework

9.1.2 Applicable Standards from the HIPAA Security Rule

9.2 Configuration Management Policies

  1. Chef and Salt are used to standardize and automate configuration management.
  2. No systems are deployed into Patient Pattern environments without approval of the Patient Pattern CTO.
  3. All changes to production systems, network devices, and firewalls are approved by the Patient Pattern CTO before they are implemented to assure they comply with business and security requirements.
  4. All changes to production systems are tested before they are implemented in production.
  5. Implementation of approved changes are only performed by authorized personnel.
  6. Tooling to generate an up-to-date inventory of systems, including corresponding architecture diagrams for related products and services, is hosted on GitLab.
    • All systems are categorized as production and utility to differentiate based on criticality.
    • The Security Officer maintains scripts to generate inventory lists on demand using APIs provided by each cloud provider.
    • These scripts are used to generate the diagrams and asset lists required by the Risk Assessment phase of Patient Pattern’s Risk Management procedures (§4.3.1).
    • After every use of these scripts, the Security Officer will verify their accuracy by reconciling their output with recent changes to production systems. The Security Officer will address any discrepancies immediately with changes to the scripts.
  7. All frontend functionality (developer dashboards and portals) is separated from backend (database and app servers) systems by being deployed on separate servers or containers.
  8. All software and systems are tested using unit tests and end to end tests.
  9. All committed code is reviewed using pull requests to assure software code quality and proactively detect potential security issues in development.
  10. Patient Pattern utilizes development and staging environments that mirror production to assure proper function.
  11. Patient Pattern also deploys environments locally using Vagrant to assure functionality before moving to staging or production.
  12. All formal change requests require unique ID and authentication.
  13. Patient Pattern uses the Security Technical Implementation Guides (STIGs) published by the Defense Information Systems Agency as a baseline for hardening systems.
    • Windows-based systems use a baseline Active Directory group policy configuration in conjunction with the Windows Server 2012 STIG.
    • Linux-based systems use a Red Hat Enterprise Linux STIG which has been adapted for Ubuntu and improved based on the results of subsequent vulnerability scans and risk assessments.
  14. Clocks are continuously synchronized to an authoritative source across all systems using NTP or a platform-specific equivalent. Modifying time data on systems is restricted.

9.3 Provisioning Production Systems

  1. Before provisioning any systems, ops team members must file a request in the JIRA Deployment Ticket (DT) project.
  2. The VP Engineering or CTO must approve the provisioning request before any new system can be provisioned.
  3. Once provisioning has been approved, the ops team member must configure the new system according to the standard baseline chosen for the system’s role.
    • For Linux systems, this means adding the appropriate grains to the Salt configuration file and running a highstate operation.
    • For Windows systems, this means adding the appropriate roles to the system’s Chef profile and forcing a Chef run.
  4. If the system will be used to house production data (ePHI), the ops team member must add an encrypted block data volume to the VM during provisioning.
    • For systems on cloud providers, the ops team member must add a block data volume and set up OS-level data encryption using Salt or Chef.
  5. Once the system has been provisioned, the ops team member must contact the security team to inspect the new system. A member of the security team will verify that the secure baseline has been applied to the new system, including (but not limited to) verifying the following items:
    • Removal of default users used during provisioning.
    • Network configuration for system.
    • Data volume encryption settings.
    • Intrusion detection and virus scanning software installed.
    • All items listed below in the operating system-specific subsections below.
  6. Once the security team member has verified the new system is correctly configured, the team member must add that system to the Nessus security scanner configuration.
  7. The new system may be rotated into production once the CTO verifies all the provisioning steps listed above have been correctly followed and has marked the Issue with the Approved state.

9.3.1 Provisioning Linux Systems

  1. Linux systems have their baseline security configuration applied via Salt states. These baseline Salt states cover:
    • Ensuring that the machine is up-to-date with security patches and is configured to apply patches in accordance with our policies.
    • Stopping and disabling any unnecessary OS services.
    • Installing and configuring the OSSEC IDS agent.
    • Installing and configuring the ClamAV virus scanner.
    • Installing and configuring the NTP daemon, including ensuring that modifying system time cannot be performed by unprivileged users.
    • Configuring LUKS volumes for providers that do not have native support for encrypted data volumes, including ensuring that encryption keys are protected from unauthorized access.
    • Configuring authentication to the centralized LDAP servers.
    • Configuring audit logging as described in the Auditing Policy section.
  2. Any additional Salt states applied to the Linux system must be clearly documented by the ops team member in the DT request by specifying the purpose of the new system.

9.3.2 Provisioning Windows Systems

  1. Windows systems have their baseline security configuration applied via the combination of Group Policy settings and Chef recipes. These baseline settings cover:
    • Joining the Windows Domain Controller and applying the Active Directory Group Policy configuration.
    • Ensuring that the machine is up-to-date with security patches and is configured to apply patches in accordance with our policies.
    • Stopping and disabling any unnecessary OS services.
    • Installing and configuring the OSSEC IDS agent.
    • Installing and configuring the Avast virus scanner.
    • Configuring the system clock, including ensuring that modifying system time cannot be performed by unprivileged users.
    • Configuring audit logging as described in the Auditing Policy section.
  2. Any additional Salt states applied to the Linux system must be clearly documented by the ops team member in the DT request by specifying the purpose of the new system.

9.3.3 Provisioning Management Systems

  1. Provisioning management systems such salt servers, LDAP servers, or VPN appliances follows the same procedure as provisioning a production system.
  2. Provisioning the first Salt server for a production pod requires bootstrapping Salt. The VP Engineering will oversee provisioning a new Salt server.
    • Once the Salt server has been bootstrapped, the ops team member will apply the baseline configuration to the Salt server by performing a highstate operation as usual.
  3. Critical infrastructure services such as logging, monitoring, LDAP servers, or Windows Domain Controllers must be configured with appropriate Salt states.
    • These Salt states have been approved by the VP Engineering and CTO to be in accordance with all Patient Pattern policies, including setting appropriate:
      • Audit logging requirements.
      • Password size, strength, and expiration requirements.
      • Transmission encryption requirements.
  4. Critical infrastruture roles applied to new systems must be clearly documented by the ops team member in the DT request.

9.4 Changing Existing Systems

  1. Subsequent changes to already-provisioned systems are unconditionally handled by one of the following methods:
    • Changes to Salt states or pillar values.
    • Changes to Chef recipes.
    • For configuration changes that cannot be handled by Chef or Salt, a runbook describing exactly what changes will be made and by whom.
  2. Configuration changes to Chef recipes or Salt states must be initiated by creating a Merge Request in GitLab.
    • The ops team member will create a feature branch and make their changes on that branch.
    • The ops team member must test their configuration change locally when possible, or on a development and/or staging sandbox otherwise.
    • At least one other ops team member must review the Chef or Salt change before merging the change into the main branch.
  3. In all cases, before rolling out the change to production, the ops team member must file an Issue in the DT project describing the change. This Issue must link to the reviewed Merge Request and/or include a link to the runbook.
  4. Once the request has been approved by the CTO, the ops team member may roll out the change into production environments.

9.5 Patch Management Procedures

  1. Patient Pattern uses automated tooling to ensure systems are up-to-date with the latest security patches.
  2. On Ubuntu Linux systems, the unattended-upgrades tool is used to apply security patches in phases.
    • The security team maintains a mirrored snapshot of security patches from the upstream OS vendor. This mirror is synchronized bi-weekly and applied to development systems nightly.
    • If the development systems function properly after the two-week testing period, the security team will promote that snapshot into the mirror used by all staging systems. These patches will be applied to all staging systems during the next nightly patch run.
    • If the staging systems function properly after the two-week testing period, the security team will promote that snapshot into the mirror used by all production systems. These patches will be applied to all production systems during the next nightly patch run.
    • Patches for critical kernel security vulnerabilities may be applied to production systems using hot-patching tools at the discretion of the Security Officer. These patches must follow the same phased testing process used for non-kernel security patches; this process may be expedited for severe vulnerabilities.
  3. On Windows systems, the baseline Group Policy setting configures Windows Update to implement the patching policy.

9.6 Software Development Procedures

  1. All development uses feature branches based on the main branch used for the current release. Any changes required for a new feature or defect fix are committed to that feature branch.
    • These changes must be covered under 1) a unit test where possible, or 2) integration tests.
    • Integration tests are required if unit tests cannot reliably exercise all facets of the change.
  2. Developers are strongly encouraged to follow the commit message conventions suggested by GitHub.
    • Commit messages should be wrapped to 72 characters.
    • Commit messages should be written in the present tense. This convention matches up with commit messages generated by commands like git merge and git revert.
  3. Once the feature and corresponding tests are complete, a pull request will be created using the GitHub/GitLab web interface. The pull request should indicate which feature or defect is being addressed and should provide a high-level description of the changes made.
  4. Code reviews are performed as part of the pull request procedure. Once a change is ready for review, the author(s) will notify other engineers using an appropriate mechanism, typically via an @channel message in Slack.
    • Other engineers will review the changes, using the guidelines above.
    • Engineers should note all potential issues with the code; it is the responsibility of the author(s) to address those issues or explain why they are not applicable.
  5. If the feature or defect interacts with ePHI, or controls access to data potentially containing ePHI, the code changes must be reviewed by the Security Officer before the feature is marked as complete.
    • This review must include a security analysis for potential vulnerabilities such as those listed in the OWASP Top 10.
    • This review must also verify that any actions performed by authenticated users will generate appropriate audit log entries.
  6. Once the review process finishes, each reviewer should leave a comment on the pull request saying “looks good to me” (often abbreviated as “LGTM”), at which point the original author(s) may merge their change into the release branch.

9.7 Software Release Procedures

  1. Software releases are treated as changes to existing systems and thus follow the procedure described in §9.4.

10. Facility Access Policy

Patient Pattern works with Subcontractors to assure restriction of physical access to systems used as part of the Patient Pattern Platform. Patient Pattern and its Subcontractors control access to the physical buildings/facilities that house these systems/applications, or in which Patient Pattern workforce members operate, in accordance to the HIPAA Security Rule 164.310 and its implementation specifications. Physical Access to all of Patient Pattern facilities is limited to only those authorized in this policy. In an effort to safeguard ePHi from unauthorized access, tampering, and theft, access is allowed to areas only to those persons authorized to be in them and with escorts for unauthorized persons. All workforce members are responsible for reporting an incident of unauthorized visitor and/or unauthorized access to Patient Pattern’s facility.

Of note, Patient Pattern does not have ready access to ePHI, it provides cloud-based, compliant infrastructure to covered entities and business associates. Patient Pattern does not physically house any systems used by its Platform in Patient Pattern facilities. Physical security of our Platform servers is outlined in §1.4.

10.1 Applicable Standards

10.1.1 Applicable Standards from the HITRUST Common Security Framework

10.1.2 Applicable Standards from the HIPAA Security Rule

10.2 Patient Pattern-controlled Facility Access Policies

  1. Visitor and third party support access is recorded and supervised. All visitors are escorted.
  2. Repairs are documented and the documentation is retained.
  3. Fire extinguishers and detectors are installed according to applicable laws and regulations.
  4. Maintenance is controlled and conducted by authorized personnel in accordance with supplier-recommended intervals, insurance policies and the organizations maintenance program.
  5. Electronic and physical media containing covered information is securely destroyed (or the information securely removed) prior to disposal.
  6. The organization securely disposes media with sensitive information.
  7. Physical access is restricted using smart locks that track all access.
    • Restricted areas and facilities are locked and when unattended (where feasible).
    • Only authorized workforce members receive access to restricted areas (as determined by the Security Officer).
    • Access and keys are revoked upon termination of workforce members.
    • Workforce members must report a lost and/or stolen key(s) to the Security Officer.
    • The Security Officer facilitates the changing of the lock(s) within 7 days of a key being reported lost/stolen
  8. Enforcement of Facility Access Policies
    • Report violations of this policy to the restricted area’s department team leader, supervisor, manager, or director, or the Privacy Officer.
    • Workforce members in violation of this policy are subject to disciplinary action, up to and including termination.
    • Visitors in violation of this policy are subject to loss of vendor privileges and/or termination of services from Patient Pattern.
  9. Workstation Security
    • Workstations may only be accessed and utilized by authorized workforce members to complete assigned job/contract responsibilities.
    • All workforce members are required to monitor workstations and report unauthorized users and/or unauthorized attempts to access systems/applications as per the System Access Policy.
    • All workstations purchased by Patient Pattern are the property of Patient Pattern and are distributed to users by the company.

11. Incident Response Policy

Patient Pattern implements an information security incident response process to consistently detect, respond, and report incidents, minimize loss and destruction, mitigate the weaknesses that were exploited, and restore information system functionality and business continuity as soon as possible.

The incident response process addresses:

Note: These policies were adapted from work by the HIPAA Collaborative of Wisconsin Security Networking Group. Refer to the linked document for additional copyright information.

11.1 Applicable Standards

11.1.1 Applicable Standards from the HITRUST Common Security Framework

11.1.2 Applicable Standards from the HIPAA Security Rule

11.2 Incident Management Policies

The Patient Pattern incident response process follows the process recommended by SANS, an industry leader in security. Process flows are a direct representation of the SANS process which can be found in this document.

Patient Pattern’s incident response classifies security-related events into the following categories:

Patient Pattern employees must report any unauthorized or suspicious activity seen on production systems or associated with related communication systems (such as email or Slack). In practice this means keeping an eye out for security events, and letting the Security Officer know about any observed precursors or indications as soon as they are discovered.

11.2.1 Identification Phase

  1. Immediately upon observation Patient Pattern members report suspected and known Events, Precursors, Indications, and Incidents in one of the following ways:
    1. Direct report to management, the Security Officer, Privacy Officer, or other;
    2. Email;
    3. Phone call;
    4. Incident response form located here;
    5. Secure Chat.
    6. Anonymously through workforce members desired channels.
  2. The individual receiving the report facilitates completion of an Incident Identification form and notifies the Security Officer (if not already done).
  3. The Security Officer determines if the issue is an Event, Precursor, Indication, or Incident.
    1. If the issue is an event, indication, or precursor the Security Officer forwards it to the appropriate resource for resolution.
      1. Non-Technical Event (minor infringement): the Security Officer completes a SIR Form and investigates the incident.
      2. Technical Event: Assign the issue to an IT resource for resolution. This resource may also be a contractor or outsourced technical resource, in the event of a small office or lack of expertise in the area.
    2. If the issue is a security incident the Security Officer activates the Security Incident Response Team (SIRT) and notifies senior management.
      1. If a non-technical security incident is discovered the SIRT completes the investigation, implements preventative measures, and resolves the security incident.
      2. Once the investigation is completed, progress to Phase V, Follow-up.
      3. If the issue is a technical security incident, commence to Phase II: Containment.
      4. The Containment, Eradication, and Recovery Phases are highly technical. It is important to have them completed by a highly qualified technical security resource with oversight by the SIRT team.
      5. Each individual on the SIRT and the technical security resource document all measures taken during each phase, including the start and end times of all efforts.
      6. The lead member of the SIRT team facilitates initiation of a SIR Form or an Incident Survey Form. The intent of the SIR form is to provide a summary of all events, efforts, and conclusions of each Phase of this policy and procedures.
  4. The Security Officer, Privacy Officer, or Patient Pattern representative appointed notifies any affected Customers and Partners. If no Customers and Partners are affected, notification is at the discretion of the Security and Privacy Officer.
  5. In the case of a threat identified, the Security Officer is to form a team to investigate and involve necessary resources, both internal to Patient Pattern and potentially external.

11.2.2 Containment Phase (Technical)

In this Phase, Patient Pattern’s IT department attempts to contain the security incident. It is extremely important to take detailed notes during the security incident response process. This provides that the evidence gathered during the security incident can be used successfully during prosecution, if appropriate.

  1. The SIRT reviews any information that has been collected by the Security Officer or any other individual investigating the security incident.
  2. The SIRT secures the network perimeter.
  3. The IT department performs the following:
    1. Securely connect to the affected system over a trusted connection.
    2. Retrieve any volatile data from the affected system.
    3. Determine the relative integrity and the appropriateness of backing the system up.
    4. If appropriate, back up the system.
    5. Change the password(s) to the affected system(s).
    6. Determine whether it is safe to continue operations with the affect system(s).
    7. If it is safe, allow the system to continue to function;
      1. Complete any documentation relative to the security incident on the SIR Form.
      2. Move to Phase V, Follow-up.
    8. If it is NOT safe to allow the system to continue operations, discontinue the system(s) operation and move to Phase III, Eradication.
    9. The individual completing this phase provides written communication to the SIRT.
  4. Continuously apprise Senior Management of progress.
  5. Continue to notify affected Customers and Partners with relevant updates as needed

11.2.3 Eradication Phase (Technical)

The Eradication Phase represents the SIRT’s effort to remove the cause, and the resulting security exposures, that are now on the affected system(s).

  1. Determine symptoms and cause related to the affected system(s).
  2. Strengthen the defenses surrounding the affected system(s), where possible (a risk assessment may be needed and can be determined by the Security Officer). This may include the following:
    1. An increase in network perimeter defenses.
    2. An increase in system monitoring defenses.
    3. Remediation (“fixing”) any security issues within the affected system, such as removing unused services/general host hardening techniques.
  3. Conduct a detailed vulnerability assessment to verify all the holes/gaps that can be exploited have been addressed.
    1. If additional issues or symptoms are identified, take appropriate preventative measures to eliminate or minimize potential future compromises.
  4. Complete the Eradication Form.
  5. Update the documentation with the information learned from the vulnerability assessment, including the cause, symptoms, and the method used to fix the problem with the affected system(s).
  6. Apprise Senior Management of the progress.
  7. Continue to notify affected Customers and Partners with relevant updates as needed.
  8. Move to Phase IV, Recovery.

11.2.4 Recovery Phase (Technical)

The Recovery Phase represents the SIRT’s effort to restore the affected system(s) back to operation after the resulting security exposures, if any, have been corrected.

  1. The technical team determines if the affected system(s) have been changed in any way.
    1. If they have, the technical team restores the system to its proper, intended functioning (“last known good”).
    2. Once restored, the team validates that the system functions the way it was intended/had functioned in the past. This may require the involvement of the business unit that owns the affected system(s).
    3. If operation of the system(s) had been interrupted (i.e., the system(s) had been taken offline or dropped from the network while triaged), restart the restored and validated system(s) and monitor for behavior.
    4. If the system had not been changed in any way, but was taken offline (i.e., operations had been interrupted), restart the system and monitor for proper behavior.
    5. Update the documentation with the detail that was determined during this phase.
    6. Apprise Senior Management of progress.
    7. Continue to notify affected Customers and Partners with relevant updates as needed.
    8. Move to Phase V, Follow-up.

11.2.5 Follow-up Phase (Technical and Non-Technical)

The Follow-up Phase represents the review of the security incident to look for “lessons learned” and to determine whether the process that was taken could have been improved in any way. It is recommended all security incidents be reviewed shortly after resolution to determine where response could be improved. Timeframes may extend to one to two weeks post-incident.

  1. Responders to the security incident (SIRT Team and technical security resource) meet to review the documentation collected during the security incident.
  2. Create a “lessons learned” document and attach it to the completed SIR Form.
    1. Evaluate the cost and impact of the security incident to Patient Pattern using the documents provided by the SIRT and the technical security resource.
    2. Determine what could be improved.
    3. Communicate these findings to Senior Management for approval and for implementation of any recommendations made post-review of the security incident.
    4. Carry out recommendations approved by Senior Management; sufficient budget, time and resources should be committed to this activity.
    5. Close the security incident.

11.2.6 Periodic Evaluation

It is important to note that the processes surrounding security incident response should be periodically reviewed and evaluated for effectiveness. This also involves appropriate training of resources expected to respond to security incidents, as well as the training of the general population regarding the Patient Pattern’s expectation for them, relative to security responsibilities. The incident response plan is tested annually.

11.3 Security Incident Response Team (SIRT)

Current members of the Patient Pattern SIRT:

12. Breach Policy

To provide guidance for breach notification when impressive or unauthorized access, acquisition, use and/or disclosure of the ePHI occurs. Breach notification will be carried out in compliance with the American Recovery and Reinvestment Act (ARRA)/Health Information Technology for Economic and Clinical Health Act (HITECH) as well as any other federal or state notification law.

The Federal Trade Commission (FTC) has published breach notification rules for vendors of personal health records as required by ARRA/HITECH. The FTC rule applies to entities not covered by HIPAA, primarily vendors of personal health records. The rule is effective September 24, 2009 with full compliance required by February 22, 2010.

The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law on February 17, 2009. Title XIII of ARRA is the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH significantly impacts the Health Insurance Portability and Accountability (HIPAA) Privacy and Security Rules. While HIPAA did not require notification when patient protected health information (PHI) was inappropriately disclosed, covered entities and business associates may have chosen to include notification as part of the mitigation process. HITECH does require notification of certain breaches of unsecured PHI to the following: individuals, Department of Health and Human Services (HHS), and the media. The effective implementation for this provision is September 23, 2009 (pending publication HHS regulations).

In the case of a breach, Patient Pattern shall notify all affected Customers. It is the responsibility of the Customers to notify affected individuals.

12.1 Applicable Standards

12.1.1 Applicable Standards from the HITRUST Common Security Framework

12.1.2 Applicable Standards from the HIPAA Security Rule

12.2 Patient Pattern Breach Policy

  1. Discovery of Breach: A breach of ePHI shall be treated as “discovered” as of the first day on which such breach is known to the organization, or, by exercising reasonable diligence would have been known to Patient Pattern (includes breaches by the organization’s Customers, Partners, or subcontractors). Patient Pattern shall be deemed to have knowledge of a breach if such breach is known or by exercising reasonable diligence would have been known, to any person, other than the person committing the breach, who is a workforce member or Partner of the organization. Following the discovery of a potential breach, the organization shall begin an investigation (see organizational policies for security incident response and/or risk management incident response) immediately, conduct a risk assessment, and based on the results of the risk assessment, begin the process to notify each Customer affected by the breach. Patient Pattern shall also begin the process of determining what external notifications are required or should be made (e.g., Secretary of Department of Health & Human Services (HHS), media outlets, law enforcement officials, etc.)
  2. Breach Investigation: The Patient Pattern Security Officer shall name an individual to act as the investigator of the breach (e.g., privacy officer, security officer, risk manager, etc.). The investigator shall be responsible for the management of the breach investigation, completion of a risk assessment, and coordinating with others in the organization as appropriate (e.g., administration, security incident response team, human resources, risk management, public relations, legal counsel, etc.) The investigator shall be the key facilitator for all breach notification processes to the appropriate entities (e.g., HHS, media, law enforcement officials, etc.). All documentation related to the breach investigation, including the risk assessment, shall be retained for a minimum of six years. A template breach log is located here.
  3. Risk Assessment: For an acquisition, access, use or disclosure of ePHI to constitute a breach, it must constitute a violation of the HIPAA Privacy Rule. A use or disclosure of ePHI that is incident to an otherwise permissible use or disclosure and occurs despite reasonable safeguards and proper minimum necessary procedures would not be a violation of the Privacy Rule and would not qualify as a potential breach. To determine if an impermissible use or disclosure of ePHI constitutes a breach and requires further notification, the organization will need to perform a risk assessment to determine if there is significant risk of harm to the individual as a result of the impermissible use or disclosure. The organization shall document the risk assessment as part of the investigation in the incident report form noting the outcome of the risk assessment process. The organization has the burden of proof for demonstrating that all notifications to appropriate Customers or that the use or disclosure did not constitute a breach. Based on the outcome of the risk assessment, the organization will determine the need to move forward with breach notification. The risk assessment and the supporting documentation shall be fact specific and address:
    • Consideration of who impermissibly used or to whom the information was impermissibly disclosed;
    • The type and amount of ePHI involved;
    • The cause of the breach, and the entity responsible for the breach, either Customer, Patient Pattern, or Partner.
    • The potential for significant risk of financial, reputational, or other harm.
  4. Timeliness of Notification: Upon discovery of a breach, notice shall be made to the affected Patient Pattern Customers no later than 4 hours after the discovery of the breach. It is the responsibility of the organization to demonstrate that all notifications were made as required, including evidence demonstrating the necessity of delay.
  5. Delay of Notification Authorized for Law Enforcement Purposes: If a law enforcement official states to the organization that a notification, notice, or posting would impede a criminal investigation or cause damage to national security, the organization shall:
    • If the statement is in writing and specifies the time for which a delay is required, delay such notification, notice, or posting of the timer period specified by the official; or
    • If the statement is made orally, document the statement, including the identify of the official making the statement, and delay the notification, notice, or posting temporarily and no longer than 30 days from the date of the oral statement, unless a written statement as described above is submitted during that time.
  6. Content of the Notice: The notice shall be written in plain language and must contain the following information:
    • A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known;
    • A description of the types of unsecured protected health information that were involved in the breach (such as whether full name, Social Security number, date of birth, home address, account number, diagnosis, disability code or other types of information were involved), if known;
    • Any steps the Customer should take to protect Customer data from potential harm resulting from the breach.
    • A brief description of what Patient Pattern is doing to investigate the breach, to mitigate harm to individuals and Customers, and to protect against further breaches.
    • Contact procedures for individuals to ask questions or learn additional information, which may include a toll-free telephone number, an e-mail address, a web site, or postal address.
  7. Methods of Notification: Patient Pattern Customers will be notified via email and phone within the timeframe for reporting breaches, as outlined above.
  8. Maintenance of Breach Information/Log: As described above and in addition to the reports created for each incident, Patient Pattern shall maintain a process to record or log all breaches of unsecured ePHI regardless of the number of records and Customers affected. The following information should be collected/logged for each breach (see sample Breach Notification Log):
    • A description of what happened, including the date of the breach, the date of the discovery of the breach, and the number of records and Customers affected, if known.
    • A description of the types of unsecured protected health information that were involved in the breach (such as full name, Social Security number, date of birth, home address, account number, etc.), if known.
    • A description of the action taken with regard to notification of patients regarding the breach.
    • Resolution steps taken to mitigate the breach and prevent future occurrences.
  9. Workforce Training: Patient Pattern shall train all members of its workforce on the policies and procedures with respect to ePHI as necessary and appropriate for the members to carry out their job responsibilities. Workforce members shall also be trained as to how to identify and report breaches within the organization.
  10. Complaints: Patient Pattern must provide a process for individuals to make complaints concerning the organization’s patient privacy policies and procedures or its compliance with such policies and procedures.
  11. Sanctions: The organization shall have in place and apply appropriate sanctions against members of its workforce, Customers, and Partners who fail to comply with privacy policies and procedures.
  12. Retaliation/Waiver: Patient Pattern may not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against any individual for the exercise by the individual of any privacy right. The organization may not require individuals to waive their privacy rights under as a condition of the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits.

12.3 Patient Pattern Platform Customer Responsibilities

  1. The Patient Pattern Customer that accesses, maintains, retains, modifies, records, stores, destroys, or otherwise holds, uses, or discloses unsecured ePHI shall, without unreasonable delay and in no case later than 60 calendar days after discovery of a breach, notify Patient Pattern of such breach. The Customer shall provide Patient Pattern with the following information:
    • A description of what happened, including the date of the breach, the date of the discovery of the breach, and the number of records and Customers affected, if known.
    • A description of the types of unsecured protected health information that were involved in the breach (such as full name, Social Security number, date of birth, home address, account number, etc.), if known.
    • A description of the action taken with regard to notification of patients regarding the breach.
    • Resolution steps taken to mitigate the breach and prevent future occurrences.
  2. Notice to Media: Patient Pattern Customers are responsible for providing notice to prominent media outlets at the Customer’s discretion.
  3. Notice to Secretary of HHS: Patient Pattern Customers are responsible for providing notice to the Secretary of HHS at the Customer’s discretion.

12.4 Sample Letter to Customers in Case of Breach

[Date]

[Name here] [Address 1 Here] [Address 2 Here] [City, State Zip Code]

Dear [Name of Customer]:

I am writing to you from Patient Pattern, Inc., with important information about a recent breach that affects your account with us. We became aware of this breach on [Insert Date] which occurred on or about [Insert Date]. The breach occurred as follows:

Describe event and include the following information:

Other Optional Considerations:

We will assist you in remedying the situation.

Sincerely,

Brett Kellgren Co-founder - Patient Pattern, Inc. brett@patientpattern.com 212-201-1212

13. Disaster Recovery Policy

The Patient Pattern Contingency Plan establishes procedures to recover Patient Pattern following a disruption resulting from a disaster. This Disaster Recovery Policy is maintained by the Patient Pattern Security Officer and Privacy Officer.

The following objectives have been established for this plan:

  1. Maximize the effectiveness of contingency operations through an established plan that consists of the following phases:
    • Notification/Activation phase to detect and assess damage and to activate the plan;
    • Recovery phase to restore temporary IT operations and recover damage done to the original system;
    • Reconstitution phase to restore IT system processing capabilities to normal operations.
  2. Identify the activities, resources, and procedures needed to carry out Patient Pattern processing requirements during prolonged interruptions to normal operations.
  3. Identify and define the impact of interruptions to Patient Pattern systems.
  4. Assign responsibilities to designated personnel and provide guidance for recovering Patient Pattern during prolonged periods of interruption to normal operations.
  5. Ensure coordination with other Patient Pattern staff who will participate in the contingency planning strategies.
  6. Ensure coordination with external points of contact and vendors who will participate in the contingency planning strategies.

This Patient Pattern Contingency Plan has been developed as required under the Office of Management and Budget (OMB) Circular A-130, Management of Federal Information Resources, Appendix III, November 2000, and the Health Insurance Portability and Accountability Act (HIPAA) Final Security Rule, Section §164.308(a)(7), which requires the establishment and implementation of procedures for responding to events that damage systems containing electronic protected health information.

This Patient Pattern Contingency Plan is created under the legislative requirements set forth in the Federal Information Security Management Act (FISMA) of 2002 and the guidelines established by the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-34, titled “Contingency Planning Guide for Information Technology Systems” dated June 2002.

The Patient Pattern Contingency Plan also complies with the following federal and departmental policies:

Example of the types of disasters that would initiate this plan are natural disaster, political disturbances, man made disaster, external human threats, internal malicious activities.

Patient Pattern defined two categories of systems from a disaster recovery perspective.

  1. Critical Systems. These systems host application servers and database servers or are required for functioning of systems that host application servers and database servers. These systems, if unavailable, affect the integrity of data and must be restored, or have a process begun to restore them, immediately upon becoming unavailable.
  2. Non-critical Systems. These are all systems not considered critical by definition above. These systems, while they may affect the performance and overall security of critical systems, do not prevent Critical systems from functioning and being accessed appropriately. These systems are restored at a lower priority than critical systems.

13.1 Applicable Standards

13.1.1 Applicable Standards from the HITRUST Common Security Framework

13.1.2 Applicable Standards from the HIPAA Security Rule

13.2 Line of Succession

The following order of succession to ensure that decision-making authority for the Patient Pattern Contingency Plan is uninterrupted. The Chief Technology Officer (CTO) and VP Engineering are responsible for ensuring the safety of personnel and the execution of procedures documented within this Patient Pattern Contingency Plan. If the CTO and VP Engineering are unable to function as the overall authority or chooses to delegate this responsibility to a successor, the CEO or COO shall function as that authority. To provide contact initiation should the contingency plan need to be initiated, please use the contact list below.

13.3 Responsibilities

The following teams have been developed and trained to respond to a contingency event affecting the IT system.

  1. The Ops Team is responsible for recovery of the Patient Pattern hosted environment, network devices, and all servers. Members of the team include personnel who are also responsible for the daily operations and maintenance of Patient Pattern. The team leader is the VP of Engineering and directs the Dev Ops Team.
  2. The Web Services Team is responsible for assuring all application servers, web services, and platform add-ons are working. It is also responsible for testing redeployments and assessing damage to the environment. The team leader is the CTO and directs the Web Services Team.

Members of the Ops and Web Services teams must maintain local copies of the contact information from §13.2. Additionally, the CTO and VP Engineering must maintain a local copy of this policy in the event Internet access is not available during a disaster scenario.

13.4 Testing and Maintenance

The CTO and VP of Engineering shall establish criteria for validation/testing of a Contingency Plan, an annual test schedule, and ensure implementation of the test. This process will also serve as training for personnel involved in the plan’s execution. At a minimum the Contingency Plan shall be tested annually (within 365 days). The types of validation/testing exercises include tabletop and technical testing. Contingency Plans for all application systems must be tested at a minimum using the tabletop testing process. However, if the application system Contingency Plan is included in the technical testing of their respective support systems that technical test will satisfy the annual requirement.

13.4.1 Tabletop Testing

Tabletop Testing is conducted in accordance with the the CMS Risk Management Handbook, Volume 2. The primary objective of the tabletop test is to ensure designated personnel are knowledgeable and capable of performing the notification/activation requirements and procedures as outlined in the CP, in a timely manner. The exercises include, but are not limited to:

13.4.2 Technical Testing

The primary objective of the technical test is to ensure the communication processes and data storage and recovery processes can function at an alternate site to perform the functions and capabilities of the system within the designated requirements. Technical testing shall include, but is not limited to:

13.5 Disaster Recovery Procedures

13.5.1 Notification and Activation Phase

This phase addresses the initial actions taken to detect and assess damage inflicted by a disruption to Patient Pattern. Based on the assessment of the Event, sometimes according to the Patient Pattern Incident Response Policy, the Contingency Plan may be activated by either the CTO or VP of Engineering.

The notification sequence is listed below:

13.5.2 Recovery Phase

This section provides procedures for recovering the application at an alternate site, whereas other efforts are directed to repair damage to the original system and capabilities.

The following procedures are for recovering the Patient Pattern infrastructure at the alternate site. Procedures are outlined per team required. Each procedure should be executed in the sequence it is presented to maintain efficient operations.

Recovery Goal: The goal is to rebuild Patient Pattern infrastructure to a production state.

The tasks outlines below are not sequential and some can be run in parallel.

  1. Contact Partners and Customers affected - Web Services
  2. Assess damage to the environment - Web Services
  3. Begin replication of new environment using automated and tested scripts, currently Chef and Salt. At this point it is determined whether to recover in Revion.com - Dev Ops
  4. Test new environment using pre-written tests - Web Services
  5. Test logging, security, and alerting functionality - Dev Ops
  6. Assure systems are appropriately patched and up to date. - Dev Ops
  7. Deploy environment to production - Web Services
  8. Update DNS to new environment. - Dev Ops

13.5.3 Reconstitution Phase

This section discusses activities necessary for restoring Patient Pattern operations at the original or new site. The goal is to restore full operations within 24 hours of a disaster or outage. When the hosted data center at the original or new site has been restored, Patient Pattern operations at the alternate site may be transitioned back. The goal is to provide a seamless transition of operations from the alternate site to the computer center.

  1. Original or New Site Restoration
    • Begin replication of new environment using automated and tested scripts, currently Chef and Salt. - Dev Ops
    • Test new environment using pre-written tests. - Web Services
    • Test logging, security, and alerting functionality. - Dev Ops
    • Deploy environment to production - Web Services
    • Assure systems are appropriately patched and up to date. - Dev Ops
    • Update DNS to new environment. - Dev Ops
  2. Plan Deactivation
    • If the Patient Pattern environment is moved back to the original site from the alternative site, all hardware used at the alternate site should be handled and disposed of according to the Patient Pattern Media Disposal Policy.

14. Disposable Media Policy

Patient Pattern recognizes that media containing ePHI may be reused when appropriate steps are taken to ensure that all stored ePHI has been effectively rendered inaccessible. Destruction/disposal of ePHI shall be carried out in accordance with federal and state law. The schedule for destruction/disposal shall be suspended for ePHI involved in any open investigation, audit, or litigation.

Patient Pattern utilizes dedicated hardware from Subcontractors. ePHI is only stored on SSD volumes in our hosted environment. All SSD volumes utilized by Patient Pattern and Patient Pattern Customers are encrypted. Patient Pattern does not use, own, or manage any mobile devices, SD cards, or tapes that have access to ePHI.

14.1 Applicable Standards

14.1.1 Applicable Standards from the HITRUST Common Security Framework

14.1.2 Applicable Standards from the HIPAA Security Rule

14.2 Disposable Media Policy

  1. All removable media is restricted, audited, and is encrypted.
  2. Patient Pattern assumes all disposable media in its Platform may contain ePHI, so it treats all disposable media with the same protections and disposal policies.
  3. All destruction/disposal of ePHI media will be done in accordance with federal and state laws and regulations and pursuant to the Patient Pattern’s written retention policy/schedule. Records that have satisfied the period of retention will be destroyed/disposed of in an appropriate manner.
  4. Records involved in any open investigation, audit or litigation should not be destroyed/disposed of. If notification is received that any of the above situations have occurred or there is the potential for such, the record retention schedule shall be suspended for these records until such time as the situation has been resolved. If the records have been requested in the course of a judicial or administrative hearing, a qualified protective order will be obtained to ensure that the records are returned to the organization or properly destroyed/disposed of by the requesting party.
  5. Before reuse of any media, for example all ePHI is rendered inaccessible, cleaned, or scrubbed. All media is formatted to restrict future access.
  6. All Patient Pattern Subcontractors provide that, upon termination of the contract, they will return or destroy/dispose of all patient health information. In cases where the return or destruction/disposal is not feasible, the contract limits the use and disclosure of the information to the purposes that prevent its return or destruction/disposal.
  7. Any media containing ePHI is disposed using a method that ensures the ePHI could not be readily recovered or reconstructed.
  8. The methods of destruction, disposal, and reuse are reassessed periodically, based on current technology, accepted practices, and availability of timely and cost-effective destruction, disposal, and reuse technologies and services.
  9. In the cases of a Patient Pattern Customer terminating a contract with Patient Pattern and no longer utilize Patient Pattern Services, the following actions will be taken depending on the Patient Pattern Services in use. In all cases it is solely the responsibility of the Patient Pattern Customer to maintain the safeguards required of HIPAA once the data is transmitted out of Patient Pattern Systems.
    • In the case of BaaS Customer termination, Patient Pattern will provide the customer with the ability to export data in commonly used format, currently CSV, for 30 days from the time of termination.
    • In the case of PaaS Customer termination, Patient Pattern will provide the customer with 30 days from the date of termination to export data.

15. IDS Policy

In order to preserve the integrity of data that Patient Pattern stores, processes, or transmits for Customers, Patient Pattern implements strong intrusion detection tools and policies to proactively track and retroactively investigate unauthorized access. Patient Pattern currently utilizes OSSEC to track file system integrity, monitor log data, and detect rootkit access.

15.1 Applicable Standards

15.1.1 Applicable Standards from the HITRUST Common Security Framework

15.1.2 Applicable Standards from the HIPAA Security Rule

15.2 Intrusion Detection Policy

  1. OSSEC is used to monitor and correlate log data from different systems on an ongoing basis. Reports generated by OSSEC are reviewed by the Security Officer on a monthly basis.
  2. OSSEC generates alerts to analyze and investigate suspicious activity or suspected violations.
  3. OSSEC monitors file system integrity and sends real time alerts when suspicious changes are made to the file system.
  4. Automatic monitoring is done to identify patterns that might signify the lack of availability of certain services and systems (DoS attacks).
  5. Patient Pattern firewalls monitor all incoming traffic to detect potential denial of service attacks. Suspected attack sources are blocked automatically. Additionally, our hosting provider actively monitors its network to detect denial of services attacks.
  6. All new firewall rules and configuration changes are tested before being pushed into production. All firewall and router rules are reviewed every quarter.
  7. Patient Pattern utilizes redundant firewall on network perimeters.

16. Vulnerability Scanning Policy

Patient Pattern is proactive about information security and understands that vulnerabilities need to be monitored on an ongoing basis. Patient Pattern utilizes Nessus Scanner from Tenable to consistently scan, identify, and address vulnerabilities on our systems. We also utilize OSSEC on all systems, including logs, for file integrity checking and intrusion detection.

16.1 Applicable Standards

16.1.1 Applicable Standards from the HITRUST Common Security Framework

16.1.2 Applicable Standards from the HIPAA Security Rule

16.2 Vulnerability Scanning Policy

  1. Nessus management is performed by the Patient Pattern Security Officer with assistance from the VP of Engineering.
  2. Nessus is used to monitor all internal IP addresses (servers, VMs, etc) on Patient Pattern networks.
  3. Frequency of scanning is as follows:
    1. on a weekly basis;
    2. after every production deployment.
  4. Reviewing Nessus reports and findings, as well as any further investigation into discovered vulnerabilities, are the responsibility of the Patient Pattern Security Officer. The process for reviewing Nessus reports is outlined below:
    1. The Security Officer initiates the review of a Nessus Report by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
    2. The Security Officer, or a Patient Pattern Security Engineer assigned by the Security Officer, is assigned to review the Nessus Report.
    3. If new vulnerabilities are found during review, the process below is used to test those vulnerabilities is outlined below. Once those steps are completed, the Issue is then reviewed again.
    4. Once the review is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review.
    5. If the review is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
  5. In the case of new vulnerabilities, the following steps are taken:
    • All new vulnerabilities are verified manually to assure they are repeatable. Those not found to be repeatable are manually tested after the next vulnerability scan, regardless of if the specific vulnerability is discovered again.
    • Vulnerabilities that are repeatable manually are documented and reviewed by the Security Officer, VP of Engineering, and Privacy Officer to see if they are part of the current risk assessment performed by Patient Pattern.
    • Those that are a part of the current risk assessment are checked for mitigations.
    • Those that are not part of the current risk assessment trigger a new risk assessment, and this process is outlined in detail in the Patient Pattern Risk Assessment Policy.
  6. All vulnerability scanning reports are retained for 6 years by Patient Pattern. Vulnerability report review is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.
  7. Penetration testing is performed regularly as part of the Patient Pattern vulnerability management policy.
    • External penetration testing is performed bi-annually by a third party.
    • Internal penetration testing is performed quarterly. Below is the process used to conduct internal penetration tests.
      1. The Security Officer initiates the penetration test by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
      2. The Security Officer, or a Patient Pattern Security Engineer assigned by the Security Officer, is assigned to conduct the penetration test.
      3. Gaps and vulnerabilities identified during penetration testing are reviewed, with plans for correction and/or mitigation, by the Patient Pattern Security Officer before the Issue can move to be approved.
      4. Once the testing is completed, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further testing and review.
      5. If the Issue is approved, the Security Officer then marks the Issue as Done, adding any pertinent notes required.
    • Penetration tests results are retained for 6 years by Patient Pattern.
    • Internal penetration testing is monitored on an annual basis using JIRA reporting to assess compliance with above policy.
  8. This vulnerability policy is reviewed on a quarterly basis by the Security Officer and Privacy Officer.

17. Data Integrity Policy

Patient Pattern takes data integrity very seriously. As stewards and partners of Patient Pattern Customers, we strive to assure data is protected from unauthorized access and that it is available when needed. The following policies drive many of our procedures and technical settings in support of the Patient Pattern mission of data protection.

Production systems that create, receive, store, or transmit Customer data (hereafter “Production Systems”) must follow the guidelines described in this section.

17.1 Applicable Standards

17.1.1 Applicable Standards from the HITRUST Common Security Framework

17.1.2 Applicable Standards from the HIPAA Security Rule

17.2 Disabling Non-Essential Services

  1. All Production Systems must disable services that are not required to achieve the business purpose or function of the system.

17.3 Monitoring Log-in Attempts

  1. All access to Production Systems must be logged. This is done following the Patient Pattern Auditing Policy.

17.4 Prevention of Malware on Production Systems

  1. All Production Systems must have OSSEC running at set to scan system every 2 hours and at reboot to assure not malware is present. Detected malware is evaluated and removed.
  2. Virus scanning software is run on all Production Systems for anti-virus protection.
    • Hosts are scanned daily for malicious binaries in critical system paths.
    • The malware signature database is checked hourly and automatically updated if new signatures are available.
    • Logs of virus scans are maintained according to the requirements outlined in §8.6.
  3. All Production Systems are to only be used for Patient Pattern business needs.

17.5 Patch Management

  1. Software patches and updates will be applied to all systems in a timely manner. In the case of routine updates, they will be applied after thorough testing. In the case of updates to correct known vulnerabilities, priority will be given to testing to speed the time to production. Critical security patches are applied within 30 days from testing and all security patches are applied within 90 days after testing.
    • In the case of PaaS Customers, updates to Application and Database versions are the responsibility of Customers, though Patient Pattern will, at it’s own discretion, notify and recommend updates to Customer systems.
  2. Administrators subscribe to mailing lists to assure up to date on current version of all Patient Pattern managed software on Production Systems.

17.6 Intrusion Detection and Vulnerability Scanning

  1. Production systems are monitored using IDS systems. Suspicious activity is logged and alerts are generated.
  2. Vulnerability scanning of Production Systems must occur on a predetermined, regular basis, no less than annually. Currently it is weekly. Scans are reviewed by Security Officer, with defined steps for risk mitigation, and retained for future reference.

17.7 Production System Security

  1. System, network, and server security is managed and maintained by the VP of Engineering and the Security Officer.
  2. Up to date system lists and architecture diagrams are kept for all production environments.
  3. Access to Production Systems is controlled using centralized tools and two-factor authentication.

17.8 Production Data Security

  1. Reduce the risk of compromise of Production Data.
  2. Implement and/or review controls designed to protect Production Data from improper alteration or destruction.
  3. Ensure that confidential data is stored in a manner that supports user access logs and automated monitoring for potential security incidents.
  4. Ensure Patient Pattern Customer Production Data is segmented and only accessible to Customer authorized to access data.
  5. All Production Data at rest is stored on encrypted volumes using encryption keys managed by Patient Pattern. Encryption at rest is ensured through the use of automated deployment scripts referenced in the Configuration Management Policy.
  6. Volume encryption keys and machines that generate volume encryption keys are protected from unauthorized access. Volume encryption key material is protected with access controls such that the key material is only accessible by privileged accounts.
  7. Encrypted volumes use AES encryption with a minimum of 256-bit keys, or keys and ciphers of equivalent or higher cryptographic strength.

17.9 Transmission Security

  1. All data transmission is encrypted end to end using encryption keys managed by Patient Pattern. Encryption is not terminated at the network end point, and is carried through to the application.
  2. Transmission encryption keys and machines that generate keys are protected from unauthorized access. Transmission encryption key material is protected with access controls such that the key material is only accessible by privileged accounts.
  3. Transmission encryption keys use a minimum of 4096-bit RSA keys, or keys and ciphers of equivalent or higher cryptographic strength.
  4. Transmission encryption keys are limited to use for one year and then must be regenerated.
  5. In the case of Patient Pattern provided APIs, provide mechanisms to assure person sending or receiving data is authorized to send and save data.
  6. System logs of all transmissions of Production Data access. These logs must be available for audit.

18. Data Retention Policy

Despite not being a requirement within HIPAA, Patient Pattern understand and appreciates the importance of health data retention. Acting as a subcontractor, and at times a business associate, Patient Pattern is not directly responsible for health and medical records retention as set forth by each state. Despite this, Patient Pattern has created and implemented the following policy to make it easier for Patient Pattern Customers to support data retention laws.

18.1 State Medical Record Laws

18.2 Data Retention Policy

19. Employees Policy

Patient Pattern is committed to ensuring all workforce members actively address security and compliance in their roles at Patient Pattern. As such, training is imperative to assuring an understanding of current best practices, the different types and sensitivities of data, and the sanctions associated with non-compliance.

19.1 Applicable Standards

19.1.1 Applicable Standards from the HITRUST Common Security Framework

19.1.2 Applicable Standards from the HIPAA Security Rule

19.2 Employment Policies

  1. All new workforce members, including contractors, are given training on security policies and procedures, including operations security, within 30 days of employment.
    • Records of training are kept for all workforce members.
    • Upon completion of training, workforce members complete this form.
    • Current Patient Pattern training is hosted at patientpattern.com/training.
    • Employees must complete this training before accessing production systems containing ePHI.
  2. All workforce members are granted access to formal organizational policies, which include the sanction policy for security violations.
  3. The Patient Pattern Employee Handbook clearly states the responsibilities and acceptable behavior regarding information system usage, including rules for email, Internet, mobile devices, and social media usage.
    • Workforce members are required to sign an agreement stating that they have read and will abide by all terms outlined in the Patient Pattern Employee Handbook, along with all policies and processes described in this document.
    • A Human Resources representative will provide the agreement to new employees during their onboarding process.
  4. Patient Pattern does not allow mobile devices to connect to any of its production networks.
  5. All workforce members are educated about the approved set of tools to be installed on workstations.
  6. All new workforce members are given HIPAA training within 30 days of beginning employment. Training includes HIPAA reporting requirements, including the ability to anonymously report security incidents, and the levels of compliance and obligations for Patient Pattern and its Customers and Partners.
  7. All remote (teleworking) workforce members are trained on the risks, the controls implemented, their responsibilities, and sanctions associated with violation of policies. Additionally, remote security is maintained through the use of VPN tunnels for all access to production systems with access to ePHI data.
  8. All Patient Pattern-purchased and -owned computers are to display this message at login and when the computer is unlocked: This computer is owned by Patient Pattern, Inc. By logging in, unlocking, and/or using this computer you acknowledge you have seen, and follow, these policies (https:/policy) and have completed this training (https:/training). Please contact us if you have problems with this - info@patientpattern.com.
  9. Employees may only use Patient Pattern-purchased and -owned workstations for accessing production systems with access to ePHI data.
    • Any workstations used to access production systems must be configured as prescribed in §7.8.
    • Any workstations used to access production systems must have virus protection software installed, configured, and enabled.
    • Patient Pattern may monitor access and activities of all users on workstations and production systems in order to meet auditing policy requirements (§8).
  10. Access to internal Patient Pattern systems can be requested using the procedures outlined in §7.2. All requests for access must be granted by the Patient Pattern Security Officer.
  11. Request for modifications of access for any Patient Pattern employee can be made using the procedures outlined in §7.2.
  12. Patient Pattern employees are strictly forbidden from downloading any ePHI to their workstations.
    • Restricting transfers of ePHI is enforced through technical controls as described in §7.13.
    • Employees found to be in violation of this policy will be subject to sanctions as described in §5.3.3.
  13. Employees are required to cooperate with federal and state investigations.
    • Employees must not interfere with investigations through willful misrepresentation, omission of facts, or by the use of threats against any person.
    • Employees found to be in violation of this policy will be subject to sanctions as described in §5.3.3.

19.3 Issue Escalation

Patient Pattern workforce members are to escalate issues using the procedures outlined in the Employee Handbook. Issues that are brought to the Escalation Team are assigned an owner. The membership of the Escalation Team is maintained by the Chief Executive Officer.

Security incidents, particularly those involving ePHI, are handled using the process described in §11.2. If the incident involves a breach of ePHI, the Security Officer will manage the incident using the process described in §12.2. Refer to §11.2 for a list of sample items that can trigger Patient Pattern’s incident response procedures; if you are unsure whether the issue is a security incident, contact the Security Officer immediately.

It is the duty of that owner to follow the process outlined below:

  1. Create an Issue in the JIRA Compliance Review Activity (CRA) Project.
  2. The Issue is investigated, documented, and, when a conclusion or remediation is reached, it is moved to Review.
  3. The Issue is reviewed by another member of the Escalation Team. If the Issue is rejected, it goes back for further evaluation and review.
  4. If the Issue is approved, it is marked as Done, adding any pertinent notes required.
  5. The workforce member that initiated the process is notified of the outcome via email.

20. Approved Tools Policy

Patient Pattern utilizes a suite of approved software tools for internal use by workforce members. These software tools are either self-hosted, with security managed by Patient Pattern, or they are hosted by a Subcontractor with appropriate business associate agreements in place to preserve data integrity. Use of other tools requires approval from Patient Pattern leadership.

20.1 List of Approved Tools

21. 3rd Party Policy

Patient Pattern makes every effort to assure all 3rd party organizations are compliant and do not compromise the integrity, security, and privacy of Patient Pattern or Patient Pattern Customer data. 3rd Parties include Customers, Partners, Subcontractors, and Contracted Developers.

21.1 Applicable Standards

21.1.1 Applicable Standards from the HITRUST Common Security Framework

21.1.2 Applicable Standards from the HIPAA Security Rule

21.2 Policies to Assure 3rd Parties Support Patient Pattern Compliance

  1. Patient Pattern does not allow 3rd party access to production systems containing ePHI.
  2. All connections and data in transit between the Patient Pattern Platform and 3rd parties are encrypted end to end.
  3. A standard business associate agreement with Customers and Partners is defined and includes the required security controls in accordance with the organization’s security policies. Additionally, responsibility is assigned in these agreements.
  4. Patient Pattern has Service Level Agreements (SLAs) with Subcontractors with an agreed service arrangement addressing liability, service definitions, security controls, and aspects of services management.
    • Subcontractors must coordinate, manage, and communicate any changes to services provided to Patient Pattern.
    • Patient Pattern utilizes monitoring tools to regularly evaluate Subcontractors against relevant SLAs.
  5. No Patient Pattern Customers or Partners have access outside of their own environment, meaning they cannot access, modify, or delete anything related to other 3rd parties.
  6. Patient Pattern does not outsource software development.
  7. Patient Pattern maintains and annually reviews a list all current Partners and Subcontractors. This list is maintained by the Patient Pattern Privacy Officer, includes details on all provided services, and is recorded in §1.4. The annual review is conducted as a part of the below referenced SLA review.
  8. Patient Pattern assesses security requirements and compliance considerations with all Partners and Subcontractors. This includes annual assessment of SOC2 Reports for all Patient Pattern infrastructure partners.
    • Patient Pattern leverages recurring calendar invites to assure reviews of SLAs with all 3rd parties are performed annually. These are performed by the Patient Pattern Security Officer and Privacy Officer. The process for reviewing SLAs is outlined below:
      1. The Security Officer initiates the SLA review by creating an Issue in the JIRA Compliance Review Activity (CRA) Project.
      2. The Security Officer, or a Privacy Officer, is assigned to review the SLA and performance of 3rd parties. The list of current 3rd parties is also reviewed to assure it is up to date and complete.
      3. SLA performance is documented in the Issue.
      4. Once the review is completed and documented, the Security Officer approves or rejects the Issue. If the Issue is rejected, it goes back for further review and documentation.
  9. Regular review is conducted as required by SLAs to assure security and compliance. These reviews include reports, audit trails, security events, operational issues, failures and disruptions, and identified issues are investigated and resolved in a reasonable and timely manner.
  10. Any changes to Partner and Subcontractor services and systems are reviewed before implementation.
  11. For all partners, Patient Pattern reviews activity annually to assure partners are in line with SLAs in contracts with Patient Pattern.
  12. SLA review is monitored on a quarterly basis using JIRA reporting to assess compliance with above policy.

22. Key Definitions

  1. Any unintentional acquisition, access or use of PHI by a workforce member or person acting under the authority of a Covered Entity (CE) or Business Associate (BA) if such acquisition, access, or use was made in good faith and within the scope of authority and does not result in further use or disclosure in a manner not permitted under the Privacy Rule.
  2. Any inadvertent disclosure by a person who is authorized to access PHI at a CE or BA to another person authorized to access PHI at the same CE or BA, or organized health care arrangement in which the CE participates, and the information received as a result of such disclosure is not further used or disclosed in a manner not permitted under the Privacy Rule.
  3. A disclosure of PHI where a CE or BA has a good faith belief that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain such information.

23. Patient Pattern HIPAA Business Associate Agreement (“BAA”)

This HIPAA Business Associate Agreement (this “BAA”) defines the rights and responsibilities of Provider and Customer with respect to Protected Health Information (“PHI”) as defined in the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder, including the HITECH Act and Omnibus Rule, as each may be amended from time to time (collectively, “HIPAA”). This BAA shall be applicable only in the event and to the extent Provider meets, with respect to Customer, the definition of a Business Associate set forth at 45 C.F.R. §160.103, or applicable successor provisions. This BAA shall only be applicable to Customer’s Hosting Services or Services to the extent that Customer uses the Hosting Services for Customer’s Applications and as specified in the Platform as a Service Agreement of which this Exhibit C is attached and fully referenced and incorporated herein (the “PaaS Agreement”). This BAA is intended to ensure that Business Associate and Customer will establish and implement appropriate safeguards where Business Associate may receive, create, maintain, use or disclose in connection with the functions, activities and services that Business Associate performs on behalf of Customer solely to perform its duties and responsibilities under the PaaS Agreement.

  1. Applicability and Definitions. This BAA applies only where:
    1. Customer uses the Hosting Services to store or transmit any PHI as defined in 45 C.F.R. §160.103
    2. Customer has applied the required security configurations, as specified in Section 5.2 of this BAA to Customer’s Applications. Customer acknowledges that this BAA does not apply to any other accounts it may have now or in the future. Unless otherwise expressly defined in this BAA, all capitalized terms in this BAA will have the meanings set forth in the PaaS Agreement or in HIPAA.
  2. Additional Meanings.
    • “Business Associate” shall mean Provider, or Patient Pattern, Inc.
    • “HITECH ACT” shall mean the Health Information Technology for Economic and Clinical Health Act.
    • “Individual” shall have the same meaning as the term “individual” in 45 CFR § 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR § 164.502(g).
    • “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.
    • “Protected Health Information” or “PHI” shall have the same meaning as the term “protected health information” in 45 CFR § 160.103, limited to the information received by Business Associate from or on behalf of Customer.
    • “Required By Law” shall have the same meaning as the term “required by law” in 45 CFR § 164.103.
    • “Security Rule” shall mean the Security Standards for the Protection of Electronic Protected Health Information, located at 45 CFR Part 160 and Subparts A and C of Part 164.
  3. Permitted and Required Uses and Disclosures.
    1. Service Offerings. Business Associate may use or disclose PHI for or on behalf of Customer as defined in the PaaS Agreement.
    2. Administration and Management of Services. Business Associate may Use and Disclose PHI as necessary for the sole purpose of the proper management and administration of Hosting Services. Any disclosures under this section will be made only if Business Associate obtains reasonable assurances from the recipient of the PHI that (i) the recipient will hold the PHI confidentially and will use or disclose the PHI only as required by law or for the purpose for which it was disclosed to the recipient, and (ii) the recipient will notify Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.
  4. Obligations of Business Associate.
    1. Limit on Uses and Disclosures. Business Associate will use or disclose PHI only as permitted by this BAA or as required by law, provided that any such use or disclosure would not violate HIPAA if done by a Covered Entity, unless permitted for a Business Associate under HIPAA.
    2. Safeguards. Business Associate will use reasonable and appropriate safeguards to prevent Use or Disclosure of PHI other than as provided for by this BAA, consistent with the requirements of Subpart C of 45 C.F.R. Part 164 (with respect to Electronic PHI) as determined by Business Associate and as reflected in the PaaS Agreement, which includes Disk Encryption and Encryption In-Transit services.
    3. Reporting. For all reporting obligations under this BAA, the parties acknowledge that, because Business Associate does not know the details of PHI contained in any of Customer Applications, there will be no obligation on the Business Associate to provide information about the identities of the Individuals who may have been affected, or a description of the type of information that may have been subject to a Security Incident, Impermissible Use or Disclosure, or Breach. Business Associate will ensure Customer access to Audit Logging to help Customer in addressing Customer’s obligations for reporting under this BAA. Customer acknowledges Business Associate is under no obligation to provide additional support for Customer’s BAA reporting obligations but may choose to provide such additional services at its sole discretion or at Customer expense.
    4. Reporting of Impermissible Uses and Disclosures. Business Associate will report to Customer any Use or Disclosure of PHI not permitted or required by this BAA of which Business Associate becomes aware.
    5. Reporting of Security Incidents. Business Associate will report to Customer on no less than fourteen business (14) days from the date any Security Incidents involving PHI of which Business Associate becomes aware in which there is a successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an Information System in a manner that risks the confidentiality, integrity, or availability of such information. Notice is hereby deemed provided, and no further notice will be provided, for unsuccessful attempts at such unauthorized access, use, disclosure, modification, or destruction, such as pings and other broadcast attacks on a firewall, denial of service attacks, port scans, unsuccessful login attempts, or interception of encrypted information where the key is not compromised, or any combination of the above.
    6. Reporting of Breaches. Business Associate will report to Customer any Breach of Customer’s Unsecured PHI that Business Associate may discover to the extent required by 45 C.F.R. § 164.410. Business Associate will make such report without unreasonable delay, and in no case later than four (4) hours after discovery of such Breach. Business Associate undertakes no obligation to report network security related incidents which occur on its managed network but does not directly involve Customer’s use of Hosting Services.
    7. Subcontractors. Business Associate will ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree to restrictions and conditions at least as stringent as those found in this BAA, and agree to implement reasonable and appropriate safeguards to protect PHI.
    8. Access to PHI. Customer acknowledges that Business Associate is not required by this BAA to make disclosures of PHI to Individuals or any person other than Customer, and that Business Associate does not, therefore, expect to maintain documentation of such disclosure as described in 45 CFR § 164.528. In the event that Business Associate does make such disclosure, it shall document the disclosure as would be required for Customer to respond to a request by an Individual for an accounting of disclosures in accordance with 45 CFR §164.504(e)(2)(ii)(G) and §164.528, and shall provide such documentation to Customer promptly on Customer’s request. In the event that a request for an accounting is made directly to Business Associate shall, within 5 Business Days, forward such request to Customer.
    9. Accounting of Disclosures. Business Associate will make available to Customer the information required to provide an accounting of Disclosures in accordance with 45 C.F.R. § 164.528 of which Business Associate is aware, if requested by Customer. Because Business Associate cannot readily identify which Individuals are identified or what types of PHI are included in Customer Content, Customer will be solely responsible for identifying which Individuals, if any, may have been included in Customer Content that Provider has disclosed and for providing a brief description of the PHI disclosed.
    10. Internal Records. Provider will make its internal practices, books, and records relating to the Use and Disclosure of PHI available to the Secretary of the U.S. Department of Health and Human Services (“HHS”) for purposes of determining Customer compliance with HIPAA. Nothing in this section will waive any applicable privilege or protection, including with respect to trade secrets and confidential commercial information.
  5. Customer’s Obligations:
    1. Appropriate Use of HIPAA Accounts. Customer is responsible for implementing appropriate privacy and security safeguards in order to protect PHI in compliance with HIPAA and this BAA. Without limitation, Customer shall: (i) not include protected health information (as defined in 45 CFR 160.103) in any Services that are not or cannot be HIPAA compliant, (ii) utilize the highest level of audit logging in connection with its use of all Customer Applications, and (iii) maintain the maximum retention of logs in connection with its use of all Services.
    2. HIPAA Account Appropriate Configurations: Customer is solely responsible for configuring, and will configure, all Customer Applications as follows:
    3. Encryption. Customer shall encrypt all PHI stored or transmitted outside the Services in accordance with the Secretary of HHS’s Guidance to Render Unsecured Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals, available at http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/brguidance.html, as it may be updated from time to time, and as may be made available on any successor or related site designated by HHS.
    4. SSL Termination: All services must be served via SSL. Customer is responsible for providing, maintaining and updating a valid SSL certificate for use with the Service. SSL certificates must be a minimum of 4096 bit key size. Customer agrees to comply with Business Associate’s requirements regarding SSL termination.
    5. Necessary Consents. Customer warrants that it has obtained any necessary authorizations, consents, and other permissions that may be required under applicable law prior to placing Customer Content, including without limitation PHI, on the Services.
    6. Restrictions on Disclosures. Customer shall not agree to any restriction requests or place any restrictions in any notice of privacy practices that would cause Business Associate to violate this BAA or any applicable law.
    7. Compliance with HIPAA. Customer shall not request or cause Business Associate to make a Use or Disclosure of PHI in a manner that does not comply with HIPAA or this BAA.
  6. Term and Termination
    1. Term. The term of this BAA will commence on the PaaS Agreement Effective Date and will remain in effect until the earlier of the termination of the PaaS Agreement or notification by Customer that an account is no longer subject to this BAA.
    2. Effect of Termination. At termination of this BAA, Business Associate, if feasible, will return or destroy all PHI that Business Associate still maintains, if any. If return or destruction is not feasible, Business Associate will extend the protections of this Agreement to the PHI, limit further uses and disclosures to those purposes that make the return of the PHI infeasible, and make not further use or disclosure of PHI.
    3. If Customer requests contemporaneously with any termination event or notice, Business Associate will allow Customer to have access to Customer’s account for a reasonable period of time following termination as necessary for Customer to retrieve or delete any PHI at its then current monthly recurring rate; provided, however, that if the security of Customer’s servers has been compromised, or the Agreement was terminated by Customer’s failure to use reasonable security precautions, Business Associate may: (i) provide Customer with restricted access via a dedicated or private link or tunnel to Customer account or (ii) refuse to allow Customer to have access to Customer’s account but will use reasonable efforts to copy Customer data on to media Customer provides to Business Associate, and will ship the media to Customer at Customer expense. Business Associate’s efforts to copy Customer data onto Customer media shall be billable as an Additional Service at Business Associate’s then current hourly rates.
  7. No Agency Relationship. As set forth in the Agreement, nothing in this BAA is intended to make either party an agent of the other. Nothing in this BAA is intended to confer upon Customer the right or authority to control Business Associate’s conduct in the course of Business Associate complying with the Agreement and BAA.
  8. Nondisclosure. Customer agrees that the terms of this BAA are not publicly known and constitute Business Associate Confidential Information under the Agreement.
  9. Entire Agreement; Conflict. Except as amended by this BAA, the Agreement will remain in full force and effect. This BAA, together with the Agreement as amended by this BAA: (a) is intended by the parties as a final, complete and exclusive expression of the terms of their agreement; and (b) supersedes all prior agreements and understandings (whether oral or written) between the parties with respect to the subject matter hereof. If there is a conflict between the Agreement, this BAA or any other amendment or BAA to the Agreement or this BAA, the document later in time will prevail.
  10. Miscellaneous.
    1. Amendment. Customer and Business Associate agrees to take such action as is reasonably necessary to amend this HIPAA BAA from time to time as is necessary for either party to comply with the requirements of the Privacy Rule and related laws and regulations.
    2. Survival. Customer and Business Associate’s respective rights and obligations under this HIPAA BAA shall survive the termination of the Agreement.
    3. Interpretation. Any ambiguity in the PaaS Agreement shall be resolved to permit Customer to comply with HIPAA and the Privacy Rule.

SIGNATURE FOLLOWS

24. HIPAA Mappings to Patient Pattern Controls

Below is a list of HIPAA Safeguards and Requirements and the Patient Pattern controls in place to meet those.

Administrative Controls HIPAA Rule Patient Pattern Control
Security Management Process - 164.308(a)(1)(i) Risk Management Policy
Assigned Security Responsibility - 164.308(a)(2) Roles Policy
Workforce Security - 164.308(a)(3)(i) Employee Policies
Information Access Management - 164.308(a)(4)(i) System Access Policy
Security Awareness and Training - 164.308(a)(5)(i) Employee Policy
Security Incident Procedures - 164.308(a)(6)(i) IDS Policy
Contingency Plan - 164.308(a)(7)(i) Disaster Recovery Policy
Evaluation - 164.308(a)(8) Auditing Policy
Physical Safeguards HIPAA Rule Patient Pattern Control
Facility Access Controls - 164.310(a)(1) Facility and Disaster Recovery Policies
Workstation Use - 164.310(b) System Access, Approved Tools, and Employee Policies
Workstation Security - 164.310(‘c’) System Access, Approved Tools, and Employee Policies
Device and Media Controls - 164.310(d)(1) Disposable Media and Data Management Policies
Technical Safeguards HIPAA Rule Patient Pattern Control
Access Control - 164.312(a)(1) System Access Policy
Audit Controls - 164.312(b) Auditing Policy
Integrity - 164.312('c’)(1) System Access, Auditing, and IDS Policies
Person or Entity Authentication - 164.312(d) System Access Policy
Transmission Security - 164.312(e)(1) System Access and Data Management Policy
Organizational Requirements HIPAA Rule Patient Pattern Control
Business Associate Contracts or Other Arrangements - 164.314(a)(1)(i) Business Associate Agreements and 3rd Parties Policies
Policies and Procedures and Documentation Requirements HIPAA Rule Patient Pattern Control
Policies and Procedures - 164.316(a) Policy Management Policy
Documentation - 164.316(b)(1)(i) Policy Management Policy
HITECH Act - Security Provisions HIPAA Rule Patient Pattern Control
Notification in the Case of Breach - 13402(a) and (b) Breach Policy
Timelines of Notification - 13402(d)(1) Breach Policy
Content of Notification - 13402(f)(1) Breach Policy