In this conclusion of the HITRUST blog series, I would like to discuss some definite opportunities and challenges that HITRUST is likely to face.

Putting together a single prescriptive framework for the healthcare industry is truly an ambitious effort. However, cross-referencing this framework with different regulatory requirements and then proposing a mechanism by which companies can be certified against this framework takes any such ambitions to a whole new level. The good news is that many of the healthcare industry’s biggest organizations have gotten onboard and made significant contributions to this effort. Additionally, with the way HIPAA is written, there seems to be a lot of need for a framework such as this, which can enable companies to better defend their interpretations of HIPAA requirements. Therefore, I think the future of HITRUST is going to be defined within the following considerations:

• Quality of the Framework – In order for the framework to gain traction, it must be of good quality, and it should achieve its stated objectives of being risk-based and prescriptive. Even though the framework is a product of multiple organizations collaborating, HITRUST does not necessarily govern by community and will make the final decision about CSF content. Another important aspect of the framework will be the approval process of alternative or compensating controls, and ensuring that the process of approvals or denials is transparent. Nothing will de-value the framework faster than perception of its being driven by the agenda of any specific company rather than the industry as a whole.
• Maturity of the Certification Process – Having gone through the assessor training, I feel this is perhaps the weakest HITRUST point so far. In starting a certification program from scratch, mistakes are easy to make and are common (just ask the PCI Council). However, PCI DSS was not a voluntary program; compliance was mandatory. Requirements such as submitting complete gap analysis reports to HITRUST (including all found vulnerabilities spelled out in detail) are clearly not going to last, since I can’t imagine any company willing to submit a comprehensive set of their dirty laundry (including all areas where they are not compliant with regulatory requirements) to a for-profit company for their assessment and evaluation. However, I feel that once they begin to get this kind of feedback from HITRUST practitioners, they will make the necessary changes in their approach.
• Certification Quality Assurance – Not all consulting firms are equal; in fact they differ greatly in the quality of their work. Therefore, HITRUST needs to establish a better-defined QA program, to govern the certification process. Protecting the integrity of the HITRUST certification will be essential for internal auditors to begin considering it in place of alternative third-party audits.
• First Breach / Legal Challenge – In spite of the fact that HITRUST does not make any representations that regulatory compliance is synonymous with HITRUST certification, the first time a HITRUST-certified company suffers a breach or is a subject to regulatory inquiry, we will see the first official test of the framework. One of the big selling points of the framework is that their interpretations of HIPAA are valid and substantiated by the whole healthcare industry. However, if a judge disagrees with any of their interpretations, this may be very damaging to HITRUST acceptance.

I really want HITRUST to succeed. I think it’s a great initiative that has a lot of promise for the whole industry. However, I think it has a long way to go before it is widely accepted, and the certification process is sufficiently mature to inspire confidence on all sides. My recommendation for all healthcare providers and vendors is to begin looking at HITRUST and seeing how their security controls compare with those specified within the CSF. For those companies that do not have a security program in place and are looking to undergo a HIPAA gap assessment for the first time, I would recommend adopting the CSF. After all, the risks are fairly small, since the framework is based on current standards and not anything new. As to the expense of undergoing a full certification, I would recommend putting that on hold until the framework is more widely accepted, or in cases of service providers, until your customers begin to ask you for it.

Yan Kravchenko