The role of audit logs in healthcare

Healthcare organizations are encouraged to implement and maintain audit logs as part of their overall security strategy to bolster their ability to monitor and safeguard sensitive health information effectively.

What are audit logs?

Audit logs are records of activities within an information technology (IT) system that track various events, such as user logins, access to data or files, system changes, and security incidents. They serve as a chronological and comprehensive log of actions taken within the system, including who performed each action, when it occurred, and what specific activity was undertaken. 

These logs are critical for monitoring and reviewing user activities, identifying security breaches or unauthorized access, and providing valuable insights during forensic investigations. Audit logs play a role in maintaining data integrity, detecting potential risks or threats, and supporting compliance efforts. 

See also: How to conduct a HIPAA compliance audit

HIPAA Security Rule and audit logs

The HHS provides guidance on how healthcare organizations can implement effective audit protocols. The HIPAA Security Rule requires covered entities and business associates to implement policies and procedures that ensure the confidentiality, integrity, and availability of electronic protected health information (ePHI). While the Security Rule emphasizes the necessity of implementing audit controls as part of the administrative safeguards. These audit controls involve monitoring and recording system activity, including user access to ePHI and other relevant activities through audit logs, access reports, and security incident tracking reports. It highlights the need for organizations to have procedures in place to track and review these in order to protect ePHI.

What are HIPAA's requirements for audit logs?

1. Regular review of audit logs: Covered entities and business associates are required to regularly review and analyze records of information system activity, such as audit logs. This includes monitoring user activities, access to ePHI, modifications to ePHI, and other relevant events.
2. Record keeping: Organizations must retain audit log records for at least six years. The retention period begins on the date the log is created, and logs must be securely stored and available for review in case of security incidents, investigations, or compliance audits.
3. Access control monitoring: Audit logs should monitor and record user logins, logouts, and any modifications made to ePHI. System-level audit logs should capture events like system shutdowns, user authentication, and resource access by specific users.
4. Timestamps and user identification: Audit logs must include accurate timestamps for each event and unique user identification information, enabling the association of specific actions with individual users.
5. Immutability and security: Audit logs must be protected against unauthorized alteration or deletion, ensuring their integrity and reliability as evidence during investigations or compliance audits.
6. Analysis and review: Organizations should regularly review and analyze audit logs to identify potential security incidents, breaches, or unauthorized access. Prompt action should be taken in response to any identified risks or anomalies.
7. Integration with security measures: Audit logs should be integrated with the organization's security information and event management (SIEM) system to enhance security monitoring and incident detection.
8. Tracking physical access: In addition to electronic access, audit logs should also track physical access to areas where PHI is stored, including access to paper records.
9. Ensure that all communication is secure: When communicating with patients, ensure the methods used are secure and trustworthy, such as HIPAA compliant email. This can be a source of PHI, which can play a role in a healthcare organization's audit logs. 

Audit log retention 

HIPAA's requirements for audit log retention mandate that covered entities and business associates maintain comprehensive records of information system activity, such as audit logs, for a minimum of six years. The retention period commences from when the log is created and applies to electronic and physical access to PHI. 

The logs should include accurate timestamps for each event, enabling the establishment of an audit trail and facilitating the reconstruction of events if necessary. HIPAA emphasizes regularly reviewing and analyzing audit logs to identify potential security incidents, breaches, or unauthorized access.

Related: Understanding medical record retention requirements by state