Is AWS HIPAA Compliant?

Is AWS HIPAA compliant? Amazon Web Services has all the protections to satisfy the HIPAA Security Rule and Amazon will sign a business associate agreement with healthcare organizations. So, is AWS HIPAA compliant? Yes. And No. AWS can be HIPAA compliant, but it is also easy to make configuration mistakes that will leave protected health information (PHI) unprotected and accessible by unauthorized individuals, violating HIPAA Rules.

Amazon Will Sign a Business Associate Agreement for AWS

Amazon is keen for healthcare organizations to use AWS, and as such, a business associate agreement will be signed. Under that agreement, Amazon will support the security, control, and administrative processes required under HIPAA.

Previous, under the terms of the AWS BAA, the AWS HIPAA compliance program required covered entities and business associates to use Amazon EC2 Dedicated Instances or Dedicated Hosts to process Protected Health Information (PHI), although that is now no longer the case.

As part of its efforts to help healthcare organizations use AWS safely and securely without violating HIPAA Rules, Amazon has published a 26 page guide – Architecting for HIPAA Security and Compliance on Amazon Web Services – to help covered entities and business associates get to grips with securing their AWS instances, and setting access controls.

AWS HIPAA Compliance is Something of a Misnomer

Amazon supports HIPAA compliance, and AWS can be used in a HIPAA compliant way, but no software or cloud service can ever be truly HIPAA compliant. As with all cloud services, AWS HIPAA compliance is not about the platform, but rather how it is used.

The Amazon Simple Storage Service (S3) that is provided through AWS can be used for data storage, data analysis, data sharing, and many other purposes. Data can be accessed from anywhere with an Internet connection, including via websites, and mobile apps. AWS has been developed to be secure, otherwise no one would use the service. But it has also been developed to make data easy to access, by anyone with the correct permissions. Make a mistake configuring users or setting permissions and data will be left exposed.

Just because AWS is HIPAA compliant, it does not mean that using AWS is free from risk, and neither that a HIPAA violation will not occur. Leaving AWS S3 buckets unprotected and accessible by the public is a clear violation of HIPAA Rules. It may seem obvious to secure AWS S3 buckets containing PHI, but this year there have been multiple healthcare organizations that have left their PHI open and accessible by anyone.

Amazon S3 buckets are secure by default. The only way they can be accessed is by using the administrator credentials of the resource owner. It is the process of configuring permissions and providing other users with access to the resource that often goes awry.

When is AWS not HIPAA Compliant?

When is AWS HIPAA compliant? When a BAA has been signed, users have been instructed on the correct way to use the service, and when access controls and permissions have been set correctly. Misconfigure an Amazon S3 bucket and your data will be accessible by anyone who knows where to look.

Documentation is available on the correct way to configure Amazon S3 services and manage access and permissions. Unfortunately, since there are several ways to grant permissions, there are also several points that errors can occur, and simple mistakes can have grave consequences.

On numerous occasions, security researchers have discovered unprotected AWS S3 buckets and have alerted healthcare organizations that PHI has been left unprotected. However, security researchers are not the only ones checking for unsecured data. Hackers are always on the prowl. It is far easier for a hacker to steal data from cloud storage services that have had all protections removed than it is to attack organizations in other ways.

One of the mistakes that has been made time and again is setting access controls to allow access by ‘authenticated users.’ That could be taken to mean anyone who you have authenticated to have access to your data. However, that is not Amazon’s definition of an authenticated user. An authenticated user is anyone with an AWS account, and anyone can obtain an AWS account free of charge.

How Common are AWS Misconfigurations?

AWS misconfigurations are very common. So much so, that Amazon recently emailed users who had potentially misconfigured their S3 buckets to warn them that data could be accessed by anyone.

Amazon said in its email, “We’re writing to remind you that one or more of your Amazon S3 bucket access control lists (ACLs) are currently configured to allow access from any user on the internet,” going on to explain, “While there are reasons to configure buckets with world read access, including public websites or publicly downloadable content, recently, there have been public disclosures by third parties of S3 bucket contents that were inadvertently configured to allow world read access but were not intended to be publicly available.”

Some of those public disclosures have been by healthcare organisations, but the list is long and varied, including military contractors, financial institutions, mobile carriers, entertainment companies, and cable TV providers. One data analytics firm left data unprotected, exposing the records of 200 million voters. Verizon exposed the data of between 6 and 14 million customers, and World Wide Entertainment exposed the data of 3 million individuals. Patient Home Monitoring, a HIPAA covered entity, left 47GB of data unprotected.

There is no excuse for these oversights. Checking for unprotected AWS buckets is not only a quick and easy process, software can be used free of charge for this purpose. A tool has been developed Kromtech called S3 Inspector that can be used to check for unsecured S3 buckets.

Is AWS HIPAA Compliant?

So, in summary, is AWS HIPAA compliant? Yes, it can be, and AWS offers healthcare organizations huge benefits.

Can the use of AWS violate HIPAA Rules and leave PHI unprotected? Very easily.

Would misconfiguration of AWS lead to a HIPAA violation penalty? That is a distinct possibility. AWS is secure by default. Only if settings are changed will stored data be accessible. It would be hard to argue with OCR auditors that manually changing permissions to allow anyone to access a S3 bucket containing PHI is anything other than a serious violation of HIPAA Rules.

Author: Steve Alder has many years of experience as a journalist, and comes from a background in market research. He is a specialist on legal and regulatory affairs, and has several years of experience writing about HIPAA. Steve holds a B.Sc. from the University of Liverpool.