Healthcare Technology Featured Article

August 09, 2022

PCI DSS vs. HIPAA: An In-Depth Comparison

What Is PCI DSS?

What Is HIPAA?

The Payment Card Industry Data Security Standard (PCI DSS) is a compliance scheme that aims to protect credit and debit card transactions against fraud and data theft.

It was formed in 2004 by MasterCard, Visa, Discover Financial Services, American Express, and JCB International. It is now maintained by the Payment Card Industry Security Standards Council (PCI SSC),

The PCI SSC does not have the legal authority to compel compliance. However, it is regulated as a requirement for all businesses processing credit or debit card transactions.

PCI certification assures customers that a business has taken standard security measures to protect credit and debit card data as well as sensitive information.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a data protection regulation that protects personal health information (PHI), such as medical records, and personally identifiable information (PII), such as names.

HIPAA helps modernize the flow of healthcare information, specifying requirements to protect the privacy of patients, referred to by the law as covered entities. It covers a range of data types, including:

  • Social security numbers
  • Driver’s licenses
  • Names
  • Fingerprints
  • Photographs

HIPAA applies not only to healthcare institutions but also to business associates, defined as any entity, such as software vendors, that handles PHI belonging to covered entities.

PCI DSS and HIPAA: Key Requirements

The PCI DSS stipulates 12 requirements:

  1. Installing and maintaining a firewall to secure cardholder data.
  2. Refraining from using vendor default values for security parameters like system passwords.
  3. Storing cardholder information securely.
  4. Encrypting cardholder data during transmission over a public network.
  5. Installing antivirus software and updating it regularly.
  6. Building and maintaining secure applications and systems.
  7. Restricting access to cardholder information based on business requirements.
  8. Assigning unique IDs to each user who can access the computer.
  9. Restricting physical access to cardholder information.
  10. Monitoring and tracking all access to cardholder data and network resources.
  11. Periodically testing the organization’s security processes and systems.
  12. Maintaining information security policies.

The most important requirements of HIPAA are:

  • The privacy rule—governs the use and disclosure of protected health information (PHI) owned by applicable business associates and entities. PHI may contain information about an individual’s medical condition, medical service, or payments.
  • The security rule—addresses electronic PHI (ePHI), specifying three security measures (administrative, physical, and technical) required for compliance. The rule stipulates different security standards for each measure, specifying mandatory and addressable implementation details.
  • The breach notification rule—requires companies covered by HIPAA and any business partners to inform the relevant parties of PHI breaches. The Federal Trade Commission (FTC) enforces similar notification regulations under the HITECH Act, which apply to personal health record providers and third-party service providers.

PCI DSS vs. HIPAA: Similarities and Differences

PCI DSS and HIPAA are essential for their respective sectors, but they are not interchangeable. Here are some of the important similarities and differences between HIPAA and PCI DSS and their requirements:

  • HIPAA’s structure is wider, looser, and less detailed than PCI DSS, and most implementation details are left to the provider’s discretion.
  • While PCI DSS has limited security requirements, HIPAA addresses a wide range of issues related to patient safety, privacy rights, quality assurance, fraud, waste, and abuse.
  • Health records are 10 to 20 times more valuable on the black market than US credit card numbers with the three-digit CVV code. Even basic health insurance data is prized.
  • All entities covered by the regulation and any business partners must comply with HIPAA.
  • All companies that process payment card transactions must comply with the PCI DSS.
  • The concept of meaningful use, covered by HIPAA’s omnibus rule under the HITECH Act, helps address the worst threats to ePHI, including loss, theft, and unauthorized access. The PCI DSS does not refer to meaningful usage.

Both HIPAA and the PCI DSS aim to protect sensitive data, so they also have certain similarities:

  • Both PCI DSS and HIPAA security compliance can include risk analysis, remediation processes, and regular vulnerability scans.
  • Failure to comply with either regulation can result in high fines and penalties and increase a successful data breach risk.
  • Certain system components process both account and PHI data.
  • Both regulations require infrastructure components such as antivirus software, active directories, and log monitors.

Tips for Maintaining HIPAA and PCI Compliance

There are hundreds of validation points per rule, but only a handful of HIPAA and PCI standards overlap. Although both regulations aim to protect sensitive data, the way to achieve compliance is very different. HIPAA compliance does not imply PCI compliance. While they share some validation points, their specificity prevents their compliance requirements from overlapping.

The US Department of Health and Human Services (HHS) has several agencies that provide guidelines and other resources to help companies comply with HIPAA. These include the Office for Civil Rights and the Office of the National Coordinator for Health Information Technology.

Healthcare organizations must regularly analyze their security risks, train their staff, and implement technologies to prevent unauthorized entities from accessing PHI. HIPAA also requires organizations to establish incident response plans, perform third-party risk assessments, and sign the relevant business associate agreements (BAAs) with external suppliers.

Keeping track of all cardholder data in an organization's network or transmitted between organizations is critical to maintaining PCI compliance. Another way to ensure compliance is to encourage business leader buy-in by presenting compliance as a competitive advantage rather than a financial and technical obstacle.

Zero trust can help ensure data security and is the gold standard for reducing the risk of security incidents and data breaches. It includes several PCI DSS principles such as encryption, access control, segmentation, and isolation. However, zero trust extends beyond payment card information to protect all sensitive data.

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