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Protecting patient data across remote and distributed care starts with the same HIPAA Security Rule duties that apply in other settings: identify electronic protected health information (ePHI), understand the risks to it, choose safeguards that are reasonable for the organization, and keep checking that those safeguards work. Remote access, mobile devices, telehealth and vendor systems change where those protections must operate; no single product or configuration makes an organization compliant.
What the HIPAA Security Rule covers
The Security Rule sets national standards for ePHI created, received, used or maintained by covered entities and business associates. Covered entities include health plans, health care clearinghouses and qualifying health care providers. Its requirements address protecting ePHI’s confidentiality, integrity and availability; guarding against reasonably anticipated threats and impermissible use or disclosure; and ensuring workforce compliance. HHS describes the required protections as administrative, physical and technical safeguards. HHS: Summary of the HIPAA Security Rule
These duties do not disappear when staff work from home, clinicians use mobile devices or care is delivered by video. The organization remains responsible for assessing risks to ePHI and selecting safeguards appropriate to its circumstances.
Why distributed care changes the risk picture
In a dispersed care model, ePHI may be accessed, transmitted, discussed or stored across more locations, devices, systems and organizations. Each change can affect who can see information, how access is authorized and recorded, and what happens when a device is lost, a session is recorded, a vendor changes its service or an incident occurs.
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HHS provides guidance on remote use and access, mobile devices, risk analysis and ransomware, as well as resources on telehealth privacy and security. Those resources identify areas to consider; they are not a universal technical checklist. The right safeguards depend on the organization’s documented risk analysis. HHS: Security Rule Guidance Material
Build safeguards from a repeatable risk-management process
HHS describes the Security Rule as scalable and technology neutral. It does not prescribe one security product or configuration for every organization. In selecting measures, an entity should consider its size and capabilities, technical infrastructure, costs, and the probability and criticality of risks. Use that framework to connect each safeguard to a specific risk and the way care is delivered.
1. Map ePHI and the places it moves
Identify what ePHI the organization creates, receives, uses or maintains, then trace the people, devices, systems, vendors and locations that can access or handle it. Include remote access and telehealth workflows, not only systems inside a clinic. The aim is to understand where information can be exposed, altered or made unavailable and who is responsible at each point.
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2. Assess threats and vulnerabilities in context
Consider what could happen in the actual workflow: unauthorized access, accidental disclosure, malware, unpatched software, a lost device, an improperly exposed video session, or a change in a vendor’s service. Assess the likelihood and potential impact rather than assuming that every location or technology carries the same risk. HHS’s telehealth resources discuss malware, unpatched software and accidental disclosure as examples of risks to address.
3. Select safeguards that address identified risks
Translate the assessment into administrative, physical and technical measures. For example, determine who needs access and why, how that access is authorized and recorded, what workforce practices apply to remote work, and how devices and spaces are handled. These are planning questions, not a claim that one named tool or setting is required for every entity. Document why the chosen safeguards fit the risks, capabilities and infrastructure you assessed.
4. Assign responsibility and review access
Make clear who manages access, who follows workforce procedures and who responds when something changes. Review whether access remains appropriate to each person’s role, track incidents, and revisit decisions when staff duties, systems, vendors or locations change. HHS identifies role-appropriate authorization, access review and incident tracking as parts of the Security Rule’s risk-management approach.
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5. Check whether controls still work
Set a recurring process to evaluate policies and safeguards, follow up on weaknesses and reassess risks when operations change. A control that once fit a workflow may no longer address it after a new remote-access method, vendor service or care location is introduced. HHS guidance describes periodic evaluation and reevaluation as part of risk management.
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A remote-work policy, device setting or vendor agreement is only one part of the organization’s overall approach. Evaluate how the elements work together: who can reach ePHI, what systems and devices are involved, how the access is governed, and how changes or incidents are handled.
- Remote access: Identify the users, purposes, systems and locations involved, and determine how access is authorized, recorded and reviewed.
- Mobile devices: Account for the ePHI they may access, transmit or store, along with the risks if a device is lost or used in a different setting.
- Telehealth: Consider accidental disclosure, malware, unpatched software and the privacy practices of the communication service.
- Vendors: Assess relevant privacy practices and safeguards, including use of online tracking technologies, and be prepared to explain relevant practices to patients. HHS recommends discussing these matters with patients; that guidance does not certify or endorse a vendor. HHS: Resource for Health Care Providers on Educating Patients about Privacy and Security Risks to Protected Health Information when Using Remote Communication Technologies for Telehealth
A business associate agreement or a vendor’s assurances do not by themselves establish that the organization has adequately managed its risks. The organization still needs to assess its environment and safeguard the ePHI it handles.
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Give patients practical telehealth privacy guidance
Patient-facing tips can reduce the chance that someone nearby overhears or sees a visit, but they address only that situation; they do not replace an organization’s safeguards. HHS advises patients to choose a private location. If that is not possible, headphones, avoiding speakerphone and positioning the screen so other people cannot see it can help reduce accidental disclosure. HHS: Telehealth Privacy and Security Tips for Patients
For providers, explaining relevant vendor privacy and security practices helps patients understand the technology used for remote communication. It does not shift the organization’s responsibility to manage risks to ePHI.
What the proposed HIPAA Security Rule update means now
HHS says the Office for Civil Rights issued a proposed update to the Security Rule on December 27, 2024. HHS states that the current Security Rule remains in effect while rulemaking proceeds, so the proposal should not be treated as a final rule. HHS: HIPAA Security Rule NPRM
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In its 2024 announcement, HHS reported that large breaches increased by 102 percent from 2018 to 2023 and that the number of individuals affected by large breaches increased by 1,002 percent over that period. HHS also reported that more than 167 million individuals were affected by large breaches in 2023, and that large breaches caused by hacking and ransomware increased by 89 percent and 102 percent, respectively, since 2019. These are HHS-reported figures; they describe large breaches nationally, not the remote-work risk of any particular organization.
The practical decision for a healthcare organization is to work from the current rule and its own risk analysis, rather than assuming the proposed update is already binding or waiting for rulemaking before managing present risks.
Use the risk analysis to guide decisions, not a compliance shortcut
For each proposed safeguard, ask whether it addresses an identified risk, fits the organization’s users and infrastructure, and can be maintained and evaluated over time. Compare options by risk coverage, workforce and access fit, compatibility with existing systems, implementation and operating cost, and support for recurring evaluation. The aim is a documented, functioning risk-management process—not a purchase, policy document or telehealth precaution standing in for one.
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