Electronic health record (EHR) security protects the confidentiality, integrity, and availability of health information and the systems clinicians rely on. Common risks include stolen credentials, excessive or outdated access, phishing and malware, ransomware, misconfigured devices or cloud services, insecure interfaces, and weak recovery planning. No single tool eliminates risk; healthcare organizations need safeguards based on their systems, workflows, and documented risk analysis.
Common EHR security threats
- Compromised accounts: reused or stolen passwords, shared credentials, weak authentication, and unrevoked access can let an unauthorized person enter an EHR or connected service.
- Phishing and social engineering: messages or calls that impersonate a colleague, vendor, or executive may trick staff into sharing credentials, opening malicious files, or approving fraudulent requests.
- Ransomware and malware: malicious software can disrupt access, alter or encrypt data, and potentially expose information. EHR downtime can affect clinical workflows as well as privacy and security.
- Misconfiguration and unpatched systems: outdated software, exposed remote access, incorrect permissions, and poorly secured endpoints can create openings for attackers.
- Vendor, interface, and connected-device exposure: third-party systems, APIs, billing tools, imaging devices, and data exchanges can expand the environment that must be inventoried and protected.
- Insider or accidental events: inappropriate record access, misdirected messages, lost devices, and mistakes may expose information even without an external attacker.
- Weak backup and downtime readiness: backups that are reachable from compromised systems, untested restoration, or unclear paper/downtime workflows can prolong outages and complicate safe recovery.
Safeguards clinics can assess
- Know where ePHI lives. Maintain an inventory of EHR modules, endpoints, interfaces, cloud services, backups, and vendors that create, receive, maintain, or transmit electronic protected health information (ePHI).
- Use individual accounts and appropriate access. Avoid shared logins; promptly change or remove access when roles change or employment ends; review permissions periodically; and use stronger authentication, including multifactor authentication where supported and appropriate.
- Monitor and protect systems. Apply a risk-based patch and vulnerability process, endpoint protection, secure configurations, network controls, and logging that can help detect unusual access or activity. Assign owners to investigate alerts.
- Reduce phishing exposure. Train staff to verify unusual requests through a second channel, report suspicious messages quickly, and avoid entering credentials from unexpected links. Pair training with technical controls and a clear reporting route.
- Review vendors and interfaces. Understand which party is responsible for security, how access is controlled, how incidents are reported, what data is exchanged, and how changes or integrations are tested. Put appropriate agreements and safeguards in place with qualified privacy/security staff.
- Protect and test backups. Maintain backups appropriate to the organization’s recovery needs, restrict attackers’ ability to alter them, and periodically test restoration—not just backup completion.
- Plan for downtime and response. Maintain an incident-response plan and a tested continuity process for EHR outages, including how teams document urgent care, reconcile records after restoration, and communicate status.
What to do when a security incident is suspected
Follow the organization’s incident-response plan immediately. Report the concern to the designated security contact, preserve relevant information, and avoid deleting files or attempting unapproved fixes that could destroy evidence. The response team should determine scope, contain spread, restore systems safely, assess effects on care and information, and document decisions. HIPAA breach-notification duties depend on the facts and applicable requirements; involve privacy, security, legal, and leadership roles rather than assuming every incident has the same outcome.
