A Practice Manager's Guide to HIPAA Compliance in 2026

HIPAA compliance isn’t a one-time checkbox — it’s an ongoing responsibility that evolves with technology, regulations, and threat landscapes. For practice managers, staying current can feel like a moving target. This guide covers the key areas you need to focus on in 2026.

The compliance landscape today

The core HIPAA regulations haven’t fundamentally changed, but enforcement has intensified and expectations have risen. The Office for Civil Rights (OCR) has increased audits, breach penalties are being applied more aggressively, and the standard of what constitutes “reasonable safeguards” continues to climb as technology advances.

In practice, this means what was considered adequate protection five years ago may no longer meet the bar. Your compliance strategy needs to be a living document, not a binder collecting dust in the back office.

The three pillars of HIPAA compliance

1. Administrative safeguards

These are the policies and procedures that govern how your practice handles protected health information (PHI).

Risk assessments. HIPAA requires regular risk assessments — not just when something goes wrong. At minimum, conduct a formal assessment annually and whenever you make significant changes to your technology or workflows.

Workforce training. Every team member who touches PHI needs to understand their responsibilities. This includes clinical staff, front desk personnel, billing teams, and any contractors. Training should be documented and refreshed at least annually.

Access management. Implement role-based access controls. A billing specialist doesn’t need access to clinical notes, and a medical assistant doesn’t need to see financial records. Follow the principle of minimum necessary access — each person should only see the PHI they need to do their job.

Incident response planning. Have a documented plan for what happens when (not if) a security incident occurs. Who gets notified? What steps are taken to contain the breach? How do you fulfill the required reporting obligations? Practice this plan before you need it.

2. Physical safeguards

Physical security is often overlooked in favor of flashier cybersecurity measures, but it’s equally important.

Workstation security. Screens should lock automatically after brief periods of inactivity. Workstations in patient-accessible areas should be positioned so screens aren’t visible to passersby. Implement clean desk policies for any printed PHI.

Device management. Track every device that can access PHI — workstations, laptops, tablets, and phones. Have a clear policy for what happens when a device is lost, stolen, or retired. Remote wipe capabilities are essential for mobile devices.

Facility access. Limit physical access to areas where PHI is stored or displayed. This includes server rooms (if you still have them), records storage areas, and workstations with EHR access.

3. Technical safeguards

This is where your technology choices have the greatest impact on compliance.

Encryption. PHI must be encrypted both at rest (stored on devices or servers) and in transit (sent over networks). This applies to your EHR database, email communications containing PHI, and any backups. Full-disk encryption should be standard on all devices.

Audit controls. Your systems need to log who accessed what PHI and when. These audit trails should be reviewed regularly for anomalies and retained according to your state’s requirements (HIPAA mandates a minimum of six years for certain records).

Transmission security. Any communication containing PHI should use encrypted channels. This means HTTPS for web-based systems, TLS for email, and encrypted messaging for any inter-provider communication.

Authentication. Strong authentication is non-negotiable. Unique user IDs for every staff member, strong password policies, and multi-factor authentication where possible. Shared logins should be eliminated entirely — they make audit trails meaningless.

Common compliance gaps

Even well-intentioned practices frequently have gaps in these areas:

Business associate agreements (BAAs). Every vendor that handles PHI on your behalf needs a signed BAA. This includes your EHR vendor, cloud storage providers, IT support companies, billing services, and even your shredding company. Audit your vendor list and ensure every applicable relationship has a current BAA.

Email and messaging. Staff using personal email or consumer messaging apps (iMessage, WhatsApp) to discuss patient information is a common violation. Establish approved channels for any communication involving PHI.

Social media. Even well-meaning posts can violate HIPAA. A photo of the office that inadvertently captures a patient sign-in sheet, or a staff member mentioning a patient interaction online, can trigger a complaint. Have a clear social media policy.

Legacy systems. Outdated software that no longer receives security updates is a compliance risk. If your EHR vendor has stopped supporting your version, you’re likely running with known vulnerabilities.

Technology as a compliance enabler

The right technology choices can make compliance significantly easier:

Cloud-based EHR systems handle much of the technical compliance burden for you — encryption, access controls, audit logging, backups, and security monitoring are built into the platform. Your BAA with the vendor covers their infrastructure responsibilities.

Automated audit logging eliminates the need for manual tracking of PHI access. Modern EHR systems record every login, every chart access, and every modification automatically.

Role-based access controls built into your EHR make it straightforward to implement minimum necessary access without manual configuration.

Your compliance action plan

1. Schedule a risk assessment if you haven’t done one in the past 12 months.
2. Audit your BAAs — verify every vendor relationship that involves PHI has a current agreement.
3. Review access controls — are former employees deactivated? Do current staff have appropriate access levels?
4. Update your training — schedule refresher training for all staff.
5. Test your incident response plan — run a tabletop exercise with your team.
6. Evaluate your technology — is your current EHR actively supporting your compliance needs, or creating additional burden?

HIPAA compliance is a practice-wide responsibility, not just an IT problem. When your technology, policies, and training work together, compliance becomes part of your workflow rather than an extra burden on top of it.