Develop comprehensive workstation use policies including:
• Workstation use policies and procedures
• Physical security requirements for workstations
• Workstation configuration standards
• User responsibilities for workstation security
• Workstation monitoring and auditing procedures
• Workstation disposal and sanitization procedures
Key components:
- Workstation use policies
- Physical security requirements
- Configuration standards
- User responsibilities
- Monitoring and auditing
- Disposal procedures
Workstation Use
Medium Risk
Moderate Implementation
Medium Cost
Implement policies and procedures that specify the proper functions to be performed, the manner in which those functions are to be performed, and the physical attributes of the surroundings of a specific workstation or class of workstation that can access ePHI.
Implementation Guidance
Required Documentation
• Workstation use policies and procedures
• Physical security requirements
• Workstation configuration standards
• User responsibilities documentation
• Monitoring and auditing procedures
• Disposal and sanitization procedures
• Training materials and records
• Physical security requirements
• Workstation configuration standards
• User responsibilities documentation
• Monitoring and auditing procedures
• Disposal and sanitization procedures
• Training materials and records
Best Practices
• Develop comprehensive workstation policies
• Implement physical security controls
• Establish configuration standards
• Provide user training and awareness
• Monitor workstation use regularly
• Implement proper disposal procedures
• Regular review and update of policies
• Implement physical security controls
• Establish configuration standards
• Provide user training and awareness
• Monitor workstation use regularly
• Implement proper disposal procedures
• Regular review and update of policies
Common Violations
• Lack of workstation use policies
• Inadequate physical security for workstations
• Insufficient workstation configuration standards
• Poor user training on workstation security
• Inadequate monitoring of workstation use
• Insufficient disposal procedures
• Inadequate physical security for workstations
• Insufficient workstation configuration standards
• Poor user training on workstation security
• Inadequate monitoring of workstation use
• Insufficient disposal procedures
Testing Procedures
• Review workstation use policies
• Test physical security controls
• Verify configuration standards
• Review user training records
• Test monitoring and auditing capabilities
• Verify disposal procedures
• Review policy compliance
• Test physical security controls
• Verify configuration standards
• Review user training records
• Test monitoring and auditing capabilities
• Verify disposal procedures
• Review policy compliance
Audit Considerations
• Workstation use policies and procedures
• Physical security implementation
• Configuration standards compliance
• User training and awareness
• Monitoring and auditing capabilities
• Disposal procedures
• Policy review and updates
• Physical security implementation
• Configuration standards compliance
• User training and awareness
• Monitoring and auditing capabilities
• Disposal procedures
• Policy review and updates
NIST Cybersecurity Framework Alignment
This HIPAA control aligns with the following NIST Cybersecurity Framework functions and controls:
Identify (ID)
- ID.AM-1: Physical devices and systems within the organization are inventoried
- ID.AM-2: Software platforms and applications within the organization are inventoried
- ID.AM-3: Organizational communication and data flows are mapped
Protect (PR)
- PR.AC-1: Identities and credentials are issued, managed, verified, revoked, and audited
- PR.AC-3: Remote access is managed
- PR.DS-1: Data-at-rest is protected
- PR.DS-2: Data-in-transit is protected
Detect (DE)
- DE.AE-1: A baseline of network operations and expected data flows is established
- DE.CM-1: The network is monitored to detect potential cybersecurity events
- DE.CM-3: Personnel activity is monitored to detect potential cybersecurity events
Respond (RS)
- RS.CO-1: Personnel know their roles and order of operations when a response is needed
- RS.CO-2: Incidents are reported consistent with established criteria
- RS.AN-1: Notifications from detection systems are investigated
Recover (RC)
- RC.RP-1: Recovery plan is executed during or after a cybersecurity incident
- RC.IM-1: Recovery plans incorporate lessons learned
- RC.CO-1: Public relations are managed
Note: This mapping provides a general alignment between HIPAA controls and NIST Framework functions. Specific implementation may vary based on your organization's risk profile and compliance requirements.
Implementation Templates & Checklists
Download our expert-developed templates and checklists to implement this control effectively:
Implementation Checklist
Step-by-step checklist to ensure complete implementation of this control
Download ChecklistExpert Implementation Recommendations
Based on our experience with 500+ healthcare organizations, here are our expert recommendations for implementing this control:
High Priority
Start with Risk Assessment
Conduct a comprehensive risk assessment to identify specific vulnerabilities and threats related to this control. This will help prioritize implementation efforts and allocate resources effectively.
- Identify all systems and data covered by this control
- Assess current security measures and gaps
- Evaluate potential impact of security incidents
- Document findings and remediation priorities
Medium Priority
Develop Comprehensive Policies
Create detailed policies and procedures that address all aspects of this control. Ensure policies are specific, actionable, and aligned with your organization's risk profile.
- Define roles and responsibilities clearly
- Establish approval workflows and escalation procedures
- Include specific technical requirements and standards
- Regular review and update schedules
Low Priority
Implement Monitoring and Testing
Establish ongoing monitoring and testing procedures to ensure the control remains effective over time. Regular testing helps identify new vulnerabilities and compliance gaps.
- Automated monitoring where possible
- Regular manual testing and validation
- Incident response procedures
- Continuous improvement processes
Recommended Implementation Timeline
1
Week 1-2: Assessment & Planning
Conduct risk assessment and develop implementation plan
2
Week 3-4: Policy Development
Create and review policies and procedures
3
Week 5-8: Implementation
Deploy technical controls and train staff
4
Week 9-10: Testing & Validation
Test controls and validate compliance
Related Controls
164.310(a)(1) - Facility Access Controls
164.310(a)(2)(ii) - Workstation Controls
164.310(b) - Media Controls
164.312(a)(1) - Access Control
164.310(a)(2)(ii) - Workstation Controls
164.310(b) - Media Controls
164.312(a)(1) - Access Control