Secure Healthcare APIs: A pre-requisite to HIPAA Compliance

Having spoken to over 1000 DevSecOps professionals, I can attest that they are stretched thin across all sectors. 

However, for those in healthcare, the pressure is exceptionally intense.

As the industry shifts from volume-based to value-based care, decentralization becomes essential to deliver efficient, holistic, and cost-effective outcomes. 

APIs are powering this transformation, enabling interoperability and data exchange among all healthcare system stakeholders despite their legacy infrastructure.

Recent regulations, such as the CMS Interoperability and Patient Access Final Rule, require healthcare providers to maintain accessible API directories, further accelerating API adoption. 

Today, six in ten hospitals facilitate API-powered data submissions, while nearly 90% offer EHR access through APIs. 

However, like many novel and promising technologies, APIs are often implemented without fully understanding the security risks they introduce. 

This oversight leads to successful exploitations, with 78% of surveyed healthcare enterprises reporting API-induced security incidents. 

These breaches not only undermine customer trust and organizational reputation but also result in HIPAA violations and subsequent penalties.

With regulatory and patient demands at an all-time high, slowing down or halting API adoption is not an option. And it doesn’t have to be.

I've found that compliance, regulatory, and security success do not have to be mutually exclusive, even when your APIs are growing exponentially. 

Instead, they can be achieved exhaustively by following certain API Management practices.

These core practices, which we've championed since our inception, are detailed in the blog below.

TL;DR

‍Healthcare API security is the set of practices protecting the API ecosystem powering modern patient care. With 78% of healthcare enterprises reporting API security incidents and health records selling for up to $1,000 each on the black market, unsecured APIs are the single biggest threat to HIPAA compliance and patient trust.

Healthcare’s API Boom: Innovation at the Expense of Security 

APIs enable modular development, allowing developers to bypass building functionality from scratch and instead access pre-built libraries that expose essential business logic and secure systems of record in a standardized format.

So, APIs enhance not just patient experience but also significantly enhance developer experience, hence the rapid adoption. 

But what happens when APIs proliferate uncontrolled and uncatalogued across your entire network? 

Let's look at what would happen at a Hospital. 

One team builds Scheduling APIs for real-time appointments. At the same time, another oversees the integration of Registration and Financial APIs to streamline check-ins and billing, ensuring secure integration with internal databases.

Simultaneously, IT teams handle FHIR APIs to enable compliant access to EHR systems, supporting clinicians' data needs. Meanwhile, other teams focus on IoT APIs to capture real-time patient health data and Public Health APIs to securely share information with external partners like health apps and insurers.

These integrations create an intricate, interdependent web of connections among internal applications, patient applications, databases, backend systems, and third-party entities. 

While transformative for patient care, this interconnectivity multiplies the vulnerability surface several times, as vulnerabilities within any API endpoint can become an entire system compromise. 

Here’s how you can prevent such lateral movement into your systems with the below practices: 

API Visibility through API Inventory

Prioritize and mandate structured cataloging of APIs, categorizing them as internal, external, or third-party. 

This ensures that all development and security teams within the hospital have visibility into every API in the infrastructure, regardless of who built or integrated them or the specific care touchpoint they support.

Without a comprehensive inventory, most APIs would remain undetected and thus insecure, providing a direct pathway to attackers. 

For instance, consider an unauthenticated third-party API from a mental health application. 

Built by third-party developers and overlooked after integration by internal teams, it remains unmonitored and unprotected. 

Attackers could access and modify linked patient records in the EHR or appointment scheduling system, bypassing the security controls built around primary APIs.

API Documentation

While an API Inventory is helpful, it's insufficient by itself. 

API documentation should be actively maintained, covering all of the below details for each endpoint: 

Security teams will struggle to carry out customized negative security testing on each endpoint without adequate documentation. 

This results in missed business vulnerabilities, including potential gaps in authentication, misconfigurations, and other weak points that attackers could exploit.

Map Sensitive Data Flows

Knowing which APIs handle sensitive data such as patient medical records, billing details, or regulatory information is non-negotiable. 

Without it, these endpoints could be left unmonitored, unauthenticated, or with inadequate authorization, exposing sensitive patient data to attackers.

Take, for example, the 2019 Quest Diagnostics breach. An unauthorized user accessed a billing API, exposing the personal and financial data of nearly 12 million patients. 

This breach could have been prevented if the security team had clear visibility into the APIs handling sensitive information and ensured they were properly secured.

Pre-Production API Security Testing

Healthcare enterprises are the most susceptible to cybersecurity attacks among all industries—and rightly so, considering the price of health data, which sells for up to $1,000 per record on the black market compared to $1 for credit card or social security numbers.

These breaches massively dent your financial standing, as each costs an average of around $11 million for detection, isolation, notification, post-breach response, and lost business. This doesn't even account for the loss of productivity experienced by 55% of affected enterprises.

Conducting pre-production security testing can help you mitigate, or at least decelerate such devastating incidents. 

Thus, offensive security testing should be mandated for all APIs before they are released into production for these categories: 

Automated API Security Platform Levo.ai

In conclusion, APIs are a net positive for healthcare enterprises and patient care . However, without proper security measures, the risks can overshadow the benefits.

To mitigate these risks, healthcare enterprises should:

While the above practices will certainly help you mitigate security incidents, manual implementation of either or all is simply not possible, considering the current rate of adoption. 

The lack of coverage and high probability of manual errors are not worth the effort, given the repercussions of a subsequent breach. 

We at Levo.ai have automated all of the above use cases, so you can focus on delivering the best quality patient experiences.

Book a demo through this link to see them live in action! 

Conclusion

Healthcare APIs are essential for modern patient care but every undocumented, untested, and unmonitored API is a liability attackers are already looking for. Levo.ai automates API discovery, documentation, sensitive data mapping, and pre production security testing so your team focuses on patient outcomes, not manual audits. See Levo.ai in action

FAQs

Why are healthcare APIs such a high value target for attackers?‍

Health records sell for up to $1,000 per record compared to $1 for credit card data. The average healthcare breach costs $11 million in detection, response, and lost business. Start by identifying every API that handles patient data in your environment.

What happens when healthcare APIs grow without proper security?

Every unmonitored API becomes an entry point. The 2019 Quest Diagnostics breach exposed data of 12 million patients through a single unsecured billing API the security team had no visibility into. Build a complete API inventory before adding new integrations.

Why is API inventory the most critical first step?

Without a complete inventory most APIs remain undetected and unprotected. A third party mental health API overlooked after integration gives attackers direct access to EHR records, bypassing every security control built around primary APIs. Catalogue all internal, external, and third party APIs first.

What pre production security tests matter most for healthcare APIs?

Test authentication and authorisation using OAuth 2.0 and OpenID Connect, validate encryption across SSL and TLS, run SQL injection tests on database connected endpoints, and check verbose messaging to prevent data leakage through error responses before any API reaches production.

How does incomplete API documentation create security gaps?

Over 65% of enterprises admit their API documentation is incomplete. Without accurate parameters, request bodies, and authentication details, security teams cannot run targeted tests, leaving authentication gaps and misconfigurations open for attackers to exploit. Automate documentation through runtime traffic to keep it accurate.