RISK ASSESSMENT PROJECTBy Robin Beckwith, Lisa Neuttila & Kathy Cotterman 1
R.L.K. EnterprisesMedical Records Storage Company. 2
RLK Enterprises Risk Management Proposal Identify risks Create security controls and mitigation procedures Develop an operational framework of safeguards, procedures and controls Reduce risks and liabilities to an acceptable level Meet legal and statutory requirements
Risk Management Policy
Does not eliminate risk totally, but provides the structural means to identify, prioritize, and manage the risks
Cost of managing and treating risks vs the anticipated benefits
Risk management is an essential element of good corporate governance and management practice
Everyone at RLK has a role in the effective management of risk. All personnel should actively participate in identifying potential risks in their area and contribute to the implementation of appropriate treatment actions.
Risk Assessment Framework Introduces a structured, flexible, extensible, and repeatable process for managing organizational risk and achieving risk-based protection related to the operation and use of information
Security Rule Goals and Objectives As required by the “Security standards: General rules” section of the HIPAA Security Rule, each covered entity must: Ensure the confidentiality, integrity, and availability of EPHI that it creates, receives, maintains, or transmits; Protect against any reasonably anticipated threats and hazards to the security or integrity of EPHI; and Protect against reasonably anticipated uses or disclosures of such information that are not permitted by the Privacy Rule.
How to Conduct a Risk Assessment Scope the Assessment Gather Information Identify Realistic Threats Identify Potential Vulnerabilities Assess Current Security Controls Determine the Likelihood and the Impact of a Threat Exercising a Vulnerability Determine the Level of Risk Recommend Security Controls Document the Risk Assessment Results
Identification and Categorization of Information Types in RLK System Category 0-1 -- The potential impact is LOW if: The loss of confidentiality, integrity, or availability could be expected to have a limited adverse effect on organizational operations, organizational assets, or individuals Category 2-3 -- The potential impact is MODERATE if: The loss of confidentiality, integrity, or availability could be expected to have a serious adverse effect on organizational operations, organizational assets, or individuals. Category 4-5 -- The potential impact is HIGH if: The loss of confidentiality, integrity, or availability could be expected to have a severe or catastrophic adverse effect on organizational operations, organizational assets, or individuals.
Proposed Solution The above Framework of risk identification, security controls and mitigation procedures, when scoped to the particular needs and applied to the specific operation of RLK Enterprises, is designed to provide an acceptable level of data assurance as well as meeting Federal Government requirements and guidelines
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