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12/06/2026 12:55 am
TL;DR: HITRUST and HIPAA both protect PHI, but they differ in scope, enforcement, certification, cost, and how organisations prove control maturity, according to Zluri. For IAM and access governance teams, the practical question is less which label applies and more whether access reviews, audit trails, and remediation are actually working.
NHIMG editorial — based on content published by Zluri: Access Management HITRUST vs HIPAA: 6 Key Differences
By the numbers:
- Only 20% have formal processes for offboarding and revoking API keys, and even fewer have procedures for rotating them.
- 80% of identity breaches involved compromised non-human identities such as service accounts and API keys.
- 90% of IT leaders say properly managing NHIs is essential for a successful zero-trust implementation.
Questions worth separating out
Q: How should healthcare teams evidence access governance for HIPAA and HITRUST?
A: They should show current entitlement data, approver records, remediation actions, and deprovisioning evidence for systems that touch PHI.
Q: When does HITRUST add value beyond HIPAA compliance alone?
A: HITRUST adds value when an organisation needs a structured way to translate HIPAA obligations into repeatable controls, assessments, and third-party assurance.
Q: What do teams get wrong about access reviews in regulated healthcare environments?
A: They often treat access review as an annual paperwork exercise instead of a control that must reflect live entitlements.
Practitioner guidance
- Map PHI access to accountable owners Assign explicit business and technical owners for every role, group, and privileged account that can reach PHI or ePHI.
- Automate access certification for regulated systems Run recurring access reviews against HR, vendor, and application data so approvals are based on current entitlements rather than spreadsheets.
- Extend offboarding to vendors and service accounts Include business associates, contractors, API keys, and service accounts in the same deprovisioning workflow used for employees.
What's in the full article
Zluri's full article covers the implementation and compliance detail this post intentionally leaves for the source:
- The article walks through the specific HIPAA and HITRUST certification steps, including self-audits, remediation, and validated assessments.
- It explains the timing and cost differences between HIPAA compliance work and HITRUST certification cycles.
- It outlines how Zluri positions access review automation for teams that need recurring certification evidence.
- It includes FAQ-style clarification on whether HITRUST replaces HIPAA or simply complements it.
👉 Read Zluri's comparison of HITRUST vs HIPAA for healthcare compliance →
HITRUST vs HIPAA: where access review and compliance diverge?
Explore further
12/06/2026 10:28 am
Compliance labels do not reduce identity risk unless access governance is continuous. The article correctly separates HIPAA as a legal requirement from HITRUST as a framework, but both depend on the same control reality: who can access PHI, how that access is reviewed, and whether it is removed when no longer needed. In healthcare, that is an identity governance problem first and a certification problem second. Practitioners should treat compliance evidence as a by-product of control discipline, not as a substitute for it.
A few things that frame the scale:
- 96% of organisations store secrets outside of secrets managers in vulnerable locations including code, config files, and CI/CD tools, according to Ultimate Guide to NHIs.
- Only 5.7% of organisations have full visibility into their service accounts, which means most identity programmes still lack a complete control inventory.
A question worth separating out:
Q: Who is accountable when third-party access to PHI is overbroad or unreviewed?
A: The covered entity remains accountable for governance, even when a business associate or vendor holds the access. Contracts help, but the organisation still needs entitlement scoping, review cadence, and offboarding evidence so external access is managed as part of the regulated environment.
👉 Read our full editorial: HITRUST vs HIPAA: what access governance teams need to know
