What Is HITRUST

HITRUST (Health Information Trust Alliance) is a private organization that developed the HITRUST CSF — the Common Security Framework — as a comprehensive, certifiable security framework specifically designed for healthcare and healthcare-adjacent industries. Launched in 2007, it has become the dominant certification for healthcare vendors, health tech companies, and business associates handling protected health information (PHI).

The Short Answer

HITRUST CSF is a certification framework that consolidates multiple healthcare security requirements — HIPAA, NIST, ISO 27001, SOC 2, and others — into a single, structured set of control requirements organized across 19 domains. Organizations that achieve HITRUST certification have demonstrated to an external assessor that they meet a rigorous, comprehensive set of security controls.

Unlike HIPAA, HITRUST is not a law. It’s a certification program — but it has effectively become a market requirement in healthcare. Large health systems, major health insurance payers, and pharmaceutical companies increasingly require their vendors to hold HITRUST certification before sharing PHI or integrating systems.

Why HITRUST Was Created

Healthcare faces a unique challenge: multiple overlapping regulatory requirements (HIPAA, NIST, Medicare Conditions of Participation, state privacy laws) combined with extremely high-value data (PHI is worth significantly more than credit card data on the dark web) and an industry that lags other sectors in security investment.

HITRUST was created by a consortium of healthcare and technology companies to solve this problem: instead of every health system conducting its own security assessments of every vendor, there would be one rigorous certification that any vendor could achieve and that any health system could accept.

HITRUST’s 19 Control Domains

The HITRUST CSF organizes its requirements across 19 domains:

1. Information Protection Program
2. Endpoint Protection
3. Portable Media Security
4. Mobile Device Security
5. Wireless Protection
6. Configuration Management
7. Vulnerability Management
8. Network Protection
9. Password Management
10. Access Control
11. Audit Logging & Monitoring
12. Education, Training & Awareness
13. Third-Party Security
14. Incident Management
15. Business Continuity & Disaster Recovery
16. Risk Management
17. Physical & Environmental Security
18. Data Protection & Privacy
19. Transmission Protection

The number of control requirements within each domain varies by certification level and organizational risk factors.

Three Certification Levels

HITRUST now offers three certification levels designed for different organizational sizes and risk profiles:

• e1 (Essential, 1-year): 44 mandatory requirements covering the most essential cybersecurity practices. Designed for lower-risk organizations or those earlier in their compliance journey.
• i1 (Implemented, 1-year): ~182 requirements based on leading cybersecurity practices. Provides a more comprehensive assessment than e1 and is valid for 1 year.
• r2 (Risk-based, 2-year): 200+ requirements tailored based on the organization’s specific risk factors (size, regulatory environment, systems in scope). The most comprehensive and widely recognized HITRUST certification. Valid for 2 years with an interim assessment at year 1.

How the Assessment Process Works

HITRUST certification follows a structured process:

1. Readiness assessment: Internal assessment of current controls against HITRUST requirements
2. Remediation: Close identified gaps before the validated assessment
3. Validated assessment: External HITRUST assessor (must be a HITRUST-authorized firm) evaluates controls
4. HITRUST review: HITRUST organization reviews the assessor’s findings
5. Certification: HITRUST issues the certification if requirements are met

The timeline from start to certification typically ranges from 6–18 months depending on starting maturity and certification level.

How Espresso Labs Helps

Espresso Labs builds and maintains the technical controls required for HITRUST certification as a managed service. We handle endpoint protection, access controls, vulnerability management, configuration management, audit logging, and more — so your team can focus on the assessment process and patient care rather than managing dozens of security tools. Contact us to learn how we can accelerate your HITRUST certification while reducing ongoing compliance costs.