iCloud is not HIPAA compliant and cannot be used by HIPAA Covered Entities or Business Associates to create, receive, maintain, transmit, store, sync, or share electronic protected health information because Apple’s iCloud Terms of Service prohibit that use and Apple does not offer a business associate agreement for iCloud.
Healthcare organizations evaluate iCloud because it is integrated into iPhones, iPads, and Macs and it enables users to access files and backups across multiple devices. iCloud uses authentication and access controls, and Apple encrypts data in storage and during transfer. Technical safeguards alone do not authorize the use of a cloud service for electronic protected health information under HIPAA.
A cloud storage provider becomes a business associate when it creates, receives, maintains, or transmits electronic protected health information on behalf of a HIPAA Covered Entity, and a business associate agreement is required before the service is used for electronic protected health information. Cloud storage services are not treated as conduits under the HIPAA Conduit Exception Rule. When no business associate agreement exists, electronic protected health information cannot be placed into the service even when access controls and encryption are present.
Apple’s iCloud terms and conditions prohibit HIPAA Covered Entities, business associates, and their representatives from using any component, function, or facility of iCloud to create, receive, maintain, or transmit protected health information or to use iCloud in any manner that would make Apple or an Apple subsidiary a business associate. This restriction applies to iCloud features that upload, synchronize, or back up content, including photo syncing, file syncing, and device backups when protected health information exists in the content being handled.
A frequent operational risk is unintended capture of protected health information when staff use Apple devices for clinical activity. Photographs taken for clinical documentation, referral documents stored in files, screenshots that contain scheduling details, and application data can be included in backups or synchronization workflows when iCloud is enabled. Users can also share files through iCloud features without recognizing that the disclosure places protected health information into a non-permitted cloud environment.
Healthcare organizations can still allow iCloud for purposes that do not involve protected health information, but that requires controls that prevent protected health information from being stored, synced, or shared through iCloud. Device configuration management and restricted account settings can be used to disable iCloud backup and synchronization features on devices and applications that handle protected health information. Written procedures and workforce training are also required so that staff understand which device features are prohibited for work content that contains protected health information and what alternatives are authorized.
Vendor selection should account for the availability of other cloud storage services that will sign a business associate agreement and can be configured for regulated use. A business associate agreement establishes contractual responsibilities for safeguarding electronic protected health information, including breach notification obligations. iCloud does not provide that contractual framework for HIPAA-regulated use, so it should be excluded from workflows that store, sync, or transmit electronic protected health information.