Compliance refers to adherence to external requirements, laws, regulations, industry standards, and contractual obligations that mandate specific practices. For healthcare organizations, HIPAA's Privacy and Security Rules establish baseline requirements for protecting protected health information (PHI). Other frameworks like HITRUST, SOC 2, and state-specific regulations layer additional requirements depending on organizational scope and function.
As academic researchers define it, "Compliance is a constraint or assertion that prescribes a desired result or purpose to be achieved by incorporating actions or control procedures in processes." Compliance requirements place demands not only on business processes but also on components of information technology architecture, including data protection and information security laws addressing the operation of software and hardware.
Security, by contrast, refers to the actual protection of systems, data, and operations from unauthorized access, disruption, or destruction. Security encompasses the technical controls, operational practices, and organizational culture that defend against threats, whether or not those defenses appear in any regulatory checklist.
The traditional definition of security through the CIA triad, confidentiality, integrity, and availability, has dominated information security literature. However, researchers have challenged this framework as both too broad and too narrow. As Lundgren and Möller argue in their analysis of information security definitions, "The CIA definition is both too broad and too narrow, i.e., it defines insecure states as secure and secure states as insecure."
They propose instead what they call the "Appropriate Access" definition, "The information I is secure for stakeholder H if, and only if: For every agent A, and every part P of I, A has just the appropriate access to P relative to H." This definition recognizes that security is contextual and stakeholder-relative; what constitutes appropriate access varies with organizational needs, threat landscapes, and operational contexts.
Where confidentiality focuses on who should have access to what, the Appropriate Access framework asks whether each agent has just the appropriate access, no more, no less, for the stakeholder's purposes. The availability requirements under CIA demand that information be accessible upon demand, yet a time-lock provides security precisely by making content unavailable. The Appropriate Access definition accommodates this because restricted availability may be exactly what is appropriate for a given stakeholder. Similarly, integrity under CIA requires that information remain accurate and complete, but an open collaborative document designed for modification would be "insecure" under CIA while perfectly secure under the Appropriate Access framework because unrestricted modification is appropriate for that system's purpose.
This stakeholder-relative view also enables organizations to recognize when the same information may be secure from one perspective but insecure from another. A database system used by an organization to inform the public might be completely secure given that organization's needs, while that same system would be entirely insecure for an organization requiring strict access controls. The Appropriate Access definition makes these contextual differences explicit rather than forcing all systems into uniform requirements.
Go deeper: Why HITRUST certification matters
Research examining 243 hospitals revealed that for mature organizations, compliance with regulatory frameworks had no impact on data breach occurrence. The study found that "immature hospitals are motivated by meeting compliance mandates rather than actually protecting information." Although compliance did improve data security for these immature hospitals, it could hinder them from achieving more comprehensive data protection beyond minimum requirements.
This creates what researchers call the "checkbox mentality," where compliance instead of security becomes the goal. Organizations fall into viewing compliance as a one-time achievement rather than an ongoing commitment to maintaining security best practices. Since standards focus on the existence of certain security processes but do not prescribe quality, they could lead to a false sense of security.
The gap manifests in several ways:
Regulations emerge from documented harms, pass through legislative or administrative processes, and establish requirements based on threats that existed when the rules were written. HIPAA's Security Rule was finalized in 2003, before smartphones, cloud computing, and AI-powered attacks became standard features of the threat landscape.
Organizations prepare for annual audits, document their controls, demonstrate adherence at a point in time, then return to operational priorities until the next assessment cycle. Microsoft customers around the globe received over 600 million cyberattacks each day in 2023, a continuous assault that point-in-time compliance assessments cannot address.
Compliance frameworks specify particular controls without accounting for how those controls perform against evolving attack techniques. An organization can achieve technical compliance with access control requirements while remaining vulnerable to credential stuffing, session hijacking, or prompt injection attacks that regulation authors never anticipated.
Compliance frameworks struggle with several dimensions of actual security.
Research on security knowledge categorization found that security "cannot be considered singular in concept definition, as definition is dependent on applied context." The multidimensional nature of security, spanning physical security, information security, personnel security, investigations, risk management, and more, resists the uniform treatment that compliance frameworks provide.
The Snowden-NSA incident illustrates this limitation. Before collecting and leaking documents, Snowden reported problems to officials whose non-action contributed to his decision to act. As Lundgren and Möller note, "it was the breach of security that enabled the sharing of confidential information, not the other way around." The CIA definition could not identify this breach because no technical property was violated until documents were actually shared, yet security was clearly compromised the moment an authorized user decided to act against organizational interests.
HIPAA doesn't spell out "no self-signed certificates," but the Security Rule requires organizations to verify the integrity of connections. A self-signed certificate cannot provide that verification, which means the encryption cannot be trusted or proven. Organizations may be technically compliant with encryption requirements while their actual email security silently fails.
Effective security begins where compliance ends, with threat intelligence, adversary modeling, and defensive capabilities calibrated to actual risks rather than regulatory minimums.
By adhering to established compliance requirements, organizations can systematically evaluate their security controls, policies, and practices. Compliance frameworks like the NIST Cybersecurity Framework and ISO/IEC 27001 emphasize a risk-based approach that aligns security initiatives with identified threats and vulnerabilities. However, implementing these frameworks requires going beyond checkbox completion to genuine risk assessment.
Organizations are required to conduct regular risk assessments as part of compliance obligations. These assessments help identify potential threats and weaknesses, allowing for prioritization of resources to mitigate identified risks effectively. The proactive nature of compliance facilitates the identification of emerging threats, enabling organizations to stay ahead of potential risks through continuous monitoring and evaluation.
Compliance may require certain controls, and security requires those controls to work together. Email security that stops phishing at the gateway combines with authentication that prevents credential theft, endpoint detection that identifies malware execution, network segmentation that limits lateral movement, and backup systems that enable recovery. Each layer addresses gaps that others cannot cover.
Most healthcare providers assume their email is secure because TLS is enabled, but TLS only works when certificates hold the line. Cloud email platforms routinely accept weak or unverifiable certificates because the alternative is message failure, deliverability wins over security, and that behavior extends risk across every domain that depends on them.
Security requires actively checking the certificates on receiving servers before sending PHI, looking for expired certificates, self-signed certificates, incomplete certificate chains, and revoked or malformed certificates. When validation fails, secure alternatives must be used rather than hoping the connection works. This level of verification exceeds what compliance frameworks require but addresses real vulnerabilities that compliance ignores.
Regulatory mandates often require organizations to establish protocols for incident detection, reporting, and remediation. By formalizing incident response procedures, compliance initiatives enable organizations to respond promptly and effectively to security incidents. However, compliance-driven incident response often emphasizes documentation over actual response capability.
Organizations that prioritize security beyond compliance are better positioned to learn from past incidents. Many compliance frameworks encourage post-incident reviews and assessments, allowing organizations to identify weaknesses and make necessary improvements. This continuous refinement of incident response strategies enhances resilience against future threats, but only when treated as genuine learning rather than audit preparation.
Compliance programs promote an accountable culture where employees understand their responsibilities for protecting sensitive information. Regular training and awareness initiatives ensure all staff members understand compliance requirements and the consequences of non-compliance. However, there is a difference between compliance training and security training; compliance training teaches what rules exist, while security training teaches how to recognize and respond to threats.
Yes. Compliance establishes minimum requirements based on regulations that may not address current threats. An organization can satisfy every regulatory requirement while remaining vulnerable to prompt injection, sophisticated phishing, or infrastructure failures like expired certificates that regulations don't specifically address.
An organization might implement strong security controls without documenting them in formats regulators require, or might prioritize security investments differently than compliance frameworks mandate. However, organizations with mature security programs usually achieve compliance as a byproduct of their security practices.
The checkbox mentality refers to organizations treating compliance as a one-time achievement rather than an ongoing security commitment. This creates a false sense of security completion where organizations tick off items from requirement lists without recognizing that cybersecurity is constantly changing.