HITRUST vs SOC 2: Key Differences for Healthcare Vendors

Photo: Unsplash

If you sell into healthcare, you will eventually get a security questionnaire that asks for HITRUST, SOC 2, or both. They are the two most common ways vendors prove their security programs to health systems and payers, but they work very differently. This guide compares HITRUST and SOC 2 on structure, scope, effort, and what buyers expect, so you can decide which one your company needs and when.

Key takeaways

• HITRUST is a certification. SOC 2 is an attestation report. HITRUST certifies you against a prescriptive control framework. SOC 2 is a CPA firm's opinion on controls you define.
• HITRUST is more prescriptive. The HITRUST CSF tells you which requirements apply based on your scope and risk factors. SOC 2 lets you design your own controls to meet the Trust Services Criteria.
• HITRUST has three levels: e1 (essentials), i1 (implemented), and r2 (risk-based, the most rigorous). Buyers often specify the level in the contract.
• SOC 2 is the broader market default. Almost every B2B buyer accepts it. HITRUST is requested mainly by larger health systems and payers.
• The work overlaps heavily. Controls built for SOC 2 and HIPAA carry over into a HITRUST assessment, so most HealthTech companies start with SOC 2 and add HITRUST when a customer requires it.

HITRUST vs SOC 2 at a glance

	HITRUST	SOC 2
What you get	A HITRUST certification and report	An attestation report with a CPA firm's opinion
Who issues it	HITRUST, after an authorized external assessor tests your controls and HITRUST completes a quality assurance review	A licensed CPA firm
Framework	HITRUST CSF, which harmonizes requirements from HIPAA, ISO 27001, NIST, and other sources	AICPA Trust Services Criteria
Control design	Prescriptive requirements selected by scope and risk factors	You define controls that meet the criteria
Levels or types	e1, i1, r2	Type 1 (point in time) and Type 2 (over a period)
Validity	e1 and i1: one year. r2: two years, with an interim assessment	Report covers a period, typically renewed annually
Scoring	Requirements scored against maturity levels, with minimum thresholds to certify	Controls tested; exceptions reported in the opinion
Most requested by	Large health systems, payers, and healthcare enterprises	Most B2B buyers across industries
Typical effort	Higher, especially for r2	Lower to moderate

How HITRUST works

The HITRUST CSF is a control framework that pulls requirements from many sources, including HIPAA, ISO 27001, NIST publications, and PCI DSS, into one structure. Instead of choosing your own controls, you define your scope and risk factors, and HITRUST determines which requirements apply.

There are three assessment levels:

• e1 (Essentials, one-year certification): a small set of foundational cybersecurity requirements. A good fit for lower-risk vendors or as a first step.
• i1 (Implemented, one-year certification): a broader set of leading practices, tested for implementation.
• r2 (Risk-based, two-year certification): tailored to your risk factors, usually with the largest number of requirements, and tested for both policy and implementation maturity. It includes an interim assessment in the first year. This is the level most large health systems ask for when they ask for "HITRUST".

The process runs through MyCSF, HITRUST's platform. You complete a readiness or self-assessment, an authorized external assessor tests your controls and submits the results, and HITRUST performs quality assurance before issuing the certification. Controls your cloud provider already operates can often be inherited through HITRUST's inheritance program instead of being tested again.

How SOC 2 works

A SOC 2 examination is performed by a licensed CPA firm against the AICPA Trust Services Criteria. Security is required in every SOC 2. Availability, Processing Integrity, Confidentiality, and Privacy are optional categories you add when customers need them.

You design and document your own controls to meet those criteria. The auditor then tests them:

• Type 1 reports whether your controls are suitably designed at a point in time.
• Type 2 reports whether they operated effectively over a period, usually 3 to 12 months. This is what most buyers want.

The result is a report you share under NDA, containing the auditor's opinion, your system description, and the tests performed. For more detail, see SOC 2 Type 1 vs Type 2.

Key differences that matter in practice

Flexibility. SOC 2 lets you describe controls that fit your company. HITRUST prescribes requirements, so you may need to implement or formalize controls you would not have chosen, especially at r2.

Proof of maturity. HITRUST r2 scores policies, procedures, and implementation, which is why risk teams at large health systems value it. SOC 2 reports whether controls operated, not how mature the program is.

Effort and cost. HITRUST, especially r2, usually takes longer and costs more than SOC 2. You pay for the MyCSF subscription, the external assessor, and more internal preparation time. See SOC 2 audit costs for the SOC 2 side of the comparison.

Market acceptance. SOC 2 is accepted almost everywhere. HITRUST carries the most weight in US healthcare and is less familiar to buyers outside it.

HIPAA mapping. The HITRUST CSF maps directly to HIPAA, so a HITRUST certification is a strong way to show HIPAA safeguards. SOC 2 overlaps heavily with HIPAA but does not map to it by default. See HIPAA vs SOC 2.

Which one do you need?

• You sell B2B software across industries, including some healthcare: start with SOC 2 Type 2. It unlocks the most deals for the least effort.
• Your customers are mid-market clinics and digital health companies: SOC 2 Type 2 plus documented HIPAA compliance and a signed BAA is usually enough.
• A large health system or payer names HITRUST in the contract: you need HITRUST, at the level they specify. Ask whether e1 or i1 is acceptable before committing to r2.
• Healthcare is your only market and you are moving upmarket: plan for both. Keep SOC 2 for broad acceptance and add HITRUST as enterprise health customers require it.

Before you commit, ask your target customers exactly what they accept. Many health systems accept SOC 2 Type 2 with HIPAA mapping for vendors below a certain risk tier and reserve HITRUST r2 for the highest-risk contracts.

Running HITRUST and SOC 2 together

Because the control sets overlap, you do not need two separate programs:

1. Build one control set that meets the SOC 2 criteria and HIPAA Security Rule safeguards.
2. Map it to the HITRUST CSF requirements for your target level, and close the gaps.
3. Collect evidence once and reuse it across the SOC 2 audit and the HITRUST assessment.
4. Use inheritance from your cloud provider to reduce the HITRUST requirements you must test yourself.
5. Align audit timing so the SOC 2 observation period and HITRUST assessment draw on the same evidence.

How SecureSlate helps

SecureSlate runs SOC 2, HIPAA, and HITRUST as one program, for one fixed price:

• A dedicated compliance lead matches the HITRUST level to what your customer actually requires, prepares your evidence for MyCSF, and works with your HITRUST assessor.
• Evidence reuse across frameworks. Work you already do for HIPAA, SOC 2, or ISO 27001 carries over. See multi-framework compliance.
• Continuous evidence collection from your cloud provider, identity provider, code host, and devices, plus security scanning that evidences technical safeguards.

See SecureSlate for healthcare for how it fits a HealthTech company.

FAQ

Is HITRUST better than SOC 2?

Neither is better in general. HITRUST is more prescriptive and more rigorous at the r2 level, which large healthcare organizations value. SOC 2 is more flexible, less costly, and accepted by more buyers. The right choice depends on what your customers require.

Does HITRUST replace SOC 2?

Sometimes, for healthcare buyers that accept HITRUST in place of SOC 2. Buyers outside healthcare usually still ask for SOC 2, so many companies keep both and reuse the same evidence.

What is the difference between HITRUST e1, i1, and r2?

e1 covers foundational cybersecurity practices, i1 adds a broader set of leading practices, and r2 is a risk-based assessment tailored to your organization and scored on maturity. e1 and i1 certifications last one year, while r2 lasts two years with an interim assessment.

Does HITRUST certification mean I am HIPAA compliant?

Not automatically. The HITRUST CSF maps to HIPAA and a certification is strong evidence of the Security Rule safeguards, but HIPAA obligations such as business associate agreements, breach notification, and Privacy Rule duties still need to be met.

How long does HITRUST take compared to SOC 2?

HITRUST usually takes longer, because of readiness work, assessor testing, and HITRUST's quality assurance review, and r2 takes the longest. A SOC 2 Type 1 can be done relatively quickly, while a Type 2 needs its observation period, typically 3 to 12 months.

Disclaimer (legal note)

This article is for general information only and is not legal, regulatory, or professional advice. Framework requirements change over time. Consult qualified advisors and the framework owners for current requirements.