HITRUST has become one of the most important — and most misunderstood — compliance frameworks in healthcare and healthcare-adjacent industries.
For organizations handling sensitive health data, HITRUST is often seen as the “gold standard.” But many teams don’t realize that HITRUST is not a single certification. It’s a tiered framework with multiple assessment types, each designed for different levels of risk, complexity, and maturity.
Choosing the wrong one can mean unnecessary cost, wasted effort, or a compliance program that’s far heavier than your organization actually needs.
This guide breaks down the differences between e1, i1, and r2, explains when each makes sense, and shows how working with a HITRUST-certified partner like SmartBase Solutions can dramatically simplify your path — or even reduce the need for certification altogether.
What Is HITRUST (and Why Organizations Pursue It)
HITRUST is a security and risk management framework designed to help organizations protect sensitive data, especially protected health information (PHI).
What makes HITRUST unique is that it harmonizes multiple regulations and standards into a single, structured framework, including:
- HIPAA
- NIST
- ISO
- PCI
- State privacy laws
- Cyber insurance requirements
Rather than navigating dozens of overlapping rules, organizations can align to one framework that auditors, partners, and regulators increasingly recognize and trust.
For many healthcare organizations and vendors, HITRUST is no longer optional. It’s a requirement driven by customers, partners, or risk management teams.
The Three HITRUST Assessment Types: e1, i1, and r2
HITRUST introduced tiered assessments to better match security expectations with organizational risk. These tiers are not interchangeable — each serves a different purpose.
HITRUST e1: The Entry-Level Assessment
Best for:
Low-risk organizations, early-stage vendors, or companies beginning their compliance journey.
What it is:
The e1 assessment is a foundational cybersecurity assessment focused on basic hygiene and essential controls.
Key characteristics:
- Covers a limited set of core security controls
- Designed for organizations with low risk exposure
- Less expensive and faster than higher tiers
- Often used to demonstrate baseline security posture
What e1 does well:
- Establishes a starting point
- Helps organizations understand gaps
- Provides a recognized assessment without heavy overhead
What e1 does not do:
- It does not meet the expectations of many healthcare enterprises
- It may not satisfy vendor security requirements for PHI handling
- It is not sufficient for higher-risk environments
For many organizations, e1 is a stepping stone — not the final destination.
HITRUST i1: The Most Common Starting Point
Best for:
Healthcare-adjacent vendors, SaaS companies, MSPs, and service providers handling PHI.
What it is:
The i1 assessment is a standardized, moderate-risk assessment designed to meet the expectations of most healthcare organizations.
Key characteristics:
- Fixed control set (same for all organizations)
- Designed for environments that handle sensitive data
- Significantly stronger than e1
- Increasingly accepted by healthcare partners and customers
Why i1 is popular:
- Predictable scope
- Faster and less expensive than r2
- Aligns well with HIPAA and common vendor security requirements
- Demonstrates real security maturity
For many healthcare software companies and service providers, i1 strikes the right balance between rigor and feasibility.
HITRUST r2: The Most Comprehensive Assessment
Best for:
Healthcare providers, large enterprises, and organizations with high risk exposure.
What it is:
The r2 assessment is a fully tailored, risk-based HITRUST assessment aligned to your specific environment, data types, and threat landscape.
Key characteristics:
- Broadest and deepest control coverage
- Custom scoping based on risk factors
- Highest cost and effort
- Longest timeline
Why organizations pursue r2:
- Required by certain healthcare systems or regulators
- Necessary for high-risk data environments
- Provides maximum assurance to partners and auditors
r2 is powerful, but it’s not appropriate for every organization. Many teams pursue r2 prematurely, only to discover they could have met their needs with a lighter approach.
Choosing the Right HITRUST Tier: What Actually Matters
The right assessment depends on:
- Whether you store, process, or transmit PHI
- Your role in the healthcare ecosystem (provider vs vendor)
- Customer and partner requirements
- Risk tolerance
- Budget and internal resources
More controls does not automatically mean better security. It often just means more complexity. This is where strategy matters and where many organizations get stuck.
How a HITRUST-Certified Partner Changes the Equation
One of the biggest misconceptions about HITRUST is that your organization must shoulder the entire compliance burden alone. That’s not always true.
Working with a HITRUST-certified partner can significantly reduce:
- The number of controls you’re responsible for
- The scope of your assessment
- The cost and timeline of certification
- Ongoing compliance maintenance
In some cases, it can eliminate the need for certification entirely.
How SmartBase Solutions Supports HITRUST Alignment
SmartBase Solutions operates HITRUST-certified environments designed specifically for healthcare and regulated industries.
When your infrastructure, hosting, backups, and security controls already exist inside a HITRUST-aligned environment, much of the heavy lifting is already done.
This means:
- Fewer controls fall on your internal team
- Less evidence gathering during assessments
- Clearer audit boundaries
- Reduced implementation effort
- Faster certification timelines
Instead of building and documenting everything from scratch, organizations inherit security controls through their infrastructure partner.
When You May Not Need HITRUST Certification at All
In some cases, organizations pursue HITRUST because customers ask for it — not because it’s legally required.
When infrastructure, hosting, backup, and security controls are already covered by a HITRUST-certified provider, many organizations can:
- Meet customer security requirements without full certification
- Provide inherited control documentation
- Pass security reviews more efficiently
- Avoid unnecessary compliance spend
This is especially common for smaller healthcare-adjacent vendors who don’t directly store PHI but still need to demonstrate strong security posture.
HITRUST Is Not Just a Checkbox
Regardless of tier, HITRUST is not about paperwork. It’s about building a defensible, repeatable security program. The difference between a painful HITRUST experience and a manageable one usually comes down to architecture, scope, and partnerships, not effort alone.
Planning Your HITRUST Path the Smart Way
Before choosing e1, i1, or r2, organizations should ask:
- What level of assurance do our customers actually require?
- Which controls can be inherited from partners?
- What risks are we truly trying to mitigate?
- How do we avoid over-engineering compliance?
These are strategic questions, not technical ones.
How SmartBase Can Help
SmartBase Solutions helps organizations:
- Understand which HITRUST tier makes sense
- Reduce assessment scope through inherited controls
- Align infrastructure, backups, and security with HITRUST expectations
- Prepare for audits without unnecessary complexity
Whether you’re pursuing certification, planning for future requirements, or trying to avoid compliance overreach, the right partner makes all the difference.
If HITRUST feels overwhelming, it doesn’t have to be. Let’s talk.
