Katana314 , 6 days ago

HIPAA applies to whichever entity consciously chooses to move/store data.

Generally, after a patient downloads a healthcare-related item, they are that entity - and as the patient, they have full control/decisions about where it goes, so they can’t violate their own HIPAA agreement even if they print it and scatter it to the wind.

BUT, if your operating system “decides” to upload that document without the user’s involvement, then Microsoft is that entity - and having not received conscious permission from the patient, would be in violation. It’s an entirely different circumstance if the user is always going through clear prompts, but their more recent OneDrive Backup goal has been extremely forceful and easy to accidentally turn on - even to the point of being hard to disable. As you said, encryption has nothing to do with it.