Electronic health records ripe for theft


From a recent POLITICO Article:

America’s medical records systems are flirting with disaster, say the experts who monitor crime in cyberspace. A hack that exposes the medical and financial records of hundreds of thousands of patients is coming, they say — it’s only a matter of when.

As health data become increasingly digital and the use of electronic health records booms, thieves see patient records in a vulnerable health care system as attractive bait, according to experts interviewed by POLITICO. On the black market, a full identity profile contained in a single record can bring as much as $500.

The issue has yet to capture attention on Capitol Hill, which has been slow to act on cybersecurity legislation.

The full POLITICO Article can be read here.

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Law Firms, HIPAA and the “Minimum Necessary Standard” Rule


TMI blogThe HIPAA Omnibus Rule became effective on March 26, 2013. Covered entities and Business Associates had until September 23, 2013 to become compliant with the entirety of the law including the security rule, the privacy rule and the breach notification rule. Law firms that do business with a HIPAA regulated organization and receive protected health information (PHI) are considered a Business Associate (BA) and subject to all regulations including the security, privacy and breach notification rules. These rules are very prescriptive in nature and can impose additional procedures and additional cost to a law firm.

Under the HIPAA, there is a specific rule covering the use of PHI by both covered entities and Business Associates called the “Minimum Necessary Stand” rule or 45 CFR 164.502(b), 164.514(d). The HIPAA Privacy rule and minimum necessary standard are enforced by the U.S. Department of Health and Human Services Office for Civil Rights (OCR). Under this rule, law firms must develop policies and procedures which limit PHI uses, disclosures and requests to those necessary to carry out the organization’s work including:

  • Identification of persons or classes of persons in the workforce who need access to PHI to carry out their duties;
  • For each of those, specification of the category or categories of PHI to which access is needed and any conditions appropriate to such access; and
  • Reasonable efforts to limit access accordingly.

The minimum necessary standard is based on the theory that PHI should not be used or disclosed when it’s not necessary to satisfy a particular job. The minimum necessary standard generally requires law firms to take reasonable steps to limit the use or disclosure of, PHI to the minimum necessary to represent the healthcare client. The Privacy Rule’s requirements for minimum necessary are designed to be flexible enough to accommodate the various circumstances of any covered entity.

The first thing firms should understand is that, as Business Associates subject to HIPAA through their access and use of client data, firms are subject to the Minimum Necessary Standard, which requires that when a HIPAA-covered entity or a business associate (law firm) of a covered entity uses or discloses PHI or when it requests PHI from another covered entity or business associate, the covered entity or business associate must make “reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.”

Law firm information governance professionals need to be aware of this rule and build it into their healthcare client related onboarding processes.

Finding the Cure for the Healthcare Unstructured Data Problem


Healthcare information/ and records continue to grow with the introduction of new devices and expanding regulatory requirements such as The Affordable Care Act, The Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). In the past, healthcare records were made up of mostly paper forms or structured billing data; relatively easy to categorize, store, and manage.  That trend has been changing as new technologies enable faster and more convenient ways to share and consume medical data.

According to an April 9, 2013 article on ZDNet.com, by 2015, 80% of new healthcare information will be composed of unstructured information; information that’s much harder to classify and manage because it doesn’t conform to the “rows & columns” format used in the past. Examples of unstructured information include clinical notes, emails & attachments, scanned lab reports, office work documents, radiology images, SMS, and instant messages.

Who or what is going to actually manage this growing mountain of unstructured information?

To insure regulatory compliance and the confidentiality and security of this unstructured information, the healthcare industry will have to 1) hire a lot more professionals to manually categorize and mange it or 2) acquire technology to do it automatically.

Looking at the first solution; the cost to have people manually categorize and manage unstructured information would be prohibitively expensive not to mention slow. It also exposes private patient data to even more individuals.  That leaves the second solution; information governance technology. Because of the nature of unstructured information, a technology solution would have to:

  1. Recognize and work with hundreds of data formats
  2. Communicate with the most popular healthcare applications and data repositories
  3. Draw conceptual understanding from “free-form” content so that categorization can be accomplished at an extremely high accuracy rate
  4. Enable proper access security levels based on content
  5. Accurately retain information based on regulatory requirements
  6. Securely and permanently dispose of information when required

An exciting emerging information governance technology that can actually address the above requirements uses the same next generation technology the legal industry has adopted…proactive information governance technology based on conceptual understanding of content,  machine learning and iterative “train by example” capabilities

 

Healthcare Information Governance Requires a New Urgency


From safeguarding the privacy of patient medical records to ensuring every staff member can rapidly locate emergency procedures, healthcare organizations have an ethical, legal, and commercial responsibility to protect and manage the information in their care. Inadequate information management processes can result in:

  • A breach of protected health information (PHI) costing millions of dollars and ruined reputations.
  • A situation where accreditation is jeopardized due to a team-member’s inability to demonstrate the location of a critical policy.
  • A premature release of information about a planned merger causing the deal to fail or incurring additional liability.

The benefits of effectively protecting and managing healthcare information are widely recognized but many organizations have struggled to implement effective information governance solutions. Complex technical, organizational, regulatory and cultural challenges have increased implementation risks and costs and have led to relatively high failure rates.  Ultimately, many of these challenges are related to information governance.

In January 2013, The U.S. Department of Health and Human Services published a set of modifications to the HIPAA privacy, security, enforcement and breach notification rules.  These included:

  • Making business associates directly liable for data breaches
  • Clarifying and increasing the breach notification process and penalties
  • Strengthening limitations on data usage for marketing
  • Expanding patient rights to the disclosure of data when they pay cash for care

Effective Healthcare Information Governance steps

Inadvertent or just plain sloppy non-compliance with regulatory requirements can cost your healthcare organization millions of dollars in regulatory fines and legal penalties. For those new to the healthcare information governance topic, below are some suggested steps that will help you move toward reduced risk by implementing more effective information governance processes:

  1. Map out all data and data sources within the enterprise
  2. Develop and/or refresh organization-wide information governance policies and processes
  3. Have your legal counsel review and approve all new and changed policies
  4. Educate all employees and partners, at least annually, on their specific responsibilities
  5. Limit data held exclusively by individual employees
  6. Audit all policies to ensure employee compliance
  7. Enforce penalties for non-compliance

Healthcare information is by nature heterogeneous. While administrative information systems are highly structured, some 80% of healthcare information is unstructured or free form.  Securing and managing large amounts of unstructured patient as well as business data is extremely difficult and costly without an information governance capability that allows you to recognize content immediately, classify content accurately, retain content appropriately and dispose of content defensibly.