HIPAA Compliance for Medical Practices
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HIPAA Compliance and HIPAA Risk management Articles, Tips and Updates for Medical Practices and Physicians
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HIPAA Compliance and EHR Access

HIPAA Compliance and EHR Access | HIPAA Compliance for Medical Practices | Scoop.it

In light of the recent massive security breaches at UCLA Medical Center and Anthem Blue Cross, keeping your EHR secure has become all the more important. However, as organizations work to prevent data breaches, it can be difficult to find a balance between improving security and maintaining accessibility. To that end, HIPAA Chat host Steve Spearman addresses digital access controls, common authentication problems, and how authentication meets HIPAA compliance and helps ensure the integrity of your EHR, even after multiple revisions.


Q: What are access controls?


A: Access controls are mechanisms that appropriately limit access to resources. This includes both physical controls in a building, such as security guards, and digital controls in information systems, such as firewalls. Having and maintaining access controls are a critical and required aspect of HIPAA compliance, and is the first technical HIPAA Security Standard.


Q: What’s the most common form of digital access control we see in healthcare?


A: The username and password is the most common form of access control by far. The Access Control Standard requires covered entities to give each user a distinct and unique user ID and password in order to access protected information. These unique credentials for each employee enable covered entities to confirm (“authenticate”) the identity of users and to track and audit information access.


Q: What are the most common problems with access controls and use of passwords in healthcare?


A: The most common problem is that covered entities often use multiple systems which each may require its own set of usernames and passwords along with varying requirements for these credentials, such as minimum character length or use of capital letters. Memorizing multiple sets of passwords and usernames for multiple systems is difficult for most people. In addition, there is a conundrum between password complexity and memorization. Complex passwords (longer with multiple required character types) are better for security but much harder to memorize. This is the conundrum.


Q: Are stricter password policies always more secure?


A: No, if passwords requirement are too strict, users then use coping mechanisms such as writing them down or re-using the same password over and over and across multiple systems. This compromises security rather than enhancing it. For example, a policy that required 14 digit passwords and required, lower-case, upper-case, numbers and symbols and expired every 30 days would create huge problems for most organizations. With these policies, staff would simply write down their passwords. But this compromises security. If a bad person gets a hold of a written list of passwords they have the “keys to the kingdom”, the ability to access the accounts on that written list. So passwords should not be written down.

In addition, overly strict password policies tend to overwhelm technical support staff with password reset requests.

So passwords should be sufficiently complex to make them hard to crack which also makes them hard to memorize.


Q: This sounds like a big problem. Do you have any suggestions to make things better?


A: At a minimum, organizations need to provide training to staff on straightforward techniques to create memorable but complex passwords. I have an exquisitely terrible memory. But I have great passwords using one particular technique. Just google “create good memorable passwords” and you can find dozens of videos demonstrating how to do it. But, of course, our favorite is the video featuring our very own, Gypsy, the InfoSec Wonderdog.


Enterprises should seriously consider additional technical solutions such as two factor authentication with single sign on (2FA/SSO).


Q: What is a good, reasonable password policy?


A: I recommend a policy that:


  • Requires a minimum of 8 characters
  • Requires two or three of the options of lower-case, upper-case, numbers and symbols
  • Expire every 3 to 6 months
  • And limit limit use of historical passwords so that the previous two cannot be used.


Q: You mentioned authentication before. What is that? What is two-factor or multi-factor authentication?


A: Authentication is the process of confirming the identity of a person before granting access to a resource. Computer geeks refer to the three factors of authentication:


  • What a user has (an ID badge or phone).
  • What a user knows (a PIN number)
  • Who a user is (biometrics)


For example, ATMs use two-factor authentication:

  1. What the user has: an ATM card and
  2. What they know: a PIN.


One of my favorite tools for two factor authentication is Google Authenticator which runs as an app on my mobile phone. Another common form of two factor authentication is text codes. With this method, the website or app, after entering a correct username and password, sends a text with a numeric code that expires after a few minutes to your phone that is entered into another field in the website before access is granted.


Everyone should enable two factor authentication on their most essential systems such as to online banking and to email accounts such as gmail.


In healthcare, there is a growing trend toward biometric authentication, the use of fingerprint readers or palm readers, etc. to authenticate into systems. Biometric authentication is generally very secure and is also very easy to use since there is nothing to memorize.


Q: What is SSO?


A: Single sign-on (SSO) lets users access multiple applications through one authentication event. In other words, one password allows access to multiple systems. It enhances security because users only have to remember one password. And because it is just one, it is commonly a good complex password. Once entered, it will allow access to all the core systems (if enabled) without having to re-authenticate.


Single sign-on combined with two factor authentication or biometrics work great together in tandem and are often sold together by vendors. The leading SSO/2FA vendor in healthcare is Imprivata, but there are other vendors making great in-roads into healthcare such as Duo Security2FA.com and Secureauth.com.


Q: What do you mean by “integrity” and what does it have to do with access control and authentication?


A: Integrity in System Standards is the practices used to track and verify all changes made to a health record. It is a condition that allows us to prevent editing or deleting of records without proper authorization.


Authentication and access controls are the primary means we use to preserve integrity of a record. If the information system is programmed to track its users’ activity, then it’s possible to track who made changes to a record and how they changed it.


This is why users should never share usernames and passwords with other users. Integrity becomes impossible if a username does not signify the same user every time it appears.


Q: Any final thoughts?


A: Finding that balance between HIPAA compliance, security and accessibility can be tricky. We recommend reducing digital access controls to a single multi-factor authentication or biometrics event. This single, secure method of authentication could be the balance between security and efficiency needed to keep your EHR secure and yet accessible. In addition to improving accessibility to your system, an MFA or biometrics sign-in method could help improve your organization’s EHR integrity.

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How Do HIPAA Regulations Affect Judicial Proceedings?

How Do HIPAA Regulations Affect Judicial Proceedings? | HIPAA Compliance for Medical Practices | Scoop.it

HIPAA regulations are designed to keep healthcare organizations compliant, ensuring that sensitive data - such as patient PHI - stays secure. Should a healthcare data breach occur, covered entities or their business associates will be held accountable, and will likely need to make adjustments to their data security approach to prevent the same type of incident from happening again.


However, there are often questions and concerns in how HIPAA regulations tie into certain judicial or administrative proceedings. For example, if there is a subpoena or search warrant issued to a hospital, is that organization obligated to supply the information? What if the information being sought qualifies as PHI? Can covered entities be held accountable if they release certain information, and then that data falls into unauthorized individuals’ control?


This week, HealthITSecurity.com will break down how judicial proceedings, and other types of legal action, could potentially be impacted by HIPAA regulations. We will discuss how PHI could possibly be disclosed, and review cases where search warrants and similar issues were affected by HIPAA.


What does HIPAA say about searches and legal inquiries?

The HIPAA Privacy Rule states that there are several permitted uses and disclosures of PHI. This does not mean that covered entities are required to disclose PHI without an individual’s permission, but healthcare organizations are permitted to do so under certain circumstances.


“Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make,” the Privacy Rule explains.


The six examples of permitted uses and disclosures are the following:

  • To the Individual (unless required for access or accounting of disclosures)
  • Treatment, Payment, and Health Care Operations
  • Opportunity to Agree or Object
  • Incident to an otherwise permitted use and disclosure
  • Public Interest and Benefit Activities
  • Limited Data Set for the purposes of research, public health or health care operations.


Under the public interest and benefit activities, the Privacy Rule dictates that there are “important uses made of health information outside of the healthcare context.” Moreover, a balance must be found between individual privacy and the interest of the public.

There are several examples that relate to disclosing PHI due to types of legal action:


  • Required by law
  • Judicial and administrative proceedings
  • Law enforcement purposes


Covered entities and their business associates are permitted to disclose PHI as required by statute, regulation or court orders.

“Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided,” according to the HHS website.


For “law enforcement purposes” HIPAA regulations state that PHI can also be disclosed to help identify or locate a suspect, fugitive, material witness, or missing person. Law enforcement can also make requests for information if they are trying to learn more information about a victim - or suspected victim. Another important aspect to understand is that a covered entity can can disclose sensitive information if it believes that PHI is evidence of a crime that took place on the premises. Even if the organization does not think that a crime took place on its property, HIPAA regulations state that PHI can disclosed “when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.”


Essentially, covered entities and business associates must use their own judgement when determining if it is an appropriate situation to release PHI without an individual’s knowledge. For example, if local law enforcement want more information from a hospital about a former patient whom they believe is dangerous, it is up to the hospital to weigh the options of releasing the information.

How have HIPAA regulations affected court rulings?

There have been several court rulings in the last year discussing HIPAA regulations and how covered entities are allowed to release PHI.


Connecticut: The Connecticut Supreme Court ruled in November 2014 that patients can sue a medical office for HIPAA negligence if it violates regulations that dictate how healthcare organizations must maintain patient confidentiality. In that case, a patient found out that she was pregnant in 2004 and asked her medical facility to not release the medical information to the child’s father. However, the organization released the patient’s information when it received a subpoena. The case claimed that the medical office was negligent in releasing the information, and that the child’s father used the information  for “a campaign of harm, ridicule, embarrassment and extortion” against the patient.


Florida: Just one month earlier, a Florida federal appeals court ruled that it is not a HIPAA violationfor physician defendants to have equal access to plaintiffs’ health information. In this case, a patient sued his doctor for medical negligence. Florida law states that the plaintiff must provide a health history, including copies of all medical records the plaintiff’s experts relied upon in forming their opinions and an “executed authorization form” permitting the release of medical information. However, the plaintiff claimed the move would violate his privacy. The appeals court ruled that two instances applied in this case where HIPAA regulations state that covered entities are permitted to release PHI.


As demonstrated in these two court cases, it is not always easy for covered entities to necessarily determine on their own when they are compromising patient privacy and when they are adhering to a court order. However, by seeking appropriate counsel, healthcare organizations can work on finding a solution that meets the needs of all parties involved.

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The Cloud is Good, But Know Where Data Go

The Cloud is Good, But Know Where Data Go | HIPAA Compliance for Medical Practices | Scoop.it
A recent settlement announcement from the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) highlights the need to evaluate web-based applications and storage solutions. Web-based or cloud solutions are viable options and tools for healthcare entities to utilize, but those tools need to evaluated for compliance with HIPAA security requirements.

Saint Elizabeth’s Medical Center (“SEMC”), located outside of Boston, MA, learned this lesson the hard way. On November 16, 2012, certain workforce members at SEMC reported suspected non-compliance with HIPAA to OCR. The report focused upon use of an internet-based document sharing and storage application. The specific site is not identified in the OCR Resolution Agreement, but Dropbox is an example of an online storage site that does not meet HIPAA security requirements. OCR notified SEMC of the results of its investigation on February 14, 2013. Fast forward a year and SEMC then reported a breach regarding a workforce member’s unsecured laptop and USB storage device. The combination of events led OCR to conclude that SEMC failed to implement sufficient security measures required by HIPAA and SEMC did not timely identify or mitigate harmful effects from identified deficiencies.

As a result of the two reported incidents, SEMC is now paying $218,400 to OCR in settlement funds. The settlement continues to trend of not being able to accurately guess the amount of a fine that will be levied. As stated in the announcement, OCR “takes into consideration the circumstances of the complaint and breach, the size of the entity, and the type of PHI disclosed.” This statement potentially gives some insight, which can be interpreted to mean that entities with bigger pockets will be hit with larger fines because such entities can absorb larger fines.

The other consideration raised by the SEMC settlement is what to do about cloud based storage and sharing solutions. Should all such tools be locked away from use healthcare organizations? This is not necessarily the answer because some tools do follow HIPAA security requirements. For example, some cloud storage services were built specifically for healthcare, and as such are more cognizant of applicable regulatory requirements. More general sites, such as Box, noted HIPAA requirements and claim to meet required standards. As such, it is possible for organizations to utilize cloud based options.

However, it is not necessarily the choices of an organization as a whole that are troublesome. In SEMC’s case, it is not clear whether the workforce members acted under SEMC’s direction or utilized the cloud sites without SEMC’s direct knowledge. The unsupervised actions of workforce members are what can cause an organization a lot of concern. Organization’s need to train and educate workforce members, but cannot always control their actions. Despite the inability to constantly track what a workforce member is doing, certain steps could be taken to alleviate concerns. One measure would be to block access to websites that could lead to a potential breach or other non-compliance. Such a measure may not make all workforce members happy, but an organization should assess its risks and take appropriate measures. Additionally, an organization can suggest sites that are compliant be used.

Regardless of the approach taken, organizations need to be cognizant of the risks posed by cloud based storage, especially on the individual level. OCR’s settlement with SEMC is only the most recent action to highlight the concern. As has been stated before, once OCR releases a settlement addressing an issue, subsequent organizations with the same issue can expect greater focus on the identified issue and less leniency when it comes to a violation.
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Before a Medical Data Breach, Begin Your Response Plan

Before a Medical Data Breach, Begin Your Response Plan | HIPAA Compliance for Medical Practices | Scoop.it

In the last 18 months, there have been three massive data breaches involving the healthcare industry, scores of smaller breaches, and a growing trend of insider threats posed by employees who have sold protected health information (PHI) for their own personal gain. Unlike stolen credit card numbers that can be deactivated, the personal identifying information needed to commit identity-theft type crimes, such as name, address, Social Security number, and date of birth, cannot be changed easily, if at all. Because of the permanent nature of the information that they contain, health records are approximately 10 times more valuable than stolen credit card numbers on Internet black markets where they can be bought and sold in bulk.


Now more than ever, because of new threats posed by such cybercriminals, any organization that collects, uses, discloses, or stores PHI is a potential breach victim. Covered Entities and their Business Associates subject to HIPAA who suffer a data breach must act quickly and correctly in assessing the situation. They must thoroughly investigate and mitigate risks caused by the breach, attempt recovery of the lost information, and provide required notifications to affected individuals and others. Throughout this process, organizations experiencing a breach should strive to demonstrate publicly that the data loss is being handled responsibly and appropriately.


Defining a "Breach"


HIPAA defines a breach as the acquisition, access, use, or disclosure of PHI in a manner inconsistent with the Privacy Rule that compromises its security or privacy.  In most cases, a breach is presumed to have occurred unless it can be demonstrated that there is a "low probability" that the PHI has been compromised. When performing this initial inquiry, an organization must consider:


1. The nature and extent of the PHI involved, including the types of identifiers and likelihood of re-identification;


2. The unauthorized person who used the PHI or to whom the disclosure was made;


3. Whether the PHI was actually acquired or viewed; and


4. The extent to which the risk to the PHI has been mitigated.


Plan Ahead for Breach Notification



Leonardo M. Tamburello
Every Covered Entity and Business Associate that handles PHI should develop its own unique breach response plan, built upon its most recent Security Risk Assessment (SRA), itself a fundamental step in the development of a comprehensive HIPAA security program. This security program should include a complete inventory of all devices containing sensitive data and policies and procedures requiring the immediate reporting of any lost, stolen, or compromised devices or media.


Using the most critical vulnerabilities identified in the SRA as a blueprint, the "worst case" scenario should be used to develop a detailed response plan. This discussion and handling of the "crisis" in a benign environment should be memorialized and refined into a formal breach response plan that identifies clear lines of communication and responsibility, including what gets done, who does it, and when they are supposed to do it.  


Merely having a breach response plan on paper is not enough. Individuals who are expected to implement the plan must understand and be equipped to execute their responsibilities.  


Whether through a medical practice's in-house counsel or an outside law firm, there are important reasons to integrate counsel into a breach response plan. Privacy counsel with breach response experience can bring valuable insight and steadying presence to an unfamiliar and sometimes chaotic situation. In the event of a follow-up investigation by HHS' Office for Civil Rights (OCR) (which is mandated in breaches affecting 500 or more individuals) or civil litigation, an organization's deliberative processes and internal communications and/or actions involving their counsel regarding breach response may be kept confidential through these doctrines. Without the involvement of counsel, the entirety of an organization's actions and communications would be potentially discoverable in the now familiar class-action lawsuits that inevitably follow data breaches.


Activating the Breach Response Plan


If it is determined that a breach has occurred, an organization should immediately take all possible steps to minimize or limit the impact of the breach while documenting its efforts to do so. Mitigation often occurs parallel with an investigation, and its own document trail, into the cause of the breach. In some cases, such as when a device is physically lost or stolen, mitigation may be impossible unless there is a way to remotely wipe the data contained on it. If the breach involves media or paper that can be tracked or retrieved, every effort should be made to recover it.  Law enforcement should be contacted if criminal activity such as theft or intrusion is suspected.  


Like other aspects of breach response, a medical practice's internal investigation into a breach should be thoroughly documented. The Privacy Officer, in consultation with privacy counsel for the organization, should collect and preserve evidence in accordance with established policies and procedures. This information may include interviews, e-mails, chat logs, voicemails, cellular calling records, computer logs, and any other information regarding the data loss.


If the breach involves cyber intrusion, the Privacy Officer will likely require the assistance of IT vendors or others such as specially-trained law enforcement divisions. Expert forensic assistance from these individuals can be invaluable when investigating a possible breach or determining the scope of known breach.


Formal Notification to Individuals, HHS, and Others


Once a breach has been internally confirmed, HIPAA requires official notification to all affected individuals and the OCR. If the breach involves 500 or more individuals, media organizations in the area where the affected individuals live must also be notified. Most times, these notifications must occur within 60 days of when the breach actually was, or should have been, discovered.


This does not necessarily mean that the breach will remain private until further disclosure. In many instances, breaches become public knowledge long before formal notification is made. To prevent such situations from spiraling out of control, it is imperative that an organization's breach response team be prepared to make public limited information in which there is a high degree of confidence, while stressing that the investigation is ongoing and this information may evolve. Scrambling to figure out a breach response strategy while trying to investigate and mitigate the possible harm can easily lend to inaccurate and/or harmful information being disseminated. Responding with silence will only intensify the scrutiny in such situations. A breach response plan will help a practice follow a "script" through an otherwise unfamiliar and potentially high-stakes crisis.


Poor breach notifications can take many shapes. Some fail to acknowledge the seriousness of the situation. Others provide incomplete or incorrect information. Another poor "response strategy" is complete silence or other tone-deaf actions which demonstrate organizational discord or a misunderstanding of the severity of the situation. Any of these missteps can be severely damaging, not only from a reputational point of view, but also during later phases if there is a formal investigation by OCR.  


After the required notifications have been made, the organization should update its current risk management plan to reflect lessons learned and vulnerabilities addressed as a result of the breach.


Conclusion


Most cyber intrusions are not brutish acts of virtual "smash and grab" thuggery, but well-planned and strategic, with the hallmarks of stealth and patience. As data collection and information sharing among healthcare providers and their affiliates grows in the future, the threats to the security and integrity of this information will continue to increase.

Failing to prepare for a breach is the same as preparing to fail at responding to one. As electronic health information continues to multiply along with data sharing among multiple providers and affiliates, preparing for this threat must become an organizational priority for everyone.

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When does HIPAA require more than encryption?

When does HIPAA require more than encryption? | HIPAA Compliance for Medical Practices | Scoop.it

Encryption of sensitive electronic personal health information (ePHI) on mobile devices – including PCs – is often considered sufficient to protect that data well enough to achieve HIPAA compliance. However, it’s important that those handling this data understand the circumstances where encryption alone is not enough.


These situations do exist – and can be nightmares if they occur. The Department of Health and Human Services' HIPAA Security Rule describes satisfactory encryption as “an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key … and such confidential process or key that might enable decryption has not been breached.” That last part means that encryption is only adequate as a safeguard for HIPAA-protected ePHI if the situation is such that the encryption still secures the data.


There are several scenarios where even encrypted data can be breached relatively easily and, unfortunately, there are many real world examples of each of these scenarios occurring. The trouble with encrypted data is that it needs to be decrypted to be useful to those who would access it legitimately, and the bad guys will look to take advantage of those moments when encryption’s defenses are down. Encryption is a powerful defense for data when a device’s power is off and for when the password is unknown and can’t be learned or hacked. But putting it that way, we’ve actually rather narrowly defined where encryption is effective.


Here are some cases where it isn’t.


1. The data thief gains the password needed to get around the encryption on an ePHI-filled device. This can happen when the password is stolen along with the device - for example, if a laptop is taken along with a user’s notepad containing the password needed to access ePHI. HIPAA requires not only encrypting sensitive data but also paying attention to the safety of passwords or any such methods of access. Bad password security effectively negates encryption. Too often we’ve seen a sticky note of passwords attached to a laptop – or even passwords written on USB devices themselves – which is a great example of an encryption that is not HIPAA-secure.


In another type of case at Boston’s Brigham and Women’s Hospital, a physician was robbed at gunpoint and threatened into disclosing the pass codes on the laptop and cellphone that were taken from him, each of which contained ePHI. The doctor appears to have done all that could be done to comply with HIPAA as far as keeping data encrypted, but when forced to choose between personal health information and actual personal health, he made the reasonable choice. Still, the incident was a HIPAA breach, requiring patients and officials to be notified.


2. The stolen device is already running and an authorized user has already been authenticated. In this scenario, the legitimate user has already given his or her credentials and has a session accessing ePHI running when an unauthorized user gains control of the device. HIPAA contains measures to minimize the likelihood of this scenario, calling for the issue to be addressed with automatic log-off capability to “terminate an electronic session after a predetermined time of inactivity.” Still, authorized users should take care to close out sessions themselves if stepping away from their devices and leaving them unguarded.


3. A formerly authorized user becomes unauthorized, but still has access. This can happen when an employee quits or is terminated from a job but still possesses hardware and passwords to bypass encryption. A case such as this occurred at East Texas Hospital, where a former employee was recently sentenced to federal prison for obtaining HIPAA-protected health information with the intent to sell, transfer or otherwise use the data for personal gain. Criminals in these cases often use ePHI for credit card fraud or identity theft, demonstrating how important HIPAA safeguards can be to the patients they protect.


So how can ePHI be protected beyond encryption?


The safest security system to have in place when encountering each of these scenarios is one where the organization retains control over the data, and the devices containing ePHI are equipped with the ability to defend themselves automatically.


The fact is that employees will always seek and find ways to be their most productive, meaning that policies trying to keep ePHI off of certain devices are, for all intents and purposes, doomed to be burdensome and disrespected. For doctors and other healthcare staff, productivity trumps security. It’s best to take concerns around security off their plate and provide it at an organizational level. Organizations can implement strategies that maintain regular invisible communications between the IT department and all devices used for work with ePHI in a way that isn’t cumbersome to the user. Through these communications, the IT department can access devices to remotely block or delete sensitive data and revoke access by former employees. Software installed on devices can detect security risks and respond with appropriate pre-determined responses, even when communication can’t be established.


Given the high stakes of HIPAA compliance – where a single breach can lead to government fines and costly reputational damage – it would be wise for healthcare organizations to consider encryption only the beginning when it comes to their data security.

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Data breach costs on the rise, according to annual Ponemon Institute study

Data breach costs on the rise, according to annual Ponemon Institute study | HIPAA Compliance for Medical Practices | Scoop.it

Given the number and severity of publicized data breaches over the past year, it should come as little surprise that the average cost of a data breach is on the rise. According to the “2015 Cost of Data Breach Study: Global Analysis,” which was conducted by the Ponemon Institute and sponsored by IBM, the average cost of a data breach increased from $3.52 million in last year’s study to $3.79 million in this year’s edition.


While the year-over-year jump may seem small, the rise actually represents a 23 percent increase in the total cost of a data breach since 2013. The research, which included responses from personnel at 350 companies spanning 11 different countries, also found that lost business as the result of a data breach potentially has the most severe financial consequences for organizations as these costs increased from an average of $1.33 million last year to $1.57 million in 2015. Lost business costs include; abnormal turnover of customers; increased customer acquisition activities; reputation losses; and diminished goodwill.      


Diana Kelley, executive security advisor for IBM Security, said one thing that really stood out to her was the root causes of data breaches examined in the study, the majority of which (47 percent) were found to be the result of malicious or criminal attacks. The study found that the average cost per record to resolve such an attack is $170, compared to system glitches which cost $142 per record to resolve and human error or negligence that cost $134 per record to correct.  

“That indicates something that we’ve seen in other studies that this is organized criminal activity for data breaches,” she said. “We’re moving past the random, somebody left their laptop in a car, and we’re really looking at very targeted attacks from organized criminals.”

Kevin Beaver, an IT security consultant with Atlanta-based Principle Logic LLC, said that data breaches continue to persist on such a massive scale because many companies mistakenly believe they can just buy a piece of security technology that will take care of all of their problems.


“It doesn't work that way,” he said “Even if you have the very best of security controls you still have to have ongoing oversight and vulnerability testing because things are going to fall through the cracks.”


Another common issue, according to Beaver, is that companies simply place too much trust in employees and vendors.



“It's always best to err on the side of caution and put the proper controls in place so everyone, and especially the business, are setup for success. Another big issue I see is all the organizations, especially in the healthcare industry, that believe their high-level audits and policies are sufficient for minimizing their risks. It's not. Unless and until you test for - and resolve - the growing amount of security vulnerabilities on your network, you're a sitting duck waiting to be made to look bad,” said Beaver. “This is especially true to social engineering (i.e. phishing) testing. It's unbelievable how many people are still gullible and give up their network credentials or other sensitive info without question.”


Although data breaches that involve the theft of credit or debit card numbers seem to carry a greater amount of weight with the media and public in general, Kelley said the data shows that things such as protected health Information (PHI) and other personal data are more coveted by hackers as they have a longer lifespan for resale. Kelley advises companies to identify what their “crown jewels” are from a data perspective and to conduct threat assessments and risk modeling around protecting those assets.


“I think organizations need to look at the big picture. We do see evidence of more sophisticated criminal, organized attacks. On the other hand, we can’t forget all of the good security hygiene and just try and focus on what’s the next big scary attack,” said Kelley. “We have to do a very robust, layered set of security throughout our organization to include security awareness and training and monitoring. You’re looking for anywhere in that stack where there could be an exposure or there could be a vulnerability. Companies need to not just think about the big attack, but really think about a robust security model because that is going to help prevent the smaller attacks, as well as the larger attacks.”


Perhaps one of the study’s silver linings is that the involvement of a company’s board-level managers was found to help reduce costs associated with data breaches by $5.5 per record. Insurance protection was also found to reduce cost by $4.4 per record. Despite the increased awareness and involvement by senior leadership, Kelley said companies cannot completely protect against the threats posed by hackers.


“It’s important to remember that awareness and ability to stop something aren’t necessarily always aligned. If we look in the real world, we’re all very aware and highly concerned about something like cancer, but preventing it is very, very difficult,” said Kelley. “We can have the C-suite be very aware of security, but still some companies are at different levels of maturity. Attackers, they are, again, organized and sophisticated, so the level of prevention and controls you need in place to stop the attacks is very high. The fact that we still have attacks going on doesn’t mean companies aren’t putting security controls into place.”   


However, Beaver adds that while some executives may say and do all of the right things in public when it comes to their data protection efforts, the reality is some of them are just paying lip service to the issue.



“It's all about policies and related security theater to appease those not savvy enough - or politically powerful enough - to look deeper or question things further,” said Beaver.  


Conversely, Beaver said that there are a lot of companies who are taking the right approach to cybersecurity, which involves recognition by senior management of the seriousness of the issue.


“I see many organizations doing security well,” he added. “The key characteristics of well-run security are: executive acknowledgement of the challenges, ongoing financial and political support for IT and security teams, periodic and consistent security testing, and the willingness to make changes where changes need to be made - even if it's not politically favorable.”


Another bright spot in the study was that it found a correlation between organizational preparedness and reduced financial impact of a data breach. Companies that employed some level of business continuity management (BCM) within their organization were able to reduce their costs by an average of $7.1 per compromised record.


“Companies that brought in an incident response team or had an incident response program in place were able to save $12.60 per record,” added Kelley. “The biggest takeaway is to get some kind of plan in place. Have business continuity, have an incident response plan in place and be continually detecting and monitoring activity on the network so that if a breach is occurring, you can either see the very beginning of it or you can see one in process and respond as quickly as possible to reduce the impact to the business.”

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How can hospitals protect their medical equipment from malware?

How can hospitals protect their medical equipment from malware? | HIPAA Compliance for Medical Practices | Scoop.it

The challenges in protecting hospitals from cyber attacks are very similar to those faced in ICS and SCADA environments; the equipment used in hospitals is not user-serviceable and therefore often running out-of-date software or firmware. This creates a dangerous situation where:

The devices have known vulnerabilities that can be easily exploited by bad actors

Administrators are not likely to notice malware running on the device as long as nominal operation is maintained

The end goal of bad actors infecting a medical device is to use it as an entry and pivot point in the network. Valuable patient records are not likely to be present on the medical devices, but those devices often have some level of network connection to the systems that do contain patient records.

What exactly is a bad actor likely to do after getting a foot-hold on the network? Move laterally to find patient records that can be used for:

  • Identify theft
  • Blackmail
  • Steal research data for financial gain
  • Deploy ransomware like Cryptolocker, effectively crippling the facility unless a bribe is paid
  • Trigger widespread system malfunctions as an act of terrorism
  • Carry out a 'hit' on a specific patient


The first three items are strictly motivated by financial gain, and this has been the extent of observed attacks to date. The fourth item seems possible but unlikely, either due to morals or the relatively higher value of attacking other targets like power plants or defense facilities. The fifth item hasn't been detected yet, but that doesn't exclude the possibility that it has happened. Carrying out a silent assassination with malware would be very hard to trace back to the attacker, and could even be sold as a service (similar to DDoS as a service).

The scenario for number 5 sounds like something out of a Tom Clancy novel, but it is completely plausible. The attacker (or entity paying for the attack) would only need to know the target, have knowledge of an upcoming procedure, and know where the procedure was to take place. One caveat is that identifying which device(s) would be used with that patient, and when, could be difficult but not impossible to know.#

Real-world vulnerability examples
Billy Rios, a security researcher, recently went public with a vulnerability that affects drug pumps and could potentially be exploited to administer a fatal dose of medication to a patient. Rios notified the DHS and FDA up to 400 days ago about the vulnerability and saw no response, so he went public to put pressure on the manufacturer to fix the issue. Faced with the reality that some medical equipment manufacturers do not invest in securing their devices from exploitation, the onus of security therefore falls on the users of such equipment.

This discovery shows a real-world example of how a cyber attack could affect a medical device and potentially endanger lives. There is no question that this type of threat needs to be taken seriously. The real question is, how can hospitals effectively protect devices such as these?

It's clear that installing antivirus software on medical equipment is impractical and basically impossible. Furthermore, healthcare IT are relatively helpless to patch the software and firmware running on these devices. So considering those vulnerabilities, and the difficulty in remotely scanning these devices, the best solution is simply to prevent malware from ever getting to these devices. Thankfully this challenge has already been solved in ICS and SCADA environments.

In a recently profiled attack on hospitals, one of the infection vectors was thought to be a technician visiting a compromised website on a PC with direct access to a picture archive and communication (PACS) system. The report details that the malware was detected but not before infecting the PACS system. Due to the nature of the system it could not be scanned for malware, let alone cleaned. It was then used as a pivot point to find a system with medical records that could be exfiltrated back to the attacker.

Medical facilities share vulnerabilities with SCADA and ICS, so why shouldn't they also share protection mechanisms? Critical infrastructure providers, especially power plants, often make use of air-gapped networks as a very effective defense mechanism. Taking the above story as an example, the PC with a web browser and internet access should not have also had access to PACS. This simple step would have stopped the infection from doing any damage at all. If, for example, the technician needed to download something from the internet and transfer it to PACS then it would have to be transferred onto the air-gapped network.

How sanitization of the operating room compares to preventing cyber infections
Hospitals and their staff are very accustomed to preventing the spread of biological infections and they must now apply similar levels of prevention to preventing the spread of cyber infections. Defending against cyber infections, by comparison, is much easier. The medical industry isn't alone in fighting this threat – they don't have to invent new techniques for preventing infection, they simply need to adapt the proven strategies employed by other industries.

Simply employing an air gap doesn't guarantee security. The point of the air gap is to create a point through which data movement is carefully controlled. Additional measures must be employed to ensure that pathogens are not allowed access. In medicine these measures consist of removing foreign material with soap and water, and disinfecting with various antimicrobial agents. It's not practical to scan doctors and nurses for bacteria, so every surface is assumed to be contaminated until sufficiently cleaned and disinfected. The control point in a data flow is comparatively easier to maintain, as there are techniques for quickly finding infections on media moving through the air gap. For extra protection, any files deemed 'clean' can still be disinfected to completely eradicate the possibility of a threat doing undetected.

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4 HIPAA compliance areas your BAs must check

4 HIPAA compliance areas your BAs must check | HIPAA Compliance for Medical Practices | Scoop.it

It finally looks like the feds are starting up the next phase of HIPAA audits — but there’s still time to ensure your business associates (BAs) are staying compliant. 


In preparation of the next round of audits, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has begun sending out pre-audit surveys to randomly selected providers, according to healthcare attorneys from the law firm McDermot, Will and Emory.

Originally, the surveys were meant to go out during the summer of 2014, but technical improvements and leadership transitions put the audits on hold until now.

Moving toward Phase 2

The OCR has sent surveys asking for organization and contact information from a pool of 550 to 800 covered entities. Based on the answers it receives, the agency will pick 350 for further auditing, including 250 healthcare providers.

The Phase 2 audits will primarily focus on covered entities’ and their BAs’ compliance with HIPAA Privacy, Security and Breach Notification standards regarding patients’ protected health information (PHI).

Since most of the audits will be conducted electronically, hospital leaders will have to ensure all submitted documents accurately reflect their compliance program since they’ll have minimal contact with the auditors.

4 vendor pitfalls

It’s not clear yet to what extent the OCR will evaluate BAs in the coming audits due to the prolonged delay. However, there are plenty of other good reasons hospital leaders need to pay attention to their vendors’ and partners’ approaches to HIPAA compliance and security.


Why?


Mainly because a lot of BAs aren’t 100% sure what HIPAA compliance entails, and often jeopardize patients’ PHI, according to Chris Bowen, founder and chief privacy and security officer at a cloud storage firm, in a recent HealthcareITNews article.


A large number of data breaches begin with a third party, so it’s important hospital leaders keep their BAs accountable by ensuring they regularly address these five areas:


  • Risk Assessments. As the article notes, research has shown about a third of IT vendors have failed to conduct regular risk analysis on their physical, administrative and technical safeguards. Ask your vendors to prove they have a risk analysis policy in place, and are routinely conducting these kinds of evaluations.
  • System activity monitoring. Many breaches go unnoticed for months, which is why it’s crucial your BAs have continuous logging, keep those logs protected and regularly monitor systems for strange activity.
  • Managing software patches. Even the feds can struggle with this one, as seen in a recent HHS auditon the branches within the department. Keeping up with security software patches as soon as they’re released is an important part of provider and BA security. Decisions about patching security should also be documented.
  • Staff training. Bowen recommends vendors include training for secure development practices and software development lifecycles, in addition to the typical General Security Awareness training that HIPAA requires.
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Hospital ID Theft Leads to Fraud

Hospital ID Theft Leads to Fraud | HIPAA Compliance for Medical Practices | Scoop.it

Eight alleged members of an identity theft ring, including a former assistant clerk at Montefiore Medical Center in New York, have been indicted on a variety of charges stemming from using stolen information on nearly 13,000 patients to make purchases at retailers.


Ann Patterson, senior vice president and program director of the Medical Identity Fraud Alliance, says that the incident points to the need for ongoing vigilance by healthcare organizations to prevent and detect ID theft and other related crimes.


Manhattan District Attorney Cyrus Vance Jr. alleges in a statement that members of the ID theft ring made up to $50,000 in purchases at retailers in Manhattan by opening up store credit card accounts using patient information stolen by former hospital worker, Monique Walker, 32.


Walker was an assistant clerk at Montefiore Medical Center, where her position gave her access to patients' names, dates of birth, Social Security numbers, and other personal information, Vance says.

Between 2012 and 2013, Walker allegedly printed thousands of patients' records on a near daily basis and supplied them to a co-defendant, Fernando Salazar, 28, according to Vance's statement.

Salazar is accused of acting as the ringleader of the operation. He allegedly purchased at least 250 items personal identifying information from Walker for as little as $3 per record, Vance says.


The stolen information was then allegedly provided to other defendants to open credit card accounts that were used for purchasing gift cards and merchandize at retailers, including Barneys New York, Macy's, Victoria's Secret, Zales, Bergdorf Goodman and Lord & Taylor.

Walker is charged with one count of felony grand larceny and one count of felony unlawful possession of personal identification information. The other defendants are charged with varying counts of grand larceny, identity theft and criminal possession of a forged instrument, among other charges.


All of the defendants have been arrested and arraigned in criminal court, and have various dates pending for their next court appearances.


"Case after case, we've seen how theft by a single company insider, who is often working with identity thieves on the outside, can rapidly victimize a business and thousands of its customers," Vance says. "Motivated by greed, profit and a complete disregard for their victims, identity thieves often feed stolen information to larger criminal operations, which then go on to defraud additional businesses and victims. In this case, a hospital employee privy to confidential patient records allegedly sold financial information for as little $3 per record."

Hospital Fires Worker

A Montefiore spokeswoman tells Information Security Media Group that the medical center was informed by law enforcement on May 15 of Walker's alleged crimes dating back to 2012 and 2013. As a result, Walker, who worked for the hospital for about three years, was fired, the spokeswoman says. "Montefiore is fully cooperating with law enforcement, including the Manhattan's District Attorney's office," a hospital statement says.


Law enforcement discovered the connection to Montefiore patient information while investigators were working on the ID theft case, the Montefiore spokeswoman says.


Of the 12,000-plus patient records that were compromised, it's uncertain how many individuals are victims of ID theft crimes, she says. But as a precaution, Montefiore is offering all impacted patients free identity recovery services, 12 months of free credit monitoring and a $1 million insurance policy to protect against identity theft-related costs.


Montefiore has reported the breach to the Department of Health and Human Services Office for Civil Rights, the spokeswoman says. While that incident as of June 22 was not yet listed on HHS'"wall of shame" tally of health data breaches affecting 500 or more individuals, three other breaches at Montefiore Medical Center appear on the federal website.


Those incidents, all reported in 2010, involved the theft of unencrypted computers. That includes the theft of a laptop in March 2010 which resulted in a breach impacting 625; and two July 2010 thefts of desktop computers that impacted 16,820 and 23,753 individuals.

Breach Prevention Steps

In a statement, Montefiore says that following the alleged crimes committed by Walker that were discovered in May, the hospital has expanded both its technology monitoring capabilities and employee training on safeguarding an accessing patient records to further bolster its privacy safeguards.


"The employee involved in this case received significant privacy and security training and despite that training, chose to violate our policies," the statement notes. "In response to this incident, Montefiore is also adding additional technical safeguards to protect patient information from theft or similar criminal activity in the future."


A hospital spokeswoman says the hospital has rolled out "sophisticated technology" to monitor for improper access by employees to the hospital's electronic patient records


The hospital also says it performs criminal background checks on all employees and "has comprehensive policies and procedures, as well as a code of conduct, which prohibits employees from looking at patient records when there is not a work-related reason to do so."

Steps to Take

Dan Berger, CEO of security consulting firm RedSpin, says it's not surprising the breach went undetected for so long because insider attacks are difficult to uncover. It's unclear if the Montefiore hospital clerk had "good reason to access so many records" as part of her job, he notes.


Patterson of the Medical Identity Fraud Alliance notes: "In addition to proper vetting of employees, the continued evaluation of employee education and awareness training programs and of your internal fraud detection programs is necessary. It's not something you do once and are done. Employees who are properly vetted upon initial hire may have changing circumstances that change their work integrity later on in their employ."


Additionally, security measures often need tweaking as circumstances within an organization change, she says.


"Fraud detection processes that worked when a specific type of workflow procedure was in place may need to be adjusted as that workflow process changes. An emphasis on continued evaluation of all components - people, process, technologies - for fraud detection is good practice."


Workforce training is important not only for preventing breaches, including those involving ID crimes, but also to help detect those incidents, she says. "Each employee must understand their role in protecting PHI. Equally important is regular and continued evaluation of the training programs to make sure that employees are adhering to the policies put in place, and that the 'red flags' detection systems are keeping pace with changing technologies and workplace practices."

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HIPAAChat: secure messaging and telemedicine platform

HIPAAChat: secure messaging and telemedicine platform | HIPAA Compliance for Medical Practices | Scoop.it

To provide the best care for our patients, physicians and healthcare workers must communicate constantly.  For many of us, text messaging, push-to-talk messages, and video calling have become the preferred method of contact.


However, SMS, FaceTime, Skype, and iMessage are not technically HIPAA-compliant platforms. Even though some like FaceTime may meet data security standards that could make them HIPAA compliant, they don’t necessarily commit to it.


We have seen an influx of HIPAA-compliant secure messaging apps over the past few years like AthenaTextDoximityTigerText, and others. HIPAAChat enters into this market as an easy to use app with an intuitive format and some pretty unique features that make it stand out. Following the acquisition by Everbridge, a world leader in cloud-based, unified critical communications, HIPAAChat also incorporates advanced Enterprise utility and interoperability. Secure text, group chat, image transfer – check. Dictate/audio transfer/push-to-talk – check. Real-time, live video calling? You bet! HIPAAChat provides all these features packaged in an app that is as easy to use as iMessage and FaceTime.


User Interface


After downloading the HIPAAChat app, setup was extremely simple and only required input of your name, email, and phone number. Optional information included a photo upload and a 4-digit pin setup if your phone isn’t fingerprint or password protected. In order to connect with colleagues, both parties must have the app on their smartphone. However, within the app, you can select people from your existing contacts or enter a phone number or email and an invitation will be sent prompting them to download the app to begin HIPAA-compliant communication.


HIPAAChat is available for both Android and iPhone devices. As a result, the app facilitates secure messaging between all members of the care team, including physicians, nurses, social workers, consultants, etc. One of the main features that kept me using the HIPAAChat app is the simple, clean, and intuitive interface. I have been using this app to answer questions about patients from residents and referring doctors. Despite a busy clinical and surgical volume, the app allows for minimal disruption in my current routine.


Functions


Messaging


The messaging features are standard and work the same as SMS or iMessage. The interface shows when a message was read and also displays when a message is being typed. A nice feature of this and other secure messaging apps is the ability to group text with users. The Enterprise software allows for additional features, including the creation of group distribution lists via active directory/ADAM and LDAP synchronization. This would be particularly useful for alerting specialized medical teams, such as a Stroke Team, Code Team, Trauma Team, etc. In our practice, we have been using HIPAAChat to relay information on surgical or clinic add-ons, questions on patient management, and consultations from other doctors. 


Photos


In ophthalmology, as with many other medical specialties, we heavily rely on imaging for patient care. A picture is often worth a thousand words. HIPAAChat allows for secure transmission of photos with a simple tap of the camera icon. Users can choose to take a new photo or choose an existing photo, without leaving the app interface. One feature missing in the current version is the ability to transmit saved videos asynchronously.


Touch-to-talk/Talk-to-text


Walkie-talkie or push-to-talk allows recording voice messages with the touch of a button. This feature actually plays the audio message instead of converting to text. However, the audio message is played back over the speaker, so you must be cognizant of people around as they will hear the message. In addition to touch-to-talk, the app also allows talk-to-text, making it extremely easy to dictate text messages on the fly. With the release of smart watches like the Apple Watch, these features could open the door to efficient audio messaging on your wrist since these devices won’t allow texting on the screens. Message alerts show up on the Apple Watch, but the current version will not display actual messages. Although future versions are likely to incorporate the use of the smart watches.


Audio/Video calling


A main distinguishing feature of HIPAAChat from several competitors is the ability for real-time audio and video calling. As a result, the HIPAAChat app can also serve as a telemedicine platform. The video calling has a similar interface as FaceTime or Skype, again contributing to the ease-of-use and intuitive nature of the app. Call clarity and picture quality was very good, without any significant delays or picture freezes when I used it on our Wifi network.


Security


With maximum fines of $50,000 per violation and up to $1.5 million annually for repeat violations, secure messaging of PHI is imperative. HIPAAChat allows for secure, encrypted transmission of messages as part of the Everbridge platform. The app meets all the administrative, technical, and physical safeguards.


Enterprise


I have been using the basic HIPAAChat lite, which is free for download and offers the core secure communication features. The Enterprise-level adds an IT administrator console for managing users and devices, an Active Directory sync, archiving and data retention, auditing, reporting, and analytics. Additionally, the Enterprise version facilitates system integration with EHRs, labs, admissions/discharge/transfer systems, and nurse call/intercom systems. For institutions wanting custom integration, fully documented APIs are available and based on specific needs.


Telemedicine


The live video calling feature of the HIPAAChat app sets it apart from other secure messaging apps that I have used. Whereas two systems are usually needed for secure messaging and telemedicine, HIPAAChat combines the two in one platform. Additionally, unlike many telemedicine platforms, the physician can access secure video on their smartphone or tablet, making it truly portable.


The HIPAAChat platform enables physicians to communicate virtually with other medical staff, consultants, and even patients from anywhere. I have found that the video consultations can be very useful in the emergency room setting, often preventing unneeded transfers, follow-up, or unnecessary treatment. Everbridge also offers an iCart that serves as a mobile telemedicine platform, ideally suited for the emergency room. The iCart is a mobile cart on wheels with the attachment of a tablet. The housing of the tablet allows for attachment of video lights, a Wood’s lamp, and macro lenses specifically for ophthalmology and dermatology.

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Lyfe Media's curator insight, June 19, 2015 1:48 PM

Technology is quickly coming to the medical fields rescue by improving processes and cutting costs. HIPAACHAT is just one of the tools doing exactly that. This article explains the different features the app has and how it's making incredible improvements to a necessary industry. LyfeNews

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Physicians: Protect Your Data from Hackers in 5 Steps

Physicians: Protect Your Data from Hackers in 5 Steps | HIPAA Compliance for Medical Practices | Scoop.it

According to a recent CNBC report, hackers may have stolen personnel data and Social Security numbers for every single federal employee last December. If true, the cyberattack on federal employee data is far worse than the Obama administration has acknowledged.

J. David Cox, president of the American Federal of Government Employees Union, believes "hackers stole military records and veterans' status information, address, birth date, job and pay history, health insurance, life insurance, and pension information; [as well as] age, gender, race data," according to the report. This would be all that is needed for cybercriminals to steal identities of the employees, divert funds from one account to another, submit fake healthcare claims, and create fake accounts for everything from credit cards to in-store credit card purchases.


Although physicians maintain personal and professional data which is especially valuable to thieves, you are not the federal government. Make it hard enough on cybercriminals, and they will move on for lower-hanging fruit. Readers Digest offers good advice in five simple steps in its article, "Internet Security, How not to Get Hacked":


1. Be aware of what you share.


On Facebook, Twitter, or social media, avoid posting birth dates, graduation years, or your mother's maiden name — info often used to answer security questions to access your accounts online or over the phone.


2. Pick a strong password.


Hackers guess passwords using a computer. The longer your password and the more nonsensical characters it contains, the longer it takes the computer. The idea here is that longer, more complicated passwords could take a computer 1,000 years to guess. Give 'em a challenge


3. Use a two-step password if offered.


Facebook and Gmail have an optional security feature that, once activated, requires you to enter two passwords: your normal password plus a code that the companies text to your phone-to access your account. "The added step is a slight inconvenience that's worth the trouble when the alternative can be getting hacked,"  CNET tech writer Matt Elliot told Readers Digest. To set up the verification on Gmail, click on Account, then Security. On Facebook, log in, click on the down icon next to Home, and then click on Account Setting, Security, and finally Login Approvals.


4. Use Wi-Fi hot spots sparingly.


By now, you probably know that Internet cafés and free hotspots are not secure. You shouldn't be doing your online banking from these spots. However, the little button that turns off your laptops Wi-Fi so that your laptop cannot be accessed remotely is also handy. In Windows, right click on the wireless icon in the taskbar to it off. On a Mac, click the Wi-Fi icon in the menu bar to turn off Wi-Fi.


5. Back up your data.


Hackers can delete years' worth of e-mails, photos, documents, and music from your computer in minutes. Protect your digital files by using a simple and free backup system available on websites such as Crashplan and Dropbox


Take this basic instruction and build on it yourself. Google, for example offers advice expanding on the concept of "stong passwords." The worst thing you can do is use "dictionary words," the word "password," and sequential keystrokes, such as "1234" or "qwerty," because the hacker's computers will try these first. For e-mail, pick a phrase, such as "[m]y friends Tom and Jasmine send me a funny e-mail once a day" and then use numbers and letters to recreate it as a cryptic password. "MfT&Jsmafe1ad."

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Four Common HIPAA Misconceptions

Four Common HIPAA Misconceptions | HIPAA Compliance for Medical Practices | Scoop.it

While practices must work hard to comply with HIPAA, some are taking HIPAA compliance efforts a bit too far. That's according to risk management experts, who say there are some common compliance misconceptions that are costing practices unnecessary time and resources.

Here's what they say many practices are avoiding that they don't necessarily need to avoid, and some extra steps they say practices are taking that they don't necessarily need to take.


1. Avoiding leaving phone messages

While it's true that a phone message from your practice to a patient could be overheard by the wrong party, phone messages that contain protected health information (PHI) don't need to be strictly off limits at your practice, says Jim Hook, director of consulting services at healthcare consulting firm The Fox Group, LLC."Many offices adopt a blanket policy of, well, 'We can't leave you any phone messages because HIPAA says we can't,' and, that's really not true," he says. "You can always get consent from a patient on how they want to be communicated with."


Hook recommends asking all of your patients to sign a form indicating in what manner you are permitted to communicate with them, such as by mail, e-mail, text, and phone message. "If the patient says, 'Yes, you can call and leave me phone messages at this phone number I'm giving you,' then it's not a HIPAA violation to use that method of communication," he says.


2. Avoiding discussing PHI

It's important to safeguard PHI as much as possible, but some practices are taking unnecessary precautions, says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC.


"I think there's still a fear among small providers ... that they can't discuss protected health information anywhere in the [practice]," she says. "They feel that they have to almost build soundproof walls and put up bulletproof glass or soundproof glass to prevent any sort of disclosure of protected health information, and that's not what HIPAA requires at all. HIPAA allows for incidental disclosures, [which] are disclosures that happen [incidentally] around your job. So if you've got a nurse and a doctor talking, maybe at the nurses' station, and someone overhears that Mr. Smith has blood work today, that probably wouldn't be a violation because it's incidental to the job. Where else are the doctors and nurses going to talk?"


As long as you are applying "reasonable and appropriate" safeguards, Caswell says you should be in the clear.


3. Requiring unnecessary business associate agreements

HIPAA requires practices to have written agreements, often referred to as business associate agreements (BAAs), with other entities that receive or work with their PHI. Essentially, the agreements state that the business associates will appropriately safeguard the PHI they receive or create on behalf of the practice.


Still, some practices take unnecessary precautions when it comes to BAAs, says Robert Tennant, senior policy adviser of government affairs for the Medical Group Management Association. "A lot of practices are very concerned about people like janitorial services [and] plant maintenance folks, and they have them sign business associate agreements, but those folks are not business associates for the most part," says Tennant. "You may want to have them sign confidentiality agreements basically saying, 'If you do come across any information of a medical nature, protected health information, you are not permitted to look at it, copy it, keep it ...,' But, you do not need to sign a business associate agreement with anybody other than those folks that you actually give PHI to for a specific reason, like if you've got a law office or accounting office or a shredding company that is coming in to pick up PHI to destroy it."


4. Requiring unnecessary patient authorizations

While it's critical to comply with HIPAA's requirement that only those who have a valid reason to access a patient's medical record, such as treatment purposes, payment purposes, or healthcare operations, have access to it — some practices are misconstruing that rule, says Tennant. "They demand patient authorization before they transfer data to another provider for treatment purposes," he says. "I understand why they do it, but it's one of those things that … can cause delays and confusion, and even some acrimony between the patient and the provider. If it's for treatment purposes specifically, you do not need a patient authorization."

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Think Your Practice is HIPAA Compliant? Think Again.

Think Your Practice is HIPAA Compliant? Think Again. | HIPAA Compliance for Medical Practices | Scoop.it

You may think you know HIPAA inside and out, but experts say many practices and physicians are making mistakes regarding protected health information (PHI) that could get them into big trouble with the law. Here are nine of the most common compliance missteps they say practices and physicians are making.

1. TEXTING UNENCRYPTED PHI

For most physicians, texting is an easy, convenient, and efficient way to communicate with patients and colleagues. But if a text contains unencrypted PHI, that could raise serious HIPAA problems.


"One of the big things people are doing these days is texting PHI, and people seem to be ignoring the fact that text messages can be read by anyone, they can be forwarded to anyone, [and] they're not encrypted in any fashion when they reside on a telecommunications provider's server," says Jim Hook, director of consulting services at healthcare consulting firm The Fox Group, LLC. "People really need to understand that [short message service (SMS)] text messaging is inherently nonsecure, and it's noncompliant with HIPAA."


That's not to say that texting PHI is never appropriate, it just means that physicians must find a way to do so securely. While the privacy and security rules don't provide explicit text messaging guidelines, they do state that covered entities must have "reasonable and appropriate safeguards to protect the confidentiality, availability, and integrity of protected health information," says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC. As a result, Caswell, who formerly worked for HHS' Office for Civil Rights, says physicians must consider, "What would I put on my [smart] phone to reasonably and appropriately safeguard that information?" Most likely, the answer will be a secure messaging service with encryption, she says, adding that many inexpensive solutions are available to providers.


2. E-MAILING UNENCRYPTED PHI

Similar to text messaging, many physicians are e-mailing unencrypted PHI to patients and colleagues. As Robert Tennant, senior policy adviser of government affairs for the Medical Group Management Association says, e-mailing is becoming ubiquitous in our society, and healthcare is no exception.


If your providers are e-mailing PHI, consider implementing a secure e-mail application; for instance, one that recognizes when content included in the e-mail contains sensitive information and therefore automatically encrypts the e-mail. Your practice could use the application to specify certain circumstances in which e-mails should be encrypted; such as the inclusion of social security numbers or credit card numbers. The application would then filter e-mails for that specified content, and when it finds that content, encrypt those e-mails automatically, says Caswell.


Another option is to use a secure e-mail application to set up filters to automatically encrypt e-mails sent with attachments, or encrypt e-mails when senders include a word like "sensitive" or "encrypt" in the subject line, she says. An added benefit of encrypting e-mail is if a potential breach occurs, like the theft of a laptop containing e-mails with PHI, that is not considered a reportable breach if the e-mails stored on the laptop are encrypted, says Tennant. "You don't need to go through all of the rigmarole in terms of reporting the breach to the affected individual, and ultimately, to the government," he says. "So it's sort of a get out of jail free card in that sense."


If your practice would rather prohibit the use of e-mail altogether, a great alternative might be a patient portal that enables secure messaging.


Finally, if patients insist on having PHI e-mailed to them despite the risks, get their permission in writing for you to send and receive their e-mails, says Tennant.


3. FAILING TO CONDUCT A RISK ANALYSIS

If your practice has not conducted a security risk analysis — and about 31 percent of you have not, according to our 2014 Technology Survey, Sponsored by Kareo — it is violating HIPAA. The security rule requires any covered entity creating or storing PHI electronically to perform one. Essentially, this means practices must go through a series of steps to assess potential risks and vulnerabilities to the confidentiality, integrity, and availability of their electronic protected health information (ePHI).


Though the security risk analysis requirement has been in place since the security rule was formally adopted in 2003, it's been pretty widely ignored by practices, says Hook. Part of the reason, he says, is lack of enforcement of the requirement until recently. Since conducting a security risk analysis is now an attestation requirement in the EHR incentive program, auditors are increasingly noting whether practices are in compliance.


4. FAILING TO UPDATE THE NPP

If your practice has not updated its Notice of Privacy Practices (NPP) recently, it could be violating HIPAA. The HIPAA Omnibus Rule requires practices to update these policies and take additional steps to ensure patients are aware of them, says Tennant.

Some of the required updates to the NPP include:


• Information regarding uses and disclosures that require authorization;

• Information about an individual's right to restrict certain disclosures of PHI to a health plan; and

• Information regarding an affected individual's right to be notified following a privacy or security breach.


In addition to updating the NPP, a practice must post it prominently in its facility and on the website, and have new patients sign it and offer a copy to them, says Tennant. "I'd say of every 10 practices, hospitals, dental offices I go into, nine of them don't have their privacy notice in the waiting room," he says.


5. IGNORING RECORD AMMENDMENT REQUESTS

Don't hesitate to take action when patients request an amendment to information in their medical records, cautions Cindy Winn, deputy director of consulting services at The Fox Group, LLC. Under the HIPAA Privacy Rule, patients have the right to request a change to their records, and providers must act on those requests within 60 days, she says.


If you disagree with a patient's requested change, you must explain, in writing, why you are not making the requested change, says Hook. Then, share that reasoning with the patient and store a copy of it in the patient's medical record, as well as a copy of the patient's written request for the amendment.


6. NOT PROVIDING ENOUGH TRAINING

The privacy and security rules require formal HIPAA education and training of staff. Though the rules don't provide detailed guidance regarding what training is required, Hook recommends training all the members of your workforce on policies and procedures that address privacy and security at the time of hire, and at least annually thereafter.


The HIPAA Security Rule also requires practices to provide "periodic security reminders" to staff, says Caswell, adding that many practices are unaware of this. Actions that might satisfy this requirement include sending e-mails to staff when privacy and security issues come up in the news, such as information about a recent malware outbreak; or inserting a regular "security awareness" column in staff e-newsletters.

Finally, be sure to document any HIPAA training provided to staff.


7. OVERCHARING FOR RECORD COPIES

With few exceptions, the privacy rule requires practices to provide patients with copies of their medical records when requested. It also requires you to provide access to the record in the form requested by the individual, if it is readily producible in that manner.


While practices can charge for copies of records, some practices may be getting into trouble due to the fee they are charging, says Tennant. "HIPAA is pretty clear that you can only charge a cost-based fee and most of those are set by the state, so most states have [limits such as] 50 cents a page up to maybe $1 a page ... but you can't charge a $50 handling fee or processing fee; at least it's highly discouraged," says Tennant.


To ensure you are following the appropriate guidelines when dealing with record copy requests, review your state's regulations and consult an attorney. Also, keep in mind that though the privacy rule requires practices to provide copies within 30 days of the request, some states require even shorter timeframes.


8. BEING TOO OPEN WITH ACCESS

If your practice does not have security controls in place regarding who can access what medical records and in what situations, it's setting itself up for a HIPAA violation. The privacy rule requires that only those who have a valid reason to access a patient's record — treatment purposes, payment purposes, or healthcare operations — should do so, says Caswell. "If none of those things exist, then a person shouldn't [access] an individual's chart."


Caswell says practices need to take steps to ensure that staff members do not participate in "record snooping" — inappropriately accessing a neighbor's record, a family member's record, or even their own record.


She recommends practices take the following precautions:


• Train staff on appropriate record access;

• Implement policies related to appropriate record access; and

• Run EHR audits regularly to determine whether inappropriate access is occurring.


9. RELEASING TOO MUCH INFORMATION

Similar to providing too much access to staff, some practices provide too much access to outside entities, says Caswell. For instance, they release too much PHI when responding to requests such as subpoenas for medical records, requests for immunization information from schools, or requests for information from a payer.


"If there's, say, for instance, litigation going on and an attorney says, 'I need the record from December 2012 to February 2014,' it is your responsibility to only send that amount of information and not send anything else, so sort of applying what's called the minimum necessary standard," says Caswell. "When you receive outside requests for PHI, pay close attention to the dates for which information is requested, as well as the specific information requested."

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Patients suing Fort Wayne medical company over data breach

Patients suing Fort Wayne medical company over data breach | HIPAA Compliance for Medical Practices | Scoop.it

Two lawsuits have been filed in federal court in Fort Wayne seeking class action status on behalf of patients who have had their data compromised by Medical Informatics Engineering.


The Fort Wayne-based medical software company has reported that the private information of 3.9 million people nationwide was exposed when its networks were hacked earlier this year. The compromised information includes patients' names, Social Security numbers, birth dates and addresses, The (Fort Wayne) Journal Gazette (http://bit.ly/1W3PLHO ) reported.


The company contacted the FBI to report the data breach in May and began issuing letters to patients, letting them know which provider's information was hacked and offering them credit monitoring services, in mid-July.


The first lawsuit was filed last week by one patient, while the second lawsuit was filed Tuesday by three other patients.


Both lawsuits are similar and accuse the company of negligence. The plaintiffs argue that the company should've realized the risks associated with collecting and storing patients' personal information, and that the company had a responsibility to protect their data, according to court documents.


The lawsuits allege that Medical Informatics Engineering failed to take steps to prevent and stop the data breach, failed to comply with industry standards for safeguarding such data, and failed to properly implement technical systems or security practices, the documents said.

"Given the risk involved and the amount of data at issue, MIE's breach of its duties was entirely unreasonable," the attorneys wrote in the lawsuit.


In addition to class action status, all four patients also are seeking damages and expenses.


Eric Jones, co-founder and CEO of Medical Informatics Engineering, confirmed to the Associated Press Thursday that the company is aware of the two pending lawsuits.


"Our primary focus at this time is on responding to requests for information to those affected and helping them to enroll in credit monitoring and identity protection services," he said.

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Three Steps to Preventing Data Breaches in Your Practice

Three Steps to Preventing Data Breaches in Your Practice | HIPAA Compliance for Medical Practices | Scoop.it

Every few weeks, there’s a headline about a healthcare organization that’s been victimized by a hacker or a disgruntled employee. What is your practice doing to protect its data against theft? It can be a balancing act for physician practices that want to provide access to patient information in the EHR and elsewhere, while preventing data breaches. Here are a few steps that can help practices avoid those unfortunate headlines:


Know where your data is


First, you have to know where your data is, said Jim Kelton, managing principal at Costa Mesa, Calif,-based Altius Information Technologies. If you don’t know where your data is transmitted or where it’s stored, you can’t provide the layers of protection that are needed.


 "You have to know where [your data is] transmitted and where it’s stored," he said. Part of this exercise includes determining the practice’s EHR and other clinical information systems—and whether that software is hosted on the cloud. It can also be as mundane as making sure that printed e-mails from patients aren’t sitting around the office.


"There are 18 forms of protected health information, even an e-mail address can identify someone and needs to be protected,” he said.


Know what assets provide access to your data


Once this is done, you need to determine the assets that provide access to the practice’s data. This could be in the doctor’s office, within computer systems, on a server, or in the EHR and other clinical applications themselves. There are often multiple threats to consider, said Kelton. For example, the threat with a laptop is it’s portable and it’s vulnerable because it contains protected patient information.


Having a BYODT – or Bring Your Own Device and Technology – policy is very important, he said. This requires surveying your staff and doing an inventory of the types of technology you’re using to run the practice. It’s during this step that you should determine whether your employees are using smart phones and tablets, cloud storage, flash drives, or external hard drives. It’s also important to keep in mind any data sharing with external contractors doing software development for the practice. "For smaller practices that outsource a lot of services, they need to make sure their business agreements [with vendors and consultants] are solid,” said Kelton.


Identify threats to those assets and build in controls


Those threats could be physical, such as someone entering the practice and stealing a laptop. They could also mean your practice is the intended victim of hackers or viruses, which can infiltrate the EHR and other clinical systems. Some practices even need to be prepared for the actions of a disgruntled employee who sends your client list to their future employer, an action that puts your practice at risk, Kelton said.


Password protection for laptops is a pretty simple solution that works. Also to consider is encrypting the laptop’s hard drive. This action will mean that the hacker won’t be able to access protected patient data on the EHR and other information about your practice, Kelton said

HIPAA requires that each practice identify a security official to develop and implement security policies, implement procedures, and oversee and protect protected health information. According to Kelton, putting together a plan in advance is the most cost-effective way to ensure that data breaches don’t occur.

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Cybersecurity: Things Are Getting Worse, But Need to Get Better

Cybersecurity: Things Are Getting Worse, But Need to Get Better | HIPAA Compliance for Medical Practices | Scoop.it

In his opening keynote address at the CHIME Lead Forum at iHT2-Denver, sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) and by the Institute for Health Technology Transformation (iHT2—a sister organization of Healthcare Informatics through our parent company, the Vendome Group LLC), being held at the Sheraton Downtown Denver, Mac McMillan laid out in the clearest possible terms for his audience of IT executives the growing cybersecurity dangers threatening patient care organizations these days.


Under the heading, “What Is Cyber Security and Why Is It Crucial to Your Organization?” McMillan, the CEO of the Austin, Tex.-based CynergisTek consulting firm, used his opening keynote address to challenge his audience to think strategically and proactively about the growing cyber-threats hitting patient care organizations across the U.S.

McMillan elaborated on what he sees as 11 key areas of concern going forward right now for healthcare IT leaders: “increased reliance”; “insider abuse”; “questionable supply chains”; “device-facilitated threats”; “malware”; “mobility”: “identity theft and fraud”; “theft and losses”; “hacking and cyber-criminality”; “challenges emerging out of intensified compliance demands”; and a shortage of chief information security officers, or CISOs.


In fact, McMillan said, cybersecurity threats are accelerating and intensifying, and are coming through such a broad range of threat vehicles—hacking by criminal organizations and foreign governments, penetration of information networks via the deliberate infiltration via medical devices, and a crazed proliferation of all types of malware across the cyber universe, that the leaders of patient care organizations must take action, and take it now, he urged.


As for “increased reliance,” the reality, McMillan noted, is that “We live in a world today that is hyper-connected. When I left the government and came back into healthcare in 2000,” he noted, “probably the total number of people who looked at any patient record, was about 50, and all were hospital employees. Today, that average is more like 150, and half of those individuals are not hospital employees. And our systems are interconnected. Digitizing the patient record, under meaningful use, coincided with the rise in breaches. Not that any of that is bad,” he emphasized. “But it did become easier for bad people to do bad things; it also increased the number of mistakes that could be made. If I wanted to carry out paper medical records” in the paper-based world, he noted, “I was limited to the number I could put into a basket. Now, I can download thousands at a time onto a flash drive.”


With regard to “insider abuse,” McMillan made a big pitch for the use of behavior pattern recognition strategies and tools. “We have to actively monitor what’ going on,” he urged. “It doesn’t mean running random audits. You have to actively monitor activity, and you can’t do that manually, and we have to recognize that. Also, a lot of activity, particularly identity theft, is not captured by monitoring compliance rules, but rather, by capturing activity patterns. The fact that someone looks at information four times the frequency that their neighbor does—the fact that an individual is looking at four times as many records, is absolutely a flag. They’re either working four times as hard/fast, or are snooping, or are engaged in nefarious activities. But fewer than 10 percent of hospitals are actively monitoring behavior patterns.”


McMillan was totally blunt when it came to discussing “questionable supply chains.” “I’ll just come out and say it: vendors are a threat,” he told his audience. “We’ve had cases where vendors have been hacked or have had incidents, and the vendor didn’t have a good procedure for restoration or what have you. We need to do a better job of vetting our vendors, of holding them to a higher standard for performance. And this industry needs to create a better baseline—basic requirements—if you connect my network, this is how you have to connect, this is the basic level of encryption required, that kind of thing. This is about creating and adhering to minimal requirements, not creating a new framework,” he said. “We’re already got a million frameworks out there.”


What about medical devices? The threats there are absolutely exploding, McMillan said. He noted that successful hacks have now been documented via such devices as insulin pumps and blood pumps, all of which are relatively recent, as most medical devices weren’t networkable until at least 2006.


Meanwhile, the malware explosion dwarfs just about all other issues, at least in terms of volume. At the beginning of last year, McMillan reported, there were 100 million instances of malware floating around; by the end of the year, there were 370 million. Importantly, he noted, “Malware is no longer produced by smart people in dark rooms writing code. It’s now being produced by bots morphing old malware. And this is putting more pressure on people in terms of the integrity of the environment.” He warned his audience that “The anti-virus products we have today are antiquated products. Less than half of the malware out there is recognized by anti-virus anymore; if you’re relying on antivirus, you’ve already lost the battle. In the next decade,” he predicted, “we’ll move from a speed of computing of 10 to the 8th power, to one of 10 to the 26th power—that’s how fast we’ll be computing. That’s phenomenal. So decisions will be made by computers so fast that any technology relying on signatures to be looked up, will be blown by. It will never keep up. So our security vendors have got to get ahead of this curve, have got to recognize that this whole paradigm we’re dealing with is changing, and we’ve got to change the way we act around this.”


With regard to the rest of the 11 key areas he cited, McMillan made a number of important comments. Among them, with regard to mobility and data, he said, “We’ve got to quit chasing the device. I’ve said this for the better part of five years now. If we chase the device, we’ll never catch up. We’ve got to focus on how the devices connect the environment and how we register and protect those devices.” Meanwhile, he emphasized that while hacking and cyber-criminality represented only 10 percent of data breaches only two years ago, breaches created by hacking and cyber-criminality are now surging.


A lot of these challenges really require a level of IT security management and governance that remains lacking in U.S. healthcare, McMillan said. “I absolutely believe that we need more CISOs in healthcare. I think we need to improve the education of our CISOs and need to help professionalize them. We need to find ways for CIOs to collaborate. That’s the way we help everyone benefit and get ahead.”

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Avoid this little-known but costly HIPAA trap

Avoid this little-known but costly HIPAA trap | HIPAA Compliance for Medical Practices | Scoop.it

Healthcare providers who call patients or send automated calls or text messages may be running afoul of federal law.


The law in question, the Telephone Consumer Protection Act (TCPA), was enacted in the 1990s to protect consumers against unwanted automated calls sent to residences or cellphones. The Federal Communications Commission recently established an exemption for healthcare messages that are regulated through HIPAA.


The problem? According to Christine Reilly, co-chair of the TCPA Compliance and Class Action Defense group at the law firm of Manatt, Phelps & Philips, HIPAA doesn't specifically define a "healthcare message."


"There really is not a lot there about those requirements," she told mHealth News. "It is not exactly a model of clarity."


The TCPA, Reilly says, was designed primarily to eliminate unwanted solicitations, and gave birth to the more-well-known Do Not Call Registry in 2003. But how does that translate to a healthcare message that may or may not be selling the provider's services – such as reminders for screenings or appointments, prescription refills and general health and wellness information?


"Those are a little bit more hybrid," Reilly said. "TCPA might consider it marketing, but with a healthcare message it likely falls under HIPAA."

Healthcare providers risk falling into the "TCPA trap," Reilly says, if they enable these types of messages without examining the legal implications. And those are costly – fines of between $500 and $1,500 per message.


Reilly, who will be presenting a webinar in July 30 on the TCPA, suggests healthcare providers check with legal counsel on whether their messaging protocols conform to TCPA or fall under HIPAA.

"Providers want to know what, in fact, qualifies as a healthcare message and what qualifies as an exemption," Reilly says. "A lot of the questions we're getting are about how this works in practical terms."

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Technology still meets resistance!

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Four Things MSPs Should Know About HIPAA Compliance and the Cloud

Four Things MSPs Should Know About HIPAA Compliance and the Cloud | HIPAA Compliance for Medical Practices | Scoop.it

While managed service providers (MSPs) are certainly well-versed in the areas of cloud-based file sharing and data storage, it pays to be just as familiar with some of the areas of interest of your clients. As MSPs see more healthcare companies migrating their services to the cloud – whether due to a relaxation of restrictions or a decision to evolve – the need for familiarity in this potentially lucrative market is as important as ever.


When the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996, data security and privacy on the internet were not exactly the big concerns of the day. Then again, the MSP business model we know and love today didn’t even exist.


Fast forward about 20 years – and through a couple of generations of computing platforms – and HIPAA compliance has become a hot topic as health care organizations, at long last, begin to crawl out from under mountains of paper and into the digital world.


The 2013 HIPAA Omnibus Rule is the modification to HIPAA that defines the rules governing data security for “covered entities” (healthcare providers, mostly) and their “business associates,” i.e. you, their MSP.


As the rule states, “These modifications [to the original HIPAA law] make business associates of covered entities directly liable for compliance with certain of the HIPAA Privacy and Security Rules’ requirements.” Here are the four most important things you need to know to comply with HIPAA regulations:


1. Business Associate Agreements


Law now requires that when you’re doing business with a “covered entity” (CE), you must execute agreements – called Business Associate Agreements (BAAs) – that define the permitted uses and disclosures of “protected health information” (PHI) by the business associate. Don’t start doing business with a healthcare client or other “covered entity” without a Business Associate Agreement in place. The same goes for subcontractors. You’ll want to make sure that anybody touching PHI is covered in the BAA.


2. Providing cloud storage makes you liable for HIPAA privacy


According to the HIPAA Omnibus rule, anything you store in the cloud – even on behalf of a client – that contains protected health information must be compliant with HIPAA privacy protections.  This applies whether you ever view that data or not. If you retain, maintain, or transmit protected health information for a client, then you are bound by their business associate agreement.


3. Less access = lower liability risk


According to an FAQ published by the Center for Democracy and Technology, if you don’t have the capability to access your client’s data and adhere to HHS (Department of Health and Human Services) standards with respect to encryption, you should have little liability risk as a business associate. The FAQ also states that, “if the covered entity controls the decryption keys and the CSP has no ability to access the plain text of the data, it would not be reasonable to expect the CSP to comply with the provisions... that require a BA to ‘make available’ PHI for certain purposes.”


4. Breach thresholds have been lowered


Prior to the enactment of the Omnibus rule, a security breach only had to be reported to the HHS if it posed “significant risk of reputational, financial or other harm” to individuals. Now, all breaches of unsecured PHI – information that is not rendered unusable, unreadable, or indecipherable to unauthorized persons – must be reported. However, if the BAA established between you and your healthcare client includes a multi-factor risk assessment that determines low probability of data compromise, the breach may not need to be reported. It’s probably worthwhile to check out your your legal obligations for notification.

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10 ways to prevent a data breach and protect your small business

10 ways to prevent a data breach and protect your small business | HIPAA Compliance for Medical Practices | Scoop.it

Today, virtually all businesses collect personal information about customers, employees and others. This information is valuable to hackers – evidenced by the increasing frequency and severity of data breaches across the globe.

Big businesses are not the only ones who are vulnerable. Small and medium-sized businesses with fewer data security resources are often targets for cybercriminals. In fact, research we’ve conducted with the Ponemon Institute shows that more than half have experienced a data breach and nearly three out of four report they can’t restore all their data.


The good news is that businesses can take steps to protect themselves from destructive cyber intrusions. To preempt hacking activity, you must think like a hacker. Here are a few tips to get you started.

1. Think beyond passwords. Never reuse them and don’t trust any website to store them securely. To increase the level of security, set up a two-factor authentication for all your online business accounts. This authentication relies on something only you should know (your password) and authenticates something only you should have (typically your phone) to verify your identity.

2. Stop transmission of data that is not encrypted. Mandate encryption of all data. This includes data at “rest” and “in motion.” Consider encrypting email within your company if personal information is transmitted. Avoid using WiFi networks, as they may permit interception of data.

3. Outsource payment processing. Avoid handling credit card data on your own. Reputable vendors, whether it’s for point-of-sale or web payments, have dedicated security staff that can protect data better than you can.

4. Separate social media activity from financial activity. Use a dedicated device for online banking and other financial activities, and a different device for email and social media. Otherwise, just visiting one infected social site could compromise your banking machine and sensitive business accounts.

5. “Clean house” and update procedures. Evaluate your assets and valuable data to identify where your organization is most at risk. It’s important to reduce the volume of information you keep on hand (only keep what you need!) and properly destroy all paper documents, CDs/DVDs and disks before disposal. Consider assessing your business’s email infrastructure, browser vulnerability, and ID system. Do not use Social Insurance Numbers as employee ID numbers or client account numbers. You should also question the security posture of your business lines, vendors, suppliers or partners.

6. Secure your browser. Watering holes – malicious code installed on trusted websites – are a common method of attack against businesses. How do you know which websites to trust? Focus on keeping up-to-date with the latest version of your browser. Then, test your browser’s configuration for weakness.

7. Secure your computers and operating system. Implement password protection and “time out” functions (requires re-login after period of inactivity) for all business computers. Require strong passwords that must be changed on a regular basis. Also be sure to update all operating systems, which have major security improvements baked in. It’s far easier to break into older operating systems like Windows XP or OS X 10.6.

8. Secure your internet router. Make sure someone can’t intercept all the data sent through it. Consider configuring your wireless network so the Service Set Identifier (SSID) – the name the wireless network broadcasts to identify itself – is hidden.

9. Safeguard and back up your data. Lock physical records containing private information in a secure location and create backups. These should be encrypted and off-site in case there’s a fire or burglary.

10. Educate and train employees. Establish a written policy about data security, and communicate it to all employees. Educate them about what types of information are sensitive or confidential and what their responsibilities are to protect that data. In addition, restrict employee usage of computers for only business purposes. Do not permit use of file sharing peer-to-peer websites or software applications and block access to inappropriate websites.

It’s important to remember that no business is “too small” for a hacker–all businesses are vulnerable. The sooner you can get ahead of potential hacking activity, using the above steps, the sooner you’ll be prepared to thwart, mitigate and manage a data breach.

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Audits Are Only One Way of Coming Under the HIPAA Microscope

Audits Are Only One Way of Coming Under the HIPAA Microscope | HIPAA Compliance for Medical Practices | Scoop.it

Now that the 2015 HIPAA Audits have begun, organizations are reevaluating their HIPAA compliance posture. This is a good thing being that an organization will have very little time to respond to pre-audit and audit inquiries from the Office of Civil Rights (OCR).


On the other hand, some organizations are evaluating the risk of being selected and might conclude that the risk is low. These organizations might decide that the low risk is not worth the effort to ensure HIPAA compliance. The risk of being selected by the IRS to audit your tax return is very low but most people and organizations file their taxes.

Why is this the case? People fear the IRS. They fear the hassle associated with an IRS audit, they fear the penalty associated with an IRS audit and they fear the consequences of failing an IRS audit.


Right now people don’t really fear OCR or HIPAA audits. I am pretty confident that people didn’t fear the IRS audits when they first started. It took a few years and some very high profile cases, including putting people in jail, to get people to worry about IRS audits and ensuring that they are properly filing their tax returns. It is not hard to see an analogy with the start of the HIPAA audits. The question that organizations need to ask themselves is:

Do I want to be a high profile example if my organization is selected for a HIPAA audit?


Other concerns


There is no denying that the chance of being selected for a HIPAA audit is low. But a random audit is only one of the ways that OCR could investigate an organization. Let’s take a look at some of the other ways that an organization can come under the HIPAA microscope.

Data Breaches


If an organization has a data breach (lost laptop or hacker steals protected health information -PHI) OCR may decide to investigate the incident. If OCR starts an investigation, they will want to see what safeguards the organization had in place prior to the data breach. It is almost guaranteed that OCR will want to see the following:


  • The most recent HIPAA Security Risk Assessment (SRA) and documented work plan to address any issues discovered in the SRA
  • Evidence of documented HIPAA Security and Privacy Policies and Procedures (including evidence that the organization has implemented and is following the Policies)
  • Evidence that employees have received periodic HIPAA Security and Privacy training (this should be ongoing training that occurs at least once a year)
  • Evidence of a security incident response plan


Business Associate Data Breaches


A data breach by a Business Associate may cause OCR to investigate the Covered Entity. If a billing company or IT support organization has a data breach there is a good chance that OCR will investigate both the Business Associate as well as the Covered Entity. The question that organizations need to ask themselves is:

Besides signing a Business Associate Agreement, do I have any proof that my Business Associate is protecting PHI that we disclose to them?


Patient Complaints


Another way that OCR may open an investigation into an organization’s HIPAA compliance is if a patient or former patient files a complaint. The patient may feel that their privacy or the security of their data has been breached and can file a complaint with OCR. OCR evaluates each of the complaints that have been filed and decides if they will investigate the organization.


Employee Complaints


Employees or former employees may feel that their employer is not protecting PHI and could file a complaint against the organization.


Meaningful Use


Organizations that are participating or have participated in the CMS Meaningful Use (MU) Incentive Program can be audited by CMS or the Office of Inspector General (OIG). A common reason of failing a MU audit is the lack of a Security Risk Assessment (SRA) or the lack of a thorough SRA and documented work plan to address any issues discovered in the SRA.


Conclusion


With over 100 million patient record breaches in the last few years it should come as no surprise that the government is increasing HIPAA enforcement. We have an epidemic of patient records breaches and the need to protect this very sensitive information is apparent.

Organizations can no longer ignore HIPAA. Proper safeguards and increased security is needed to protect PHI. It is a lot easier and cheaper to proactively implement HIPAA requirements than it is to respond when OCR comes knocking on your door.

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Unencrypted Device Breaches Persist

Unencrypted Device Breaches Persist | HIPAA Compliance for Medical Practices | Scoop.it

Although hacker attacks have dominated headlines in recent months, a snapshot of the federal tally of major health databreaches shows that stolen unencrypted devices continue to be a common breach cause, although these incidents usually affect far fewer patients.


As of June 23, the Department of Health and Human Services' Office for Civil Rights' "wall of shame" website of health data breaches affecting 500 or more individuals showed 1,251 incidents affecting nearly 134.9 million individuals.


Those totals have grown from 1,213 breaches affecting 133.2 million individuals in an April 29 snapshot prepared by Information Security Media Group.


The federal tally lists all major breaches involving protected health information since September 2009, when the HIPAA Breach Notification rule went into effect. As of June 23, about 52 percent of breaches on the tally listed "theft" as the cause.


Among the breaches added to the tally in recent weeks are about a dozen involving stolen unencrypted computers. Lately, those type of incidents have been overshadowed by massive hacking attacks, such as those that hit Anthem Inc.and Premera Blue Cross.


"Although we've seen some large hacking attacks, they are aimed at higher-profile organizations than the more typical provider organization," says privacy and security expert Kate Borten, founder of the consulting firm, The Marblehead Group. "Attackers know that these organizations have a very high volume of valuable data. But I continue to believe that unencrypted PHI on devices and media that are lost or stolen is 'the' most common breach scenario affecting organizations of any size."


Borten predicts that many incidents involving unencrypted devices will continue to be added to the wall of shame. "Getting those devices encrypted is an ongoing challenge when we expand the requirement to tablets and smartphones, particularly when owned by the users, not the organization," she says. "We also shouldn't overlook encryption of media, including tapes, disks and USB storage drives."

Unencrypted Device Breaches

The largest breach involving unencrypted devices that was recently added to the tally was an incident reported to HHS on June 1 by Oregon Health Co-Op., an insurer.


That incident, which impacted 14,000 individuals, involved a laptop stolen on April 3. In a statement, the insurer says the device contained member and dependent names, addresses, health plan and identification numbers, dates of birth and Social Security numbers. "There is no indication this personal information has been accessed or inappropriately used by unauthorized individuals," the statement says.

Also recently added to the federal tally was a breach affecting 12,000 individuals reported on June 10 by Nevada healthcare provider Implants, Dentures & Dental, which is listed on the federal tally as "doing business as Half Dental." The incident is listed as a theft involving electronic medical records, a laptop, a network server and other portable electronic devices.


In addition to the recent incidents involving stolen or lost unencrypted devices, several breaches added to the wall of shame involve loss or stolen paper records or film.


"Breaches of non-electronic film and paper will never end, but at least these breaches are typically limited to one or a small number of affected individuals," Borten says. Because many of the breaches involving paper or film are often due to human error, "effective, repeated training is essential" to help prevention of such incidents, she says.

Hacking Incidents Added

The largest breach added to the tally in recent weeks, however, is the hacker attack on CareFirst BlueCross BlueShield, which was reported on May 20 to HHS and affected 1.1 million individuals. Baltimore-based CareFirst has said that an "unauthorized intrusion" into a database dating back to June 2014 was discovered in April by Mandiant, a cyberforensics unit of security vendor FireEye, discovered the attack on CareFirst in April. Mandiant was asked by CareFirst to conduct a proactive examination of CareFirst's environment, following the hacker attacks on Anthem and Premera.


Another hacker incident added to the tally affected South Bend, Ind.-based Beacon Health System. That incident, reported to HHS on May 20, is listed as affecting about 307,000 individuals. The organization has said patients' protected health information, including patient name, doctor's name, internal patient ID number, and in some cases, Social Security numbers and treatment information, was exposed as a result of phishing attacks on some employees that started in November 2013. The attacks led to hackers accessing "email boxes" that contained patient information.

Addressing Multiple Threats

Healthcare organizations need to continue their efforts to protect data from the threats posed by cyber-attackers, insiders or street thieves, says Borten, the consultant.


"There's no simple answer, but security is complex, and so the solutions, or mitigating controls, must be numerous and varied."

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Four Common HIPAA Misconceptions

Four Common HIPAA Misconceptions | HIPAA Compliance for Medical Practices | Scoop.it

While practices must work hard to comply with HIPAA, some are taking HIPAA compliance efforts a bit too far. That's according to risk management experts, who say there are some common compliance misconceptions that are costing practices unnecessary time and resources.

Here's what they say many practices are avoiding that they don't necessarily need to avoid, and some extra steps they say practices are taking that they don't necessarily need to take.


1. Avoiding leaving phone messages


While it's true that a phone message from your practice to a patient could be overheard by the wrong party, phone messages that contain protected health information (PHI) don't need to be strictly off limits at your practice, says Jim Hook, director of consulting services at healthcare consulting firm The Fox Group, LLC."Many offices adopt a blanket policy of, well, 'We can't leave you any phone messages because HIPAA says we can't,' and, that's really not true," he says. "You can always get consent from a patient on how they want to be communicated with."


Hook recommends asking all of your patients to sign a form indicating in what manner you are permitted to communicate with them, such as by mail, e-mail, text, and phone message. "If the patient says, 'Yes, you can call and leave me phone messages at this phone number I'm giving you,' then it's not a HIPAA violation to use that method of communication," he says.


2. Avoiding discussing PHI


It's important to safeguard PHI as much as possible, but some practices are taking unnecessary precautions, says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC.


"I think there's still a fear among small providers ... that they can't discuss protected health information anywhere in the [practice]," she says. "They feel that they have to almost build soundproof walls and put up bulletproof glass or soundproof glass to prevent any sort of disclosure of protected health information, and that's not what HIPAA requires at all. HIPAA allows for incidental disclosures, [which] are disclosures that happen [incidentally] around your job. So if you've got a nurse and a doctor talking, maybe at the nurses' station, and someone overhears that Mr. Smith has blood work today, that probably wouldn't be a violation because it's incidental to the job. Where else are the doctors and nurses going to talk?"


As long as you are applying "reasonable and appropriate" safeguards, Caswell says you should be in the clear.


3. Requiring unnecessary business associate agreements


HIPAA requires practices to have written agreements, often referred to as business associate agreements (BAAs), with other entities that receive or work with their PHI. Essentially, the agreements state that the business associates will appropriately safeguard the PHI they receive or create on behalf of the practice.


Still, some practices take unnecessary precautions when it comes to BAAs, says Robert Tennant, senior policy adviser of government affairs for the Medical Group Management Association. "A lot of practices are very concerned about people like janitorial services [and] plant maintenance folks, and they have them sign business associate agreements, but those folks are not business associates for the most part," says Tennant. "You may want to have them sign confidentiality agreements basically saying, 'If you do come across any information of a medical nature, protected health information, you are not permitted to look at it, copy it, keep it ...,' But, you do not need to sign a business associate agreement with anybody other than those folks that you actually give PHI to for a specific reason, like if you've got a law office or accounting office or a shredding company that is coming in to pick up PHI to destroy it."


4. Requiring unnecessary patient authorizations


While it's critical to comply with HIPAA's requirement that only those who have a valid reason to access a patient's medical record, such as treatment purposes, payment purposes, or healthcare operations, have access to it — some practices are misconstruing that rule, says Tennant. "They demand patient authorization before they transfer data to another provider for treatment purposes," he says. "I understand why they do it, but it's one of those things that … can cause delays and confusion, and even some acrimony between the patient and the provider. If it's for treatment purposes specifically, you do not need a patient authorization."

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Consolidating Technology as Part of a Practice Merger

Consolidating Technology as Part of a Practice Merger | HIPAA Compliance for Medical Practices | Scoop.it

As the healthcare industry moves toward value-based care, smaller physician practices, larger group practices, health systems, and independent delivery networks  are continuing to consolidate. This process works to help organizations eliminate redundancies, reduce risk, and foster more collaborative care. In fact, according to a recent KPMG study, 84 percent of surveyed mergers and acquisitions (M&A) professionals identified healthcare as the most active M&A industry for 2015, showing this trend will only grow throughout this year.

The process of joining two distinct healthcare entities is typically complex, as organizations must try to combine and consolidate clinical, administrative, and financial operations. One task often at the top of the "to-do" list is reviewing the technology systems used across the enterprise in order to determine how to leverage technology going forward. Will they continue to use disparate systems? Will they seek to integrate their existing solutions? Will they pursue whole different systems?


Most organizations prioritize this kind of review for their EHR and practice management solutions; however, it is essential to look beyond these "usual technology players". As part of the first wave of technology analysis, merging entities should carefully consider how they plan to address compliance technology — including OSHA and HIPAA solutions or regulated medical waste disposal processes — to safeguard patients, staff, visitors, and the healthcare organization as a whole. Without this type of review, an organization may put itself at risk, ultimately impacting the success of a potential merger.


Why It's Important to Review Compliance Technology


At first glance, making a concerted effort to assess compliance technology may not seem like a top priority for organizations working through a merger. However, there are tangible benefits to establishing a cohesive compliance support system upfront in the partnership.                 

                                             

First and foremost, leveraging a single, or well-integrated set, of compliance tools can promote standardization, encouraging constant adherence to best practices throughout both the smaller practice and the rest of the associated enterprise. This, in turn, can limit potential risks. Consistent compliance technology across all settings of an enterprise, from the practices to the hospitals, ensures an organization reliably follows rules and regulations. This not only prevents fines and penalties, but also enhances patient safety and security. For example, if OSHA technology is the same throughout an entire health system, the organization can be confident that all staff members, regardless of setting, understand their role in keeping the environment safe, such as when to wear personal protective equipment or how to properly dispose of medical waste to prevent the spread of infection. When staff regularly abides by OSHA regulations, they create an environment conducive to safe patient care, enabling physicians to focus on providing top-notch care to patients.


In addition to reducing risk, standardizing compliance efforts can have patient satisfaction benefits as well, as the uniformity across settings communicates that the organization values a consistent and best practice-driven approach to safety and security. For example, if an organization has one solution that provides HIPAA education to all its staff members, the organization can be sure that everywhere a patient enters the system — hospital, physician practice, urgent care center, and so on — he or she will be treated the same way and his or her information will be preserved using the same methods. This can give patients more confidence in the organization and help the merged entity protect its reputation as it grows, which can have a positive impact on patient retention and revenue.


Things to Look for When Formulating a Technology Strategy


As previously mentioned, a key aspect in reviewing technology involves determining whether physician practices and hospitals will continue to use disparate systems or whether integration is possible and preferable.


Here are a few questions to ask when making this decision to ensure the ultimate choice best fits with the entire organization's requirements.


• Does a solution meet the compliance needs of all parties? 


For example, if a physician practice is merging with a hospital, does the solution meet both physician and hospital requirements? Similarly, if a smaller physician practice is joining with a larger one, are the nuances of both entities addressed? If the answer is no, then the organization should consider whether it should seek an alternative product that meets both need sets or whether it should keep separate technology in place. If the answer is yes, the organization should think about how best to implement the technology across various settings. This may involve pulling together an implementation team with representation from all parties to foster a more collaborative onboarding approach to ensure a smooth transition.


• Does the solution offer the necessary depth and breadth of experience?


All compliance tools are not created equally, so organizations must fully vet a solution's capabilities when considering whether to keep an existing product or pursue another one. In particular, organizations should check the level of expert support the technology offers, assessing how easy it is for staff to get questions answered. For example, navigating OSHA compliance is a complex endeavor. Not only should an OSHA tool provide clear guidance on how to meet federal regulations, but it should also have defined pathways for addressing unique issues. So, if a staff member has a question, he should be able to easily reach out to experts at the vendor to get the question answered, with a response arriving in a timely fashion.


• Is the compliance software easy to use? 


Organizations should be especially sensitive to a tool's usability because more people will be interacting with the technology once the merger is complete, and some of these individuals may have very little, if any, experience with automated solutions. A product's ease-of-use will directly correlate to adoption, and compliance technology is only as beneficial as your staff's willingness to reliably and correctly use it. If an organization has to choose between two products, and one has 24-hour customer service, easy-to-navigate pages, robust reporting, and streamlined compliance checklists, then the organization may want to select that tool over one that is not as user-friendly.


An Ounce of Prevention


As organizations continue to consolidate, they should commit time to reviewing compliance tools as part of a larger technology review, mapping out a forward strategy that includes quality compliance technology and support for all settings within the enterprise. By taking a concerted approach, organizations can ensure they remain compliant, promote standardization, and reliably support safety and security initiatives throughout all care settings — proactively mitigating risks while elevating quality.

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Think Your Practice is HIPAA Compliant? Think Again.

Think Your Practice is HIPAA Compliant? Think Again. | HIPAA Compliance for Medical Practices | Scoop.it

You may think you know HIPAA inside and out, but experts say many practices and physicians are making mistakes regarding protected health information (PHI) that could get them into big trouble with the law. Here are nine of the most common compliance missteps they say practices and physicians are making.

1. TEXTING UNENCRYPTED PHI


For most physicians, texting is an easy, convenient, and efficient way to communicate with patients and colleagues. But if a text contains unencrypted PHI, that could raise serious HIPAA problems.


"One of the big things people are doing these days is texting PHI, and people seem to be ignoring the fact that text messages can be read by anyone, they can be forwarded to anyone, [and] they're not encrypted in any fashion when they reside on a telecommunications provider's server," says Jim Hook, director of consulting services at healthcare consulting firm The Fox Group, LLC. "People really need to understand that [short message service (SMS)] text messaging is inherently nonsecure, and it's noncompliant with HIPAA."


That's not to say that texting PHI is never appropriate, it just means that physicians must find a way to do so securely. While the privacy and security rules don't provide explicit text messaging guidelines, they do state that covered entities must have "reasonable and appropriate safeguards to protect the confidentiality, availability, and integrity of protected health information," says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC. As a result, Caswell, who formerly worked for HHS' Office for Civil Rights, says physicians must consider, "What would I put on my [smart] phone to reasonably and appropriately safeguard that information?" Most likely, the answer will be a secure messaging service with encryption, she says, adding that many inexpensive solutions are available to providers.


2. E-MAILING UNENCRYPTED PHI


Similar to text messaging, many physicians are e-mailing unencrypted PHI to patients and colleagues. As Robert Tennant, senior policy adviser of government affairs for the Medical Group Management Association says, e-mailing is becoming ubiquitous in our society, and healthcare is no exception.


If your providers are e-mailing PHI, consider implementing a secure e-mail application; for instance, one that recognizes when content included in the e-mail contains sensitive information and therefore automatically encrypts the e-mail. Your practice could use the application to specify certain circumstances in which e-mails should be encrypted; such as the inclusion of social security numbers or credit card numbers. The application would then filter e-mails for that specified content, and when it finds that content, encrypt those e-mails automatically, says Caswell.


Another option is to use a secure e-mail application to set up filters to automatically encrypt e-mails sent with attachments, or encrypt e-mails when senders include a word like "sensitive" or "encrypt" in the subject line, she says. An added benefit of encrypting e-mail is if a potential breach occurs, like the theft of a laptop containing e-mails with PHI, that is not considered a reportable breach if the e-mails stored on the laptop are encrypted, says Tennant. "You don't need to go through all of the rigmarole in terms of reporting the breach to the affected individual, and ultimately, to the government," he says. "So it's sort of a get out of jail free card in that sense."


If your practice would rather prohibit the use of e-mail altogether, a great alternative might be a patient portal that enables secure messaging.


Finally, if patients insist on having PHI e-mailed to them despite the risks, get their permission in writing for you to send and receive their e-mails, says Tennant.


3. FAILING TO CONDUCT A RISK ANALYSIS


If your practice has not conducted a security risk analysis — and about 31 percent of you have not, according to our 2014 Technology Survey, Sponsored by Kareo — it is violating HIPAA. The security rule requires any covered entity creating or storing PHI electronically to perform one. Essentially, this means practices must go through a series of steps to assess potential risks and vulnerabilities to the confidentiality, integrity, and availability of their electronic protected health information (ePHI).


Though the security risk analysis requirement has been in place since the security rule was formally adopted in 2003, it's been pretty widely ignored by practices, says Hook. Part of the reason, he says, is lack of enforcement of the requirement until recently. Since conducting a security risk analysis is now an attestation requirement in the EHR incentive program, auditors are increasingly noting whether practices are in compliance.


4. FAILING TO UPDATE THE NPP


If your practice has not updated its Notice of Privacy Practices (NPP) recently, it could be violating HIPAA. The HIPAA Omnibus Rule requires practices to update these policies and take additional steps to ensure patients are aware of them, says Tennant.

Some of the required updates to the NPP include:


• Information regarding uses and disclosures that require authorization;


• Information about an individual's right to restrict certain disclosures of PHI to a health plan; and


• Information regarding an affected individual's right to be notified following a privacy or security breach.


In addition to updating the NPP, a practice must post it prominently in its facility and on the website, and have new patients sign it and offer a copy to them, says Tennant. "I'd say of every 10 practices, hospitals, dental offices I go into, nine of them don't have their privacy notice in the waiting room," he says.


5. IGNORING RECORD AMMENDMENT REQUESTS


Don't hesitate to take action when patients request an amendment to information in their medical records, cautions Cindy Winn, deputy director of consulting services at The Fox Group, LLC. Under the HIPAA Privacy Rule, patients have the right to request a change to their records, and providers must act on those requests within 60 days, she says.


If you disagree with a patient's requested change, you must explain, in writing, why you are not making the requested change, says Hook. Then, share that reasoning with the patient and store a copy of it in the patient's medical record, as well as a copy of the patient's written request for the amendment.


6. NOT PROVIDING ENOUGH TRAINING


The privacy and security rules require formal HIPAA education and training of staff. Though the rules don't provide detailed guidance regarding what training is required, Hook recommends training all the members of your workforce on policies and procedures that address privacy and security at the time of hire, and at least annually thereafter.


The HIPAA Security Rule also requires practices to provide "periodic security reminders" to staff, says Caswell, adding that many practices are unaware of this. Actions that might satisfy this requirement include sending e-mails to staff when privacy and security issues come up in the news, such as information about a recent malware outbreak; or inserting a regular "security awareness" column in staff e-newsletters.

Finally, be sure to document any HIPAA training provided to staff.


7. OVERCHARING FOR RECORD COPIES


With few exceptions, the privacy rule requires practices to provide patients with copies of their medical records when requested. It also requires you to provide access to the record in the form requested by the individual, if it is readily producible in that manner.


While practices can charge for copies of records, some practices may be getting into trouble due to the fee they are charging, says Tennant. "HIPAA is pretty clear that you can only charge a cost-based fee and most of those are set by the state, so most states have [limits such as] 50 cents a page up to maybe $1 a page ... but you can't charge a $50 handling fee or processing fee; at least it's highly discouraged," says Tennant.


To ensure you are following the appropriate guidelines when dealing with record copy requests, review your state's regulations and consult an attorney. Also, keep in mind that though the privacy rule requires practices to provide copies within 30 days of the request, some states require even shorter timeframes.


8. BEING TOO OPEN WITH ACCESS


If your practice does not have security controls in place regarding who can access what medical records and in what situations, it's setting itself up for a HIPAA violation. The privacy rule requires that only those who have a valid reason to access a patient's record — treatment purposes, payment purposes, or healthcare operations — should do so, says Caswell. "If none of those things exist, then a person shouldn't [access] an individual's chart."


Caswell says practices need to take steps to ensure that staff members do not participate in "record snooping" — inappropriately accessing a neighbor's record, a family member's record, or even their own record.


She recommends practices take the following precautions:

• Train staff on appropriate record access;

• Implement policies related to appropriate record access; and

• Run EHR audits regularly to determine whether inappropriate access is occurring.


9. RELEASING TOO MUCH INFORMATION


Similar to providing too much access to staff, some practices provide too much access to outside entities, says Caswell. For instance, they release too much PHI when responding to requests such as subpoenas for medical records, requests for immunization information from schools, or requests for information from a payer.


"If there's, say, for instance, litigation going on and an attorney says, 'I need the record from December 2012 to February 2014,' it is your responsibility to only send that amount of information and not send anything else, so sort of applying what's called the minimum necessary standard," says Caswell. "When you receive outside requests for PHI, pay close attention to the dates for which information is requested, as well as the specific information requested."

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Complying with the HIPAA Nondisclosure Rule

Complying with the HIPAA Nondisclosure Rule | HIPAA Compliance for Medical Practices | Scoop.it

Under the HIPAA Omnibus Rule, patients can request a restriction on a disclosure of PHI to a health plan if they pay out of pocket, in full for the service. Practices must agree to such a request unless they are required by law to bill that health plan (as is the case with some Medicaid plans).

During a session at the Medical Group Management Association 2014 Annual Conference, Loretta Duncan, senior medical practice consultant with malpractice insurer the State Volunteer Mutual Insurance Company in Brentwood, Tenn., shared some of her compliance tips:


• If the service the patient does not want disclosed is bundled with something else, explain that the patient may need to pay more out-of-pocket costs than expected.

• Make sure that communication is tight between all staff and departments regarding nondisclosure.

• Document your new nondisclosure policies and procedures.

• Be careful when e-prescribing, as pharmacies may bill to the insurance plan before the patient has a chance to let the pharmacy know that the information should not be disclosed.

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