Built to Optimize… HIPAA Security: A Decade of Breaches; A Decade of Ignorance CMGMA Fall Meeting September 2014

Built to Optimize…

HIPAA Security:A Decade of Breaches;A Decade of Ignorance

CMGMA Fall MeetingSeptember 2014

https://www.youtube.com/watch?v=5J67xJKpB6c

YouTube Video – If Airlines worked like US Healthcare




Outline

•HIPAA Overview – key definitions, brief history•Examples of HIPAA breaches to date•The biggest HIPAA threats•Real life HIPAA breach example•Cloud – is it HIPAA compliant?•Questions/discussion


HIPAA (one “P”, two “A”s)

•HIPAA Stands for:•Health• Insurance* •Portability** and

•Accountability •Act

*(not information)**(not privacy)


P == Portability

•Old days: • “Cradle-to-grave” patient/doctor relationship•Records belonged to the practice/physician•Patients generally could not even see them

•New world order: •Fragmented HC delivery (specialists, clinics, etc.)•Practices are caretakers of a larger patient record•Patient “activism” – records “belong” to them•Portability made safekeeping rules necessary


HIPAA Breaches - Some macro numbers

•HHS-reported HIPAA breaches since 2009• 600 993 breaches of more than 500 records each•Total is over 22 31 million patient records affected• Largest is 4.9 million (SAIC – Service Provider)•Smallest reported breach (and not on this list) is 441

records (Hospice of Northern Idaho)• Largest pending judgments are $3-4 BILLION in class

action lawsuits (Sutter Health, California) and $3-4 BILLION against SAIC (Service Provider)

All data here and following graphs from:http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html

http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html




HIPAA Breaches – Type of Breach

Theft55%

Unauthorized access19%

Loss12%

All other14%


HIPAA Breaches – Source of Breach

Laptop25%

Paper23%

Portable12%

Computer11%

Server10%

All other 19%


HIPAA Breaches – Words (All Fields)

Theft32%

Laptop17%

Computer12%

Portable8%

Loss8%

EHR0.10% All other

23%


Some Recent Headlines

•Walgreens (1 record; ~$1.44 million judgment)•Community Health Systems (2nd largest; hacking)•LA Gay/Lesbian Clinic (hacking)•Stanford Children’s Hospital (5X offender)•Oregon Health Science Unit (4X offender)•UCLA; Cedars Sanai (celebrity snooping)•Hospice of Northern Idaho (441 records; 50K)•Arizona Surgery Center ($100K fine)•LabMD in Georgia is DOA (CEO is writing a book)

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCAQFjAA&url=http://www.mondaq.com/unitedstates/x/260050/Healthcare/HIPAA%2BViolation%2BResults%2BIn%2B144m%2BJury%2BVerdict%2BAgainst%2BWalgreens%2BPharmacist&ei=MmwMVKikMcGBygTf_IK4Bw&usg=AFQjCNEF72YivezCfAS8G5UBFXsjvacwdg&sig2=9OTLHbZJLRzwsmNpZ1gxpQ&bvm=bv.74649129,d.aWw

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http://www.bizjournals.com/nashville/blog/health-care/2014/08/community-health-systems-hipaa-violation-among.html&ei=YWwMVN-rJY-nyATZp4LoCw&usg=AFQjCNEPGTbLWlOXVJe05-VzFEHrh5R86g&sig2=9HL87ejp5rkPYn7yHbW2qw

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0CDEQFjAC&url=http://healthitsecurity.com/2013/12/11/l-a-gay-and-lesbian-services-suffers-data-breach/&ei=j2wMVJq6MIyPyATG7IC4Dg&usg=AFQjCNEVgtbcWPpL-z14aAzSvC2KCRKBVg&sig2=soazGPkGuh0VFViJMNwORg

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http://www.healthcareitnews.com/news/stanford-reports-fifth-big-hipaa-breach&ei=tWwMVMnVEsGoyASo6ILACw&usg=AFQjCNHvLGCf5pUMlhh2L4G7sZvp2WPIGQ&sig2=CtISTPhrmAYk53i2yUzwRg

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http://www.healthcareitnews.com/news/fourth-big-hipaa-breach-ohsu&ei=1GwMVKaGG9ShyATb-YDwDA&usg=AFQjCNESPF71Ymzzr1xyQxr0N8b76Fy6AQ&sig2=Ma-oNm-wGEHPOGBXkiUwow

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0CDkQFjAD&url=http://www.informationweek.com/healthcare/security-privacy/ucla-health-system-pays-865000-over-priv/231001236&ei=EG0MVO2aBpKBygSwm4DoAQ&usg=AFQjCNF0Op5y4F2TwUymbiB3OUrO6EZvUA&sig2=-k4gt0ZyX0vslmWn7SeBXg

http://www.healthcareitnews.com/news/kardashian-hipaa-breach-catastrophe

http://www.hhs.gov/news/press/2013pres/01/20130102a.html

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http://www.hhs.gov/news/press/2012pres/04/20120417a.html&ei=EmwMVPzNDtS0yATy4YGgBQ&usg=AFQjCNFKn8t9h1aesnEp6BKl2fnGi0VG7A&sig2=QJOsxD8P2POhxvFddihIeg

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http://www.bizjournals.com/atlanta/print-edition/2012/09/07/atlanta-medical-lab-facing-off-against.html?page%3Dall&ei=Y20MVMH0ONK1yASakIGgCw&usg=AFQjCNGAR3-xM1u14LJuMMV4aRTjjyoC6Q&sig2=7780BaKOe04KPlMEWajbyQ


Time to dispel a big myth

•“My HIPAA Security situation is taken care of because I use a certified EHR”

•Number of breaches that have been directly caused by or involved a certified EHR:

ZERO!


HIPAA “Chapter and Verse*”

•HIPAA is contained in the Federal Register, CFR Parts 160, 162 & 164:•Section 164.308 – Administrative•Section 164.310 – Physical•Section 164.312 – Technical•Section 164.314 – Business Associate

Arrangements•Section 164.316 – Policies and

Procedures Documentation*More than 500 pages !


HIPAA on a 3x5 Card:

What does the HIPAA Security Rule* Say?

•Covered Entities must protect and secure all electronic protected health information (ePHI) against:

accidental or intentional causes of: unauthorized access, theft, loss or destruction, from either internal or external sources.

* HIPAA Security governs electronic records. HIPAA Privacy governs paper records

Accidental IntentionalCAUSES

Internal Threats

External Threats

HIPAA Security – Graphical Representation

Destruction

LossTheft

ImproperAccess

EPHI


Definition of ePHI

• “ePHI” is patient health information which is computer based (i.e., created, received, stored, maintained, processed and/or transmitted in, on or through any form of electronic means).

• “Electronic media” includes computers, laptops, memory sticks, USB drives, smartphones, PDAs, servers, data storage systems, backup tapes, disk drives, network systems, email, websites, digital printers/copiers/scanners, etc.


Things HIPAA doesn’t say…

•Length/complexity/change cycle of passwords•Timeout or logoff time interval•Type of encryption (e.g., technically WEP for WiFi is actually HIPAA compliant)•Version of OS such as Win 7, Svr 08 or higher (HIPAA doesn’t name vendor names/products)•Actually doesn’t mention laptops (or tablets, SmartPhones, PDAs, etc.), just “workstations”

Is this the biggest HIPAA threat?


No, this is the biggest HC threat:

By far, the largest number of threats are caused by, or enabled by, internal users – office and clinical staff


HIPAA – A Brief History

•HIPAA signed by President Clinton in 1996•Primary purpose was to make HC insurance portable•Governed paper records•Massive increase in administrative burden to HC•Massive efforts on compliance and training

•HIPAA Security became effective in April 2005•Most people were unaware or chose to ignore it•They assumed “IT had it taken care of”•Thought it was something they had already done


ARRA/HITECH Act 2009

•Part of “Meaningful Use” stimulus – up to $54K/ $63K for physicians, millions of $$ for hospitals to adopt EHRs (Medicare/Medicaid) •Max fines increased from $50,000 to $1.5 million•Fines apply regardless of:•Whether docs/facilities are seeking MU funds•Whether docs/facilities qualify for MU funds (e.g.,

Ambulatory Surgery Centers, self-pay, etc.)•Whether the facility has or uses an EHR


Close to home……here in Colorado

HIPAA is Very Real

22

You don’t want to get one of these nasty grams…

23

More bad news…only 15 days to respond; threatened penalties

24

Even more bad news…Freedom of Information Act may make this public

Prior to 2/2009:Up to $100 per violation$25,000/year cap

After 2/2009:$100 to $50K per violation$1.5 MILLION/year cap

Yikes!


HIPAA compliance is not optional

•HIPAA compliance is required for practices and hospitals to achieve Meaningful Use•Annual risk assessments are required•HHS is doing unannounced audits•HIPAA compliance is required with/without EHR and with/without Meaningful Use


Is “Cloud” HIPAA compliant?

•Many public cloud services are inherently unsafe and are not HIPAA compliant (but unfortunately they are used all the time):•Examples: Gmail; Hotmail; FaceBook; AOL; Twitter;

Flickr; iCloud; basically anything that’s “free”•Poorly designed/poorly run IT services are bad; moving them to the cloud doesn’t fix them•If a cloud provider refuses to sign a BAA or provide SLAs that’s a showstopper


Cloud HIPAA Headlines

•“Mobility and Cloud [Are] Keys to Fulfilling Promise of EMRs” (HealthcareIT News)• “Cloud solutions allow healthcare organizations to deliver

critical patient data…” (IDG White Paper) • "Use the Cloud to Reduce HIPAA Risk“ (HealthcareIT News)• “Google, Microsoft agree: Cloud is now safe enough to use” (

C|Net; Annual RSA Security Conference)

• “Cloud Computing Offers a Public Safety Edge:”• “The cloud is a safe, robust platform for first responders to rely on.”

“I lose control of my information.” Not true. “It’s not secure.” Again, not true.” (LawOfficer.com)

http://www.healthcareitnews.com/navigating-the-cloud

http://www.healthcareitnews.com/navigating-the-cloud

http://m.healthcareitnews.com/blog/cloud-computing-reduces-hipaa-compliance-risk-managing-genomic-data

http://www.cnet.com/news/google-microsoft-agree-cloud-is-now-safe-enough-to-use/

http://www.cnet.com/news/google-microsoft-agree-cloud-is-now-safe-enough-to-use/

http://www.lawofficer.com/cloud


Questions/Discussion

Documents

Built to Optimize… HIPAA Security: A Decade of Breaches; A Decade of Ignorance CMGMA Fall Meeting September 2014