Clouds in healthcare should be viewed as ominous- Quotes from Dr. Deborah Peel

A recent article in FierceEMR written by Marla Durben Hirsch quotes Dr. Peel about the dangers of cloud technology being used in healthcare. Dr. Peel tells FierceEMR that “There’s a lot of ignorance regarding safety and privacy of these [cloud] technologies”.

Here are a few key quotes from the story:

“It’s surely no safe haven for patient information; to the contrary it is especially vulnerable to security breaches. A lot of EHR vendors that offer cloud-based EHR systems don’t take measures to keep patient data safe. Many of them don’t think they have to comply with HIPAA’s privacy and security rules, and many of their provider clients aren’t requiring their vendors to do so.” (Hirsch)

“Many providers have no idea where the vendor is hosting the providers’ patient data. It could be housed in a different state; or even outside of the country, leaving it even more vulnerable. ‘If the cloud vendor won’t tell you where the information is, walk out the door,’ Peel says.”

“Then there’s the problem of what happens to your data when your contract with the cloud vendor ends. Providers don’t pay attention to that when they sign their EHR contract, Peel warns.”

“‘The cloud can be a good place for health information if you have iron clad privacy and security protections,’ Peel says. ‘[But] people shouldn’t have to worry about their data wherever it’s held.’”

Cloud Computing: HIPAA’s Role

The below excerpts are taken from the GOVinfoSecurity.com article Cloud Computing: HIPAA’s Role written by Marianne Kolbasuk McGee after the January 7, 2013 Panel in Washington D.C.: Health Care, the Cloud, & Privacy.

“While a privacy advocate is demanding federal guidance on how to protect health information in the cloud, one federal official says the soon-to-be-modified HIPAA privacy and security rules will apply to all business associates, including cloud vendors, helping to ensure patient data is safeguarded.

Joy Pritts, chief privacy officer in the Office of the National Coordinator for Health IT, a unit of the Department of Health and Human Services, made her comments about HIPAA during a Jan. 7 panel discussion on cloud computing hosted by Patient Privacy Rights, an advocacy group…

…Deborah Peel, M.D., founder of Patient Privacy Rights, last month sent a letter to the Department of Health and Human Services’ Office for Civil Rights urging HHS to issue guidance to healthcare providers about data security and privacy in the cloud (see: Cloud Computing: Security a Hurdle).

“The letter … asks that [HHS] look at the key problems in cloud … and what practitioners should know and understand about security and privacy of health data in the cloud,” Peel said during the panel.”

OCR Could Include Cloud Provision in Forthcoming Omnibus HIPAA Rule

The quotes below are from an article written by Alex Ruoff in the Bloomberg Health IT Law and Industry Report.

“Deborah Peel, founder of Patient Privacy Rights, said few providers understand how HIPAA rules apply to cloud computing. This is a growing concern among consumer groups, she said, as small health practices are turning to cloud computing to manage their electronic health information. Cloud computing solutions are seen as ideal for small health practices as they do not require additional staff to manage information systems, Peel said.
Cloud computing for health care requires the storage of protected health information in the cloud—a shared electronic environment—typically managed outside the health care organization accessing or generating the data (see previous article).
Little is known about the security of data managed by cloud service providers, Nicolas Terry, co-director of the Hall Center for Law and Health at Indiana University, said. Many privacy advocates are concerned that cloud storage, because it often stores information on the internet, is not properly secured, Terry said. He pointed to the April 17 agreement between Phoenix Cardiac Surgery and HHS in which the surgery practice agreed to pay $100,000 to settle allegations it violated HIPAA Security Rules (see previous article).
Phoenix was using a cloud-based application to maintain protected health information that was available on the internet and had no privacy and security controls.

Demands for Guidance

Peel’s group, in the Dec. 19 letter, called for guidance “that highlights the lessons learned from the Phoenix Cardiac Surgery case while making clear that HIPAA does not prevent providers from moving to the cloud.”

Peel’s letter asked for:
• technical safeguards for cloud computing solutions, such as risk assessments of and auditing controls for cloud-based health information technologies;
• security standards that establish the use and disclosure of individually identifiable information stored on clouds; and
• requirements for cloud solution providers and covered entities to enter into a business associate agreement outlining the terms of use for health information managed by the cloud provider.”

OCR Could Include Cloud Provision in Forthcoming Omnibus HIPAA Rule

The below excerpt is from the Bloomberg BNA article OCR Could Include Provision in Forthcoming Omnibus HIPAA Rule written by Alex Ruoff. The article is available by subscription only.

“The final omnibus rule to update Health Insurance Portability and Accountability Act regulations, expected to come out sometime early this year, could provide guidance for health care providers utilizing cloud computing technology to manage their electronic health record systems, the chief privacy officer for the Office of the National Coordinator for Health Information Technology said Jan. 7 during a panel discussion on cloud computing.

The omnibus rule is expected to address the health information security and privacy requirements for business associates of covered entities, provisions that could affect how the HIPAA Privacy Rule affects service providers that contract with health care entities, Joy Pritts, chief privacy officer for ONC, said during the panel, hosted by the consumer advocacy group, Patient Privacy Rights (PPR).

PPR Dec. 19 sent a letter to Health and Human Services’ Office for Civil Rights Director Leon Rodriguez, asking the agency to issue guidance on cloud computing security. PPR leaders say they have not received a response…

…Deborah Peel, founder of Patient Privacy Rights, said few providers understand how HIPAA rules apply to cloud computing. This is a growing concern among consumer groups, she said, as small health practices are turning to cloud computing to manage their electronic health information.”

Vast cache of Kaiser patient details was kept in private home

The excerpt below is from the LA Times article Vast cashe of Kaiser patient details was kept in private home by Chad Terhune. This shows both the negligence of Kaiser in caring for their patients, but also the lack of privacy and security that is frequently found in electronic health records.

“Federal and state officials are investigating whether healthcare giant Kaiser Permanente violated patient privacy in its work with an Indio couple who stored nearly 300,000 confidential hospital records for the company.

The California Department of Public Health has already determined that Kaiser “failed to safeguard all patients’ medical records” at one Southern California hospital by giving files to Stephan and Liza Dean for about seven months without a contract. The couple’s document storage firm kept those patient records at a warehouse in Indio that they shared with another man’s party rental business and his Ford Mustang until 2010.

Until this week, the Deans also had emails from Kaiser and other files listing thousands of patients’ names, Social Security numbers, dates of birth and treatment information stored on their home computers.

The state agency said it was awaiting more information from Kaiser on its “plan of correction” before considering any penalties.

Officials at the U.S. Department of Health and Human Services began looking into Kaiser’s conduct last year after receiving a complaint from the Deans about the healthcare provider’s handling of patient data, letters from the agency show. Kaiser said it hadn’t been contacted by federal regulators, and a Health and Human Services spokesman declined to comment.”

Health Care, the Cloud, and Privacy, Jan. 7 Panel

Health Care, the Cloud, and Privacy

Phoenix Park Hotel
520 North Capitol Street, NW | Washington, DC 20001
Georgian Room
Monday, January 7, 2013 | 12:00 p.m. ET

On behalf of Patient Privacy Rights (PPR), you are invited to attend a panel discussion on health care system privacy challenges posed by cloud computing. The one-hour discussion, “Health Care, the Cloud, and Privacy,” will be held on Monday, January 7, 2013 at the Phoenix Park Hotel in Washington, D.C. Boxed lunches will be provided.

With technological innovations that promise better efficiency and lower cost, one of the most anticipated developments is how industry and regulators will respond. That question today is focused intently on cloud computing and the implications for corporations with electronic systems containing sensitive consumer health data. Who is handling patient data? How do HIPAA and other health privacy laws and rights function in the cloud? What can policymakers do to better protect our sensitive medical data?

Our distinguished panel will feature:

Joy Pritts
Chief Privacy Officer
Office of the National Coordinator for Health IT
U.S. Department of Health and Human Services

Deborah C. Peel, MD
Founder and Chair
Patient Privacy Rights (PPR)

Nicolas P. Terry
Hall Render Professor of Law
Indiana University Robert H. McKinney School of Law

Lillie Coney
Associate Director
Electronic Privacy Information Center (EPIC)

Please RSVP to Jenna Alsayegh at jalsayegh@deweysquare.com.

We hope to see you there!

And there is more:
View the Invitation as a PDF
View the Press Release

PPR also sent a letter to the Office of Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) that urges for more comprehensive guidance on securing patient data in “the cloud.” With the healthcare industry moving their records to electronic databases, PPR sees a number of issues associated with cloud computing services, including compliance with existing healthcare privacy laws like the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, stronger state and federal health information privacy laws, medical ethics, and Americans’ rights to health information privacy. View the letter here.

Patient privacy group (PPR) asks HHS for HIPAA cloud guidance

Government HealthIT recently wrote an article about Dr. Peel’s of Patient Privacy Rights’ letter to the HHS Office for Civil Rights pushing for security guidelines, standards, and enforcements for cloud technology being used in healthcare.

Here are a few key points highlighted in the article:

“Issuing guidance to strengthen and clarify cloud-based protections for data security and privacy will help assure patients (that) sensitive health data they share with their physicians and other health care professionals will be protected,” Peel said.

“Cloud-computing is proving to be valuable, Peel said, but the nation’s transition to electronic health records will be slowed ‘if patients do not have assurances that their personal medical information will always have comprehensive and meaningful security and privacy protections.’”

“Patient Privacy Rights, a group founded in 2006, is encouraging HHS to adopt guidelines that highlight ‘the lessons learned from the Phoenix Cardiac Surgery case while making it clear that HIPAA does not prevent providers from moving to the cloud as long as it is done responsibly and in compliance with the law.’”

“In general, Peel said, cloud providers and the healthcare industry at large could benefit from guidance and education on the application of federal privacy and security rules in the cloud. ‘HHS and HIPAA guidance in this area, to date, is limited,’ Peel said, recommending the National Institute of Standards and Technology’s cloud privacy guidelines as a baseline.”

Dangers of Consumer Internet Services in Health Care

Although Internet services like Gmail, Yahoo! Mail, Hotmail and Google Calendar are familiar to patients and doctors, use of such services in health care environments creates a serious privacy risk. The U.S. Department of Health & Human Services took action earlier this year when it discovered that Phoenix Cardiac Surgery, a five-physician clinic in Arizona, was posting patient appointments on the web using Google Calendar. As a result, the appointments could be found by anyone searching the Internet. Make sure your doctors and health care providers are not using consumer Internet services such as the ones identified above to store protected health information.

Health care providers should only use cloud services that are designed to comply with HIPAA and offer a HIPAA Business Associate Agreement.

You can contact PPR if you have questions or concerns about the use of consumer Internet services by health care providers and the security of your health information.

Sizing Up De-Identification Guidance, Experts Analyze HIPAA Compliance Report (quotes PPR)

To view the full article by Marianne Kolbasuk McGee, please visit: Sizing Up De-Identification Guidance, Experts Analyze HIPAA Compliance Report.

The federal Office of Civil Rights (OCR), charged with protecting the privacy of nation’s health data, released a ‘guidance’ for “de-identifying” health data. Government agencies and corporations want to “de-identify”, release and sell health data for many uses. There are no penalties for not following the ‘guidance’.

Releasing large data bases with “de-identified” health data on thousands or millions of people could enable break-through research to improve health, lower costs, and improve quality of care—-IF “de-identification” actually protected our privacy, so no one knows it’s our personal data—-but it doesn’t.

The ‘guidance’ allows easy ‘re-identification’ of health data. Publically available data bases of other personal information can be quickly compared electronically with ‘de-identified’ health data bases, so can be names re-attached, creating valuable, identifiable health data sets.

The “de-identification” methods OCR proposed are:

  • -The HIPAA “Safe-Harbor” method:  if 18 specific identifiers are removed (such as name, address, age, etc, etc), data can be released without patient consent. But .04% of the data can still be ‘re-identified’
  • -Certification by a statistical  “expert” that the re-identification risk is “small” allows release of data bases without patient consent.

o   There are no requirements to be an “expert”

o   There is no definition of “small risk”

Inadequate “de-identification” of health data makes it a big target for re-identification. Health data is so valuable because it can be used for job and credit discrimination and for targeted product marketing of drugs and expensive treatment. The collection and sale of intimately detailed profiles of every person in the US is a major model for online businesses.

The OCR guidance ignores computer science, which has demonstrated ‘de-identification’ methods can’t prevent re-identification. No single method or approach can work because more and more ‘personally identifiable information’ is becoming publically available, making it easier and easier to re-identify health data.  See: the “Myths and Fallacies of “Personally Identifiable Information” by Narayanan and Shmatikov,  June 2010 at: http://www.cs.utexas.edu/~shmat/shmat_cacm10.pdf Key quotes from the article:

  • -“Powerful re-identification algorithms demonstrate not just a flaw in a specific anonymization technique(s), but the fundamental inadequacy of the entire privacy protection paradigm based on “de-identifying” the data.”
  • -“Any information that distinguishes one person from another can be used for re-identifying data.”
  • -“Privacy protection has to be built and reasoned about on a case-by-case basis.”

OCR should have recommended what Shmatikov and Narayanan proposed:  case-by-case ‘adversarial testing’ by comparing a “de-identified” health data base to multiple publically available data bases to determine which data fields must be removed to prevent re-identification. See PPR’s paper on “adversarial testing” at: http://patientprivacyrights.org/wp-content/uploads/2010/10/ABlumberg-anonymization-memo.pdf

Simplest, cheapest, and best of all would be to use the stimulus billions to build electronic systems so patients can electronically consent to data use for research and other uses they approve of.  Complex, expensive contracts and difficult ‘work-arounds’ (like ‘adversarial testing’) are needed to protect patient privacy because institutions, not patients, control who can use health data. This is not what the public expects and prevents us from exercising our individual rights to decide who can see and use personal health information.

Re: Heart Gadgets Test Privacy-Law Limits

In response to The Wall Street Journal article “Heart Gadgets Test Privacy-Law Limits

This story shows the ethical and legal absurdity of private corporations’ claims to own and control patient records. Greedy corporations are copying their business models from Google and Facebook: sell every piece of information about every individual to any willing buyer.

Despite patients’ strong rights to obtain copies of their entire medical records, including data from devices that monitor health status, most hospitals and electronic health systems don’t yet offer patients a way to download personal health information, which is required by HIPAA and HITECH.

EVEN MORE IMPORTANTLY patients also have very strong ethical, legal, and Constitutional rights to control the disclosure and use of personal health information.

Today’s health IT systems and data exchanges were designed to prevent patient control over personal health information. Most health IT systems have abysmal data security (millions of health data breaches and thefts) and no means for patients to control who can see, use or sell their health data.

Government and Congress have poured $29 billion in stimulus funds into defective technology systems that violate the public’s rights to privacy and control over health information in electronic systems.

Medtronic and hospitals are hiding behind illegal contracts that violate patients’ rights to access and control sensitive personal health information.

We need clear new laws to ban the sale of personal health information without informed consent and RESTORE patient control over use, disclosure, and sale of health information.

-Deborah Peel