Kaiser Had Malware on Server for 2.5 Years

By Joseph Goedert | April 8, 2014 | HealthData Management

The Northern California division of Kaiser Permanente is notifying about 5,100 patients that protected health information was on a server found in February 2014 to be infected with malicious software.

In a letter to patients, the organization says it believes the server was infected in October 2011. Kaiser removed the server–used to store research data–and confirmed other servers were not affected and appropriately secured. “We currently have no information that any unauthorized person accessed the information on the server,” according to the patient letter. “However, the malicious software broke down the server’s security barriers so we are investigating and responding with a very high level of caution and concern. We are very sorry that this happened.”

Information on the server included patient name, date of birth and gender, and also may have included address, race-ethnicity, medical record number, lab results associated with research, and patient responses to questions related to research studies in which they participated. Social Security numbers and data from Kaiser’s electronic health record were not held on the server.

(See also: Top 6 Threats to Enterprise Security)

The new breach soon will be listed on the HHS Office for Civil Rights’ website of major security breaches affecting 500 or more individuals, and it will be Kaiser’s fourth posting on the site.

In late 2013, a missing flash drive from the nuclear medicine department at Anaheim Medical Center resulted in notifications sent to about 49,000 patients. Also in 2013, Kaiser notified 647 patients after learning of unauthorized access/disclosure of the EHR. In late 2009, the organization notified about 15,500 patients following the theft of an electronic portal device.

 

 

 

What You Need to Know About Patient Matching and Your Privacy and What You Can Do About It

Today, ONC released a report on patient matching practices and to the casual reader it will look like a byzantine subject. It’s not.

You should care about patient matching, and you will.

It impacts your ability to coordinate care, purchase life and disability insurance, and maybe even your job. Through ID theft, it also impacts your safety and security. Patient matching’s most significant impact, however, could be to your pocketbook as it’s being used to fix prices and reduce competition in a high deductible insurance system that makes families subject up to $12,700 of out-of-pocket expenses every year.

Patient matching is the healthcare cousin of NSA surveillance.

Health IT’s watershed is when people finally realize that hospital privacy and security practices are unfair and we begin to demand consent, data minimization and transparency for our most intimate information. The practices suggested by Patient Privacy Rights are relatively simple and obvious and will be discussed toward the end of this article.

Health IT tries to be different from other IT sectors. There are many reasons for this, few of them are good reasons. Health IT practices are dictated by HIPAA, where the rest of IT is either FTC or the Fair Credit Reporting Act. Healthcare is mostly paid by third-party insurance and so the risks of fraud are different than in traditional markets.

Healthcare is delivered by strictly licensed professionals regulated differently than the institutions that purchase the Health IT. These are the major reasons for healthcare IT exceptionalism but they are not a good excuse for bad privacy and security practices, so this is about to change.

Health IT privacy and security are in tatters, and nowhere is it more evident than the “patient matching” discussion. Although HIPAA has some significant security features, it also eliminated a patient’s right to consent and Fair Information Practice.

Patient matching by all sorts of health information aggregators and health information exchanges is involuntary and hidden from the patient as much as NSA surveillance is.

Patients don’t have any idea of how many databases are tracking our every healthcare action. We have no equivalent to the Fair Credit Reporting Act to cover these database operators. The databases are both public and private. The public ones are called Health Information Exchanges, All Payer Claims Databases, Prescription Drug Monitoring Programs, Mental Health Registries, Medicaid, and more.

The private ones are called “analytics” and sell $Billions of our aggregated data to hospitals eager to improve their margins, if not their mission.

The ONC report overlooks the obvious issue of FAIRNESS to the patient. The core of Fair Information Practice are Consent, Minimization and Transparency. The current report ignores all of these issues:

- Consent is not asked. By definition, patient matching is required for information sharing. Patient matching without patient consent leads to sharing of PHI without patient consent. The Consent form that is being used to authorize patient matching must list the actual parameters that will be used for the match. Today’s generic Notice of Privacy Practices are as inadequate as signing a blank check.

- Data is not minimized. Citizen matching outside of the health sector is usually based on a unique and well understood identifier such as a phone number, email, or SSN. To the extent that the report does not allow patients to specify their own matching criterion, a lot of extra private data is being shared for patient matching purposes. This violates data minimization.

- Transparency is absent. The patient is not notified when they are matched. This violates the most basic principles of error management and security. In banking or online services, it is routine to get a simple email or a call when a security-sensitive transaction is made.

This must be required of all patient matching in healthcare. In addition, patients are not given access to the matching database. This elementary degree of transparency for credit bureaus that match citizens is law under the Fair Credit Reporting Act and should be at least as strict in health care.

These elementary features of any EHR and any exchange are the watershed defining patient-centered health IT. If a sense of privacy and trust don’t push our service providers to treat patients as first-class users, then the global need for improved cybersecurity will have to drive the shift. Healthcare is critical infrastructure just as much as food and energy.

But what can you, as a patient. do to hasten your emancipation? I would start with this simple checklist:

Opt-out of sharing your health records unless the system offers:

  • Direct secure messaging with patients
  • Plain email or text notification of records matching
  • Patient-specified Direct email as match criterion
  • Your specific matching identifiers displayed on all consent forms
  • Online patient access to matchers and other aggregator databases

None of these five requirements are too hard. Google, Apple and your bank have done all of these things for years. The time has come for healthcare to follow suit.

Adrian Gropper, MD is Chief Technical Officer of Patient Privacy Rights and participates in Blue Button+, Direct secure messaging governance efforts and the evolution of patient-directed health information exchange.

Check out the Latest from Dr. Gropper, courtesy of The Healthcare Blog.

ONC: Looking for ‘realistic’ ways to account for disclosures

“ONC’s Health IT Policy Committee Tiger Team held a virtual hearing Sept. 30 to gather information about the rule and explore ‘realistic ways to provide patients with greater transparency about the uses and disclosures of their digitized, identifiable information,’ according to a Sept. 23 blog post by Committee Chair Devon McGraw. The Tiger Team asked for answers to specific questions, such as what patients want to know and how transparency technologies currently are being used by covered entities.”

“Deborah Peel, Founder and Chair of the Patient Privacy Rights coalition, suggested in her testimony that accounting for disclosures needs to include all of the detailed information about all uses of a patient’s electronic health information; she added that the rule could be implemented by ‘piggybacking’ onto existing initiatives, such as the Blue Button movement.”

Read more: ONC: Looking for ‘realistic’ ways to account for disclosures – FierceEMR

To read Dr. Peel’s testimony on Accounting for Disclosures click here

Security and Privacy of Patient Data Subject of Regulatory Hearing

Representatives of patients, providers, insurers and tech companies testify before federal panel yesterday at the HIT Policy Privacy & Security Tiger Team Virtual Hearing on Accounting for Disclosures.

“We believe it’s the patient’s right to have digital access that is real-time and online for accounting of disclosures,” said Dr. Deborah Peel, the head of Patient Privacy Rights, a group she founded in 2004. Patients “need and want the data for our own health. We need to have independent agents as advisors, independent decision-making tools, we need independence from the institutions and data holders that currently control our information. We need to have agents that represent us, not the interests of corporations,” she said.

“I think the day will come when people will understand that their health information is the most valuable personal information about them in the digital world and that it’s an asset that should be protected in the same way that they protect and control their financial information online,” Peel said.

To view the full article click Security and Privacy of Patient Data Subject of Regulatory Hearing

To view a PDF of the hearing click HIT Policy Privacy & Security Tiger Team Virtual Hearing on Accounting for Disclosures

 

States Review Rules After Patients Identified via Health Records

To view the full article, please visit States Review Rules After Patients Identified via Health Records.

Key Quotes from the Article:

  • -”Some U.S. states are reviewing their policies around the collection and sale of health information to ensure that some patients can’t be identified in publicly available databases of hospital records.”
  • -Bloomberg News, working with Harvard University professor Latanya Sweeney, reported on June 4 that some patients of Washington hospitals could be identified by name and have their conditions and procedures exposed when a database sold by the state for $50 is combined with news articles and other public information.
  • -The state probes are focused on whether privacy standards for health information should be tightened as data-mining technologies get more sophisticated and U.S. President Barack Obama’s health-care overhaul drives rapid growth in the amount of patient data being generated and shared.
  • -Sweeney’s goal of identifying patients is to show that threats to privacy exist in datasets that are widely distributed and fall outside HIPAA’s regulations.

What is Snowden’s Impact on Health IT?

This article expounds upon the implications of Edward Snowden’s actions for the Health IT industry.

Key quotes:

Deborah Peel, MD, founder of Patient Privacy Rights, says there are many parallels between the Snowden controversy and the U.S. healthcare system.

According to Peel, the NSA has one million people with top security clearance to 300 million people’s data. The U.S. healthcare system has hundreds of millions of people — none with top security clearances, and the majority with inadequate basic training in security or privacy — who can access millions of patients’ most sensitive health records. Further, we don’t know how many millions of employees of BAs, subcontractors, vendors and government agencies have access to the nation’s health data, she added.

“Corporations and their employees that steal or sell Americans’ health data for ‘research’ or ‘public health’ uses or for ‘data analytics’ without patients’ consent or knowledge are rewarded with millions in profits; they don’t have to flee the country to avoid jail or charges of espionage,” she said.

“The NSA justifies its actions using the war on terror,” Peel added. “The Department of Health and Human Services claims its actions are justified to lower healthcare costs. These are obviously very different agencies collecting different kinds of very sensitive personal information, but both set up hidden, extremely intrusive surveillance systems that violate privacy rights and destroy trust in government.”

“The benefits of technology can be reaped in all sectors of our economy without the harms if we restore/update our laws to assure privacy of personally identifiable information in electronic systems. Our ethics, principles, and fundamental rights should be applied to the uses of technology,” Peel says.

Sign the Petition for Patient-Controlled Exchange of Health Information

Sign the petition asking Congress to put you in control of exchanging your sensitive health data via Health Data Exchanges (HIEs)!

Sign the petition here.

By the end of the year, every state must have one or more Health Information Exchange (HIEs) so your health data can be transferred to other doctors, the state, the federal government, insurers, technology companies, researchers, commercial users, and many other institutions.

Today those institutions and organizations decide when and to whom to transfer your health data—not you.

KEY PRINCIPLES FOR DATA EXCHANGE USING HIEs:

• You should control whether or not your health information is exchanged.

• You should have full access to electronic copies of all your health information.

• You should know what information the HIE exchanges, stores or collects, with whom your data is shared, and the purpose for using it.

View and sign the petition asking Congress to strengthen the law so Americans can trust electronic health systems and data exchanges.

May 15, 2013 Health Care Symposium – Dialogue on Diversity

PPR Founder Deborah C. Peel, MD Joins Experts at
Dialogue on Diversity’s Health Care Symposium 2013

The Elusive Concept: Health Care a $15 Tr. Economy Can “Afford”

On May 15, 2013, Dr. Deborah Peel will join other experts in Washington, DC for the Health Care Symposium 2013, “The Elusive Concept: Health Care a $15 Trillion Economy Can “Afford.” During the complimentary lunch, the Honorable Donna M. Christian-Christensen will receive Dialogue on Diversity’s Health Leadership Award, followed by Dr. Deborah Peel’s panel.

Registration is free to the public, and a complimentary breakfast will also be provided. See the full agenda with specific times here.

The day begins with focused discussions on the laws of health care as well as the rising costs, followed by a panel on food and nutrition and the need for preventative strategies. After the lunch panel, experts will discuss cultural competency and class and ethnic access disparities. The day will close with a discussion on the  chief medical threats in the United States, such as Cancer, AIDS, and Obesity.

See more on sessions and speakers in this Press Advisory.

For the past two years, Dialogue on Diversity has worked with PPR as a member of the Coalition for Patient Privacy as well as a Consumer Partner of the Health Privacy Summit.

WHAT:

Health Care Symposium 2013
The Elusive Concept: Health Care a $15 Tr. Economy Can “Afford”
WHEN:
Wednesday, May 15th, 2013 | 8:30 a.m. – 3:30 p.m. ET
WHERE:

The American Federation of Teachers
555 New Jersey Avenue, N.W.
Washington, DC 20001

The Right to Obtain Restrictions Under the HIPAA/HITECH Rule: A Return to the Ethical Practice of Medicine

To view the full article, please visit: The Right to Obtain Restrictions Under the HIPAA/HITECH Rule: A Return to the Ethical Practice of Medicine.

Great explanation of how industry has fought to influence those in government that write the ‘rules’ for how federal law works in practice. The key industry tactic is to complain that complying with the law is too costly or impossible or would take too much time. For reasons we don’t understand, the government agency that writes the ‘rules’ takes the side of industry rather than defending patients.

GOP senators seek to ‘reboot’ federal health IT policy, unveil white paper

This article is by subscription only: GOP senators seek to ‘reboot’ federal health IT policy, unveil white paper

“Key GOP senators released a white paper Tuesday (April 16) raising concerns with federal policy on health information technology, and the lawmakers seek feedback from stakeholders — including the administration, hospitals and vendors – on how the program can be improved. The senators worry that the $35 billion allocated to health IT in the 2009 stimulus package is being spent inefficiently and suggest Congress, the administration and stakeholders work together to “reboot” the electronic health record incentive program so that it to accomplish its goals.”

Materials of interest:

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