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 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.”

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.”

Health-care sector vulnerable to hackers, researchers say

From the Wall Street Journal article by Robert O’Harrow Jr. titled Health-care sector vulnerable to hackers, researchers say

“As the health-care industry rushed onto the Internet in search of efficiencies and improved care in recent years, it has exposed a wide array of vulnerable hospital computers and medical devices to hacking, according to documents and interviews.

Security researchers warn that intruders could exploit known gaps to steal patients’ records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems.

A year-long examination of cybersecurity by The Washington Post has found that health care is among the most vulnerable industries in the country, in part because it lags behind in addressing known problems.

“I have never seen an industry with more gaping security holes,” said Avi Rubin, a computer scientist and technical director of the Information Security Institute at Johns Hopkins University. “If our financial industry regarded security the way the health-care sector does, I would stuff my cash in a mattress under my bed.””

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.

How Medical Identity Theft Can Give You a Decade of Headaches

See the full article at How Medical Identity Theft Can Give You a Decade of Headaches.

This article tells us a cautionary tale about how Arnold Salinas had his identity stolen by someone who took out medical care in his name. Now, any time he gets medical treatment, he has to be extremely careful that his records are actually his own or face the possibility that he will get the WRONG treatment.

“Medical identity theft affected an estimated 1.5 million people in the U.S. at a cost of $41.3 billion last year, according to the Ponemon Institute, a research center focused on privacy and data security. The crime has grown as health care costs have swelled and job cuts have left people without employer-subsidized insurance. Making matters worse: The complexity of the medical system has made it difficult for victims to clear their name.”

It is so important that patients control and are kept abreast of their medical records, but the current system does not make this easy. According to the article, medical identity theft cases are some of the most difficult to solve and can take years. What makes it so difficult is that “‘…you have to go provider by provider, hospital by hospital, office by office and correct each record,” said Sam Imandoust, a legal analyst with the Identity Theft Resource Center. ‘The frustrating part is while you’re going through and trying to clean up the records, the identity thief can continue to go around and get medical services in the victim’s name. Really there’s no way to effectively shut it down.’” Another problem is even finding out your identity has been stolen. According to Pam Dixon, founder of World Privacy Forum, “the fractured nature of the health care system makes medical identity theft hard to detect. Victims often don’t find out until two years after the crime, and cases can commonly stretch out a decade or longer”. Banks and other institutions are used to dealing with identity theft, but the medical industry isn’t equipped to handle this kind of infringement.

5 Held Over Apps that Stole Smartphone Info

Read the full article at 5 Held Over Apps that Stole Smartphone Info.

In Japan, “free apps had reportedly been downloaded up to 270,000 times” infecting at least “90,000 people’s smartphones” with a virus that stole “10 million pieces of personal information from users’ address books”. Creating viruses is a crime in Japan.

Criminals want valuable contact information. How much more valuable do you think personal health information is?

The value of health data is the reason theft is the #1 cause of health data breaches (See “Top Reasons for HITECH Breaches As of October. 17, 2012″ by Melamedia. Sign up for free monthly breach statistics at: http://melamedia.com/index.php).

In the US, millions of employees of corporations can obtain, use, and sell your health data (See ABC News Investigation showing diabetic records for sale from $14-25/record at: http://abcnews.go.com/Health/medical-records-private-abc-news-investigation/story?id=17228986&singlePage=true#.UFKTXVHUF-Y).

Loopholes in HIPAA grant millions of employees of providers, doctors, hospitals, insurers, data clearinghouses, and health technology companies the right to use and sell our electronic health records.  We have no way to know when this happens, it’s part of the hidden US “surveillance economy“.

Tell lawmakers and the next President to require health technology systems that put you in control over who can see, use, and sell your electronic health records—from prescriptions to DNA to diagnoses. 90+% of Americans, both Republicans and Democrats, expect to control access to their sensitive health data.

Onward and upward: ONC to automate Blue Button

See the full article in HealthcareITNews: Onward and upward: ONC to automate Blue Button

Why “Blue Button” matters: It is the critical first step to restore your control over personal health data.

  • -If we can’t get our data (via a “Blue Button”), we can’t use or control it—-much less check for errors.
  • -Few of us expect or know that today our sensitive health data flows to hidden businesses and users that have nothing to do with our health or treatment—which is why we need a map of health data flows:
    • -See Prof Sweeney explain this project in a brief video: http://tiny.cc/f466kw
    • -Today’s electronic health system allows millions of people who work for doctors, hospitals, insurers, health technology companies, and health data clearinghouses, etc, to use, disclose and sell our health data without consent.
  • -The current health technology system guarantees harms: like use of personal health data by employers and banks, ID theft and medical ID theft, and health data sales (see ABC World News story that shows the sale of diabetic patient data at: http://tiny.cc/un96kw ).

In 2001, the HIPAA Privacy Rule stated that patients should be able to download electronic copies of personal health data. Finally the federal government, through the Office of the National Coordinator for Health Information Technology (ONC), will actually require all electronic health records systems to let us do that.

  • -FYI—The box to click and download personal health information is known as a “Blue Button”. Some places already let patients do this (the VA system and MD Anderson for example).

When personal control over health data is restored, we can send our records to all the right places (for treatment and research) and NOT send records to hidden users and corporations that use it now to discriminate against us for jobs or credit, for ID theft, to impersonate us and use our health insurance to obtain treatment (medical ID theft), or for insurance, Medicare, and Medicaid fraud.