HIPAA Security:
A Decade of Breaches;
A Decade of Ignorance
CMGMA Fall Meeting
September 2014
Built to Optimize…
YouTube Video – If Airlines worked
like US Healthcare
https://www.youtube.com/watch?v=5J67xJKpB6c
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
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HIPAA (one “P”, two “A”s)
•HIPAA Stands for:
• Health
• Insurance*
• Portability**
and
• Accountability
• Act
*(not information)
**(not privacy)
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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
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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
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HIPAA Breaches – Type of Breach
All other
14%
Loss
12%
Theft
55%
Unauthorized
access
19%
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HIPAA Breaches – Source of Breach
All other
19%
Laptop
25%
Server
10%
Paper
23%
Computer
11%
Portable
12%
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HIPAA Breaches – Words (All Fields)
All other
23%
EHR
0.10%
Theft
32%
Loss
8%
Portable
8%
Computer
12%
Laptop
17%
Built to Optimize…
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)
Built to Optimize…
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!
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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 !
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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
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HIPAA Security – Graphical Representation
Theft
Loss
Internal
Threats
EPHI
Improper
Access
Accidental
External
Threats
Destruction
CAUSES
Intentional
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.
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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”
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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
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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
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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
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HIPAA is Very Real
Close to home…
…here in Colorado
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You don’t
want to get
one of these
nasty grams…
22
More bad
news…only 15
days to respond;
threatened
penalties
23
Even more bad
news…Freedom of
Information Act may
make this public
24
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
Built to Optimize…
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
Built to Optimize…
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)
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Questions/Discussion
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