Patient Verification vs. Identity Fraud

A recent article in the Healthcare Info Security discusses a study conducted by the Ponemon Institute, sponsored by Experian’s ProtectMyID. The study asserts that nearly 70 percent of the medical ID theft incidents involved others fraudulently using credentials to obtain healthcare services. In more than half of the medical ID theft cases, the victims didn’t report the incidents to law enforcement, often because they knew the person who stole their identity.

This is often called the “Robin Hood effect” because family members are allowing the use of their insurance card to cover uninsured relatives. It is understandable why someone might help out an ailing relative, however, cases have been found where cards were used to purchase medical devices and equipment like scooters that were later sold on eBay.

The Affordable Care Act estimates that healthcare reform could bring coverage to 30 million uninsured who lack coverage. By covering more people with healthcare, we should see a substantial drop in the number of uninsured but will we see a corresponding drop in medical ID theft? That may be optimistic.

That’s because not all health insurance policies are created equal. Some of the least expensive new offerings expected to be obtainable on the market, or provided through the expansion of state-level Medicaid and Children’s Health Insurance Programs, might not offer all the benefits someone wants, Ponemon says. There could still be a motivation to fraudulently gain access to better polices which have more benefits.

One way to deter medical identity fraud is to add advanced technologies like biometrics to insurance cards. The biometrics would be used to verify the identity of the patient at every visit and would prevent fraudulent use of the insurance plan. Biometric identification would also support […]

Utah Getting Act Together on Healthcare IT Security

Healthcare IT security has been a sensitive subject for the past 12 months in Utah’s health care community with two major healthcare security breaches.

The Future of EHR Security: Good and Bad News

The future of Electronic Health Records (EHR) security will be impacted by the findings of several studies conducted in the past year. From what I can tell, these studies bring with them both good and bad news.

The Case for a Biometric Identifier on Health Care Records

Americans have long been concerned about privacy and have never supported a National Identity Card of any kind. But when it comes to electronic health records, we might have to give that a second thought. Right now Health and Human Services is taking comments on Conditions for Trusted Exchange (CTE) of Electronic Healthcare Care records within a Nationwide Health Information Network. They are trying to determine how to verify that your health care records are indeed Your Health Care records when they transfer information between parties.

The complexity of verifying personal identity without biometric authentication on a national level is mind-boggling. How many thousands of John Smiths and James Johnsons are there in this country? According to Howmanyofme.com there are 45,354 people named John Smith in the United States and 35,933 people in the U.S. named James Johnson. What is the probability that hundreds of those individuals also share the same birthdate?

The HHS is recommending a goal of achieving a 99.9% match rate, but no matter how sophisticated the demographic matching algorithm might be, no CTE could be expected to achieve a specificity of 99.9% when dealing with the population of the whole country. Adding some sort of biometrics, whether it be iris scans, hand scans or finger prints, will add the needed level of identification that is mandatory in life and death situations.

If every person had a medical card, which carried electronic identification data, they could have access to their medical records wherever they went. They could give access to new medical practitioners while avoiding the need to fill out the packet of forms at each appointment.

Today thousands of individuals who work in private industry and government have such a card that allows them […]

New Security Rules for the Electronic Health Care Record Incentive Program

In 2009, the Ways and Means committee put forth the Health Information Technology for Economic and Clinical Health Act or HITECH Act. The bill states that Health information technology helps save lives and lower costs. One of the four major goals of the legislation is to “Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care”.

Stage  1 of the program required hospitals and eligible professionals (physicians) to conduct or review a risk analysis and implement security updates as necessary to correct identified security deficiencies.

The proposed Stage 2 rule includes the identical requirement. But it adds that the assessment must include “addressing the encryption/security of data at rest.”

The proposed rule specifically states: “We do not propose to change the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule requirements or require any more than would be required under HIPAA. We only emphasize the importance of an eligible professional or hospital including in its security risk analysis an assessment of the reasonableness and appropriateness of encrypting electronic protected health information as a means of securing it, and where it is not reasonable and appropriate, the adoption of an equivalent alternative measure.”

Recommended Security Changes

The proposed rule would not alter the HIPAA Security Rule’s requirements on encryption. Under that rule, encryption is “addressable,” which means it must be implemented if doing so is reasonable and appropriate – which stops short of an outright mandate.
Office of the National Coordinator for Health IT, proposes ” that Electronic Health Record [EHR] vendors … by default enable encryption of data on end-user devices if any data is kept on user devices after the session ends”.
That Secure Messaging is used when doctors communicate with […]

Medical Records Access Report Too Burdensome

On May 31, 2011, the Department of Health and Human Services’ (HHS) Office for Civil Rights proposed a new rule recommending that patients have the right to ask for a report on who has accessed their medical records. The recommendation has been out for public comment since that time.

A number of healthcare organizations including the Medical Group Management Association (MGMA), the College of Healthcare Information Management Executives and the American Health Information Management Association are asking the Department of Health and Human Services’ Office for Civil Rights to reconsider the access report requirement.

The reasons given give are:

Few patients request such information and it would cost too much to add that feature to every system. 55% of 1,400 physicians surveyed stated that they had not received such a request in the past year.
MGMA contends the access report proposal could do more harm than good. There is concern that the proposed rule could serve as a “disincentive” for adoption of Electronic Health Records.
There was also concern about compromising the privacy of the health care professionals,  particularly Mental Health care providers who sometimes use pseudonyms “to avoid patients stalking or contacting them outside the workplace.”

The recommended solution is for the patient to provide a list of specific names to determine whether those individuals have or have not accessed the patient’s information.

The HHS is accepting comments on the proposed rule till August 1st.  Apparently, they will have a number of positions to reconsider before they find the right balance of cost effectiveness and protecting the privacy rights of both patients and clinicians.

HealthCare Providers Need IT Security Training

It appears that the health care industry lacks understanding of basic information technology security. Dr David Lee Scher, MD, just wrote an article for the Healthcare IT and Technology blog outlining five things healthcare providers should know about electronic health care record security. From his article, it is obvious that health care workers could use some IT security training.

Here are some of the problems he described.

30% of physicians did not use antivirus on their office computers.
34% of physicians offices did not have network firewalls.
The Inspector General of the HHS Office for Civil Right inspected 7 hospitals for HIPPA compliance and found that although ALL of them had implemented some policy and rules to protect EHRs, None had implemented sufficient controls to adequately protect patient privacy. Common violations were improper disposal of printed records and leaving computer screen on and unattended.
Most EHR systems date and time stamp all entries, these entries are permanent records and cannot be deleted, just corrected so healthcare providers should be careful about what they put in the record. The entry log may be audited by the practice or IT manager , as well as attorneys during discovery.
Most breaches of privacy data, do not come from “Hackers” but from improperly stored or lost data from individual not following hospital security protocols.

Data Security is the responsibility of everyone in the hospital or the doctor’s office. All staff should be fully aware their role and responsibilities in keeping private patient information safe and secure. Like anyone else who works with Information Technology, healthcare providers should have annual security training and be aware of the consequences for not following the protocols.

You can read Dr. Scher’s blog at healthcaretechnologymagazine.com.

Access Logs Recommended for EHRs

Department of Health and Human Services’ Office for Civil Rights’ recent notice of proposed rulemaking on accounting of disclosures introduces a valuable privacy tool for individuals—the access report.

The HIPAA Security Rule’s information system activity review specification [164.308(a)(1)] requires organizations to “implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.” The rule’s audit controls standard [164.312(b)] requires organizations to “implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information.”

Adam Greene, the primary author of the proposed accounting of disclosures rule mandated under the HITECH Act, states that the proposed rule takes a two-pronged approach.

First, the proposed rule spells out revised HIPAA requirements to provide patients with an accounting of disclosures of protected health information to outside parties for certain purposes, such as law enforcement and public health.

Second, the proposal requires providing patients, upon request, with “access reports” that summarize who electronically accessed their information. Greene explains the rule attempts to address “What’s the best way to get the information that individuals are most interested in, which is, who has seen their records?” He points out that under the proposed rule, a patient could simply ask whether a specific individual has electronically accessed their records, or they could ask for a complete list of everyone who has accessed them.

Kate Borten, president of The Marblehead Group, a health information privacy and security consulting firm, agrees that the Access Report recommendation deserves industry support.

“Access logs and reports are the primary, if not only, way for organizations and individuals to identify inappropriate electronic snooping by otherwise authorized user—a serious problem wherever many users have access […]

Health IT Policy Committee Recommends Two-Factor Authentication for EHRs

The Health IT Policy Committee on June 8 accepted a recommendation that all organizations participating in the Nationwide Health Information Network initiative (NwHIN) should use digital certificates that meet the same authentication standards already required for federal agencies. Ultimate approval for the recommendation falls on the Department of Health and Human Services.

One of the main motivations for the digital certificate requirement is that most healthcare organizations, at some point, will have to exchange information with a federal agency, and that requires use of Federal Bridge standards.

The authentication recommendation, which came from the Privacy and Security Tiger Team, states, “all certificates used in NwHIN exchanges must meet Federal Bridge standards and must be issued by a certificate authority (or one of its authorized resellers) that is a member of the Federal Public Key Infrastructure Framework.”

Paul Egerman, tiger-team co-chair, told the committee that an electronic health records (EHR) vendor, for example, could serve as a certificate reseller. Plus, about six certificate authorities now offer the Federal Bridge certificates at prices of $100 or less per organization.

In addition to the authentication recommendations, the committee recommended that for stage two of the HITECH Act electronic health record incentive program participants should verify how they’re keeping stored data secure, such as through encryption.

HHS is slated to issue a proposed rule setting requirements for stage two of the EHR incentive program by year’s end, with a final rule due by mid-2012.

In light of that timeline, the HIT Policy Committee on June 8 recommended that HHS fine-tune the deadline for certain participants in the program to achieve stage two benchmarks. Under the revised plan, those that attest to qualifying for stage one in 2011 would have until 2014, instead of 2013, […]

Electronic Health Records Help Bring Hospital Back On Line After Disaster

Just weeks before the powerful F5 tornado ripped though Joplin Missouri severely damaging the St. John’s Regional Medical Center, St. John’s had converted to a new electronic health records system. Having all their records online and backed up in another city, allowed the hospital to be up and running a 60 bed mobile hospital in less than a week.

“If the tornado had hit a month earlier, before installing the electronic health record system in Joplin, St. John’s would not have been able to bring up our mobile hospital within a week’s time. We still would not be operational at this point,” said Mike McCreary of Mercy Technology Services.

“Today, patients have continuity of care across all of our physician locations and the new St. John’s Mercy Hospital, and connection to the entire Mercy health system, because of our EHR and our ability to quickly re-establish communication services.” McCreary noted that St. John’s patients also have access to historical medical records. More current health information was stored within the new EHR, and older paper records had been scanned prior to the tornado and are securely stored on servers located in other communities.

Read the complete story at Healthcaretechnologymagazine.com.

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