healthy4u: HIPAA

But Don't Worry, Your Health Information is Secure: the Enforcers are Themselves Incompetent and Broke

Another in my "But Don't Worry, Your Health Information is Secure" series (see <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy">http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy</a>) ... a promise blindly made by the healthcare information technology hyper-enthusiasts. <blockquote class="tr_bq">The Office of the Inspector General for HHS just issued a report finding that the Office of Civil Rights (OCR), which is charged with enforcing the HIPAA/HITECH law, had itself failed to adequately protect the security of the health information it handled. Specifically OIG found that OCR “focused on system operability to the detriment of system and data security.”</blockquote> From “The Office for Civil Rights Did Not Meet All Federal Requirements in Its Oversight and Enforcement of the Health Insurance Portability and Accountability Act Security Rule”, p. ii (Nov. 2013).  <a href="http://oig.hhs.gov/oas/reports/region4/41105025.asp">http://oig.hhs.gov/oas/reports/region4/41105025.asp</a><a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=cnmQxxd1ok6fZ7r1yAFMffFwO7p2yNAIzU9ZEphzhXivZep_Icu-CQf-7PEVpCAa1XTvDnjs5d4.&URL=http%3a%2f%2foig.hhs.gov%2foas%2freports%2fregion4%2f41105025.asp" style="color: purple;" target="_blank"></a> <div class="line">Summary:</div><div class="line"> </div><blockquote class="tr_bq">The Office for Civil Rights (OCR) did not meet certain Federal requirements critical to the oversight and enforcement of the Health Insurance Portability and Accountability Act Security Rule (Security Rule). OCR had not assessed risks, established priorities, or implemented controls for its Federal requirements to provide for periodic audits of covered entities to ensure their compliance with Security Rule requirements. In addition, OCR's Security Rule investigation files did not contain required documentation supporting key decisions made because management had not implemented sufficient controls, including supervisory review and documentation retention, to ensure investigators follow investigation policies and procedures for properly initiating, processing, and closing Security Rule investigations. Further, OCR had not fully complied with Federal cybersecurity requirements for its information systems used to process and store investigation data because it focused on system operability [I presume they mean 'interoperability' - ed.] to the detriment of system and data security. We recommended that OCR (1) assess the risks, establish priorities, and implement controls for its HITECH auditing requirements; (2) provide for periodic audits in accordance with HITECH to ensure Security Rule compliance at covered entities; (3) implement sufficient controls, such as supervisory reviews and documentation retention, to ensure policies and procedures for Security Rule investigations are followed; and (4) implement the National Institute of Standards and Technology Risk Management Framework for systems used to oversee and enforce the Security Rule. In its comments on our draft report, OCR generally concurred with our recommendations and described the actions it has taken to address them. In specific comments on our second recommendation, however, OCR explained that no funds had been appropriated for it to maintain a permanent audit program and that funds used to support audit activities previously conducted were no longer available.</blockquote> The enforcers are themselves negligent, incompetent and broke.  And hospitals are expected to keep electronic protected health information secure? I comment no further.  What more could I possibly write? -- SS Dec. 9, 2013 Addendum: This woman would probably agree that this is a problem <blockquote class="tr_bq">Dec. 9, 2013 <a href="http://www.thestar.com/news/gta/2013/11/28/disabled_woman_denied_entry_to_us_after_agent_cites_supposedly_private_medical_details.html">http://www.thestar.com/news/gta/2013/11/28/disabled_woman_denied_entry_to_us_after_agent_cites_supposedly_private_medical_details.html </a> Disabled woman denied entry to U.S. after agent cites supposedly private medical details A Toronto woman is shocked after she was denied entry into the U.S. because she had been hospitalized for clinical depression. Ellen Richardson went to Pearson airport on Monday full of joy about flying to New York City and from there going on a 10-day Caribbean cruise for which she’d paid about $6,000. But a U.S. Customs and Border Protection agent with the Department of Homeland Security killed that dream when he denied her entry. “I was turned away, I was told, because I had a hospitalization in the summer of 2012 for clinical depression,’’ said Richardson, who is a paraplegic and set up her cruise in collaboration with a March of Dimes group of about 12 others. The Weston woman was told by the U.S. agent she would have to get “medical clearance’’ and be examined by one of only three doctors in Toronto whose assessments are accepted by Homeland Security. She was given their names and told a call to her psychiatrist “would not suffice.’’ At the time, Richardson said, she was so shocked and devastated by what was going on, she wasn’t thinking about how U.S. authorities could access her supposedly private medical information. “I was so aghast. I was saying, ‘I don’t understand this. What is the problem?’ I was so looking forward to getting away . . . I’d even brought a little string of Christmas lights I was going to string up in the cabin. . . . It’s not like I can just book again right away,’’ she said, referring to the time and planning that goes into taking a trip as a disabled person. Richardson said she’d had no discussion whatsoever with the agent at the airport about her medical history or background. </blockquote> Read the whole thing. -- SS

But Don't Worry, Your Health Information is Secure: the Enforcers are Themselves Incompetent and Broke

Another in my "But Don't Worry, Your Health Information is Secure" series (see http://hcrenewal.blogspot.com/search/label/med...

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Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At "<a href="http://hcrenewal.blogspot.com/2009/04/should-google-seek-resignations-of.html">Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?</a>" I expressed great concern about what I term the cross occupational intrusion of the IT industry into healthcare. My major concern in that post was how the information technologists at Google, even with nearly unlimited access to capital (and therefore to the world's informatics expertise) badly mismanaged a Personal Health Records (PHR) project through commission of a most fundamental biomedical information science blunder (quite distinct from IT; most IT technologists and MIS personnel really stink at biomedical information science). They tried to map relatively ungranular, imprecise, and often misused billing codes back to enduser-viewable diagnoses, resulting in easily predictable patient panic and mayhem. As usual in HIT: it's possibly even worse. I am quite concerned about a letter from the consumer education and advocacy organization <a target="blank" href="http://www.consumerwatchdog.org/about/">Consumer Watchdog.org</a> and their allegations that Google has been lobbying Congress to be excluded from HIPAA provisions on privacy and forbidding sales of medical records. The letter, dated April 22, is <a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">here</a> (<a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf</a>). Considering that Google is heavily into the PHR space, and even worse, considering they made an Informatics 101 error in attempting to map billing codes into user-viewable diagnostic data, I would (and I'm sure others would as well) view such attempts if they indeed occurred as ominous, a true heavy handed intrusion of the IT industry not only into the affairs of medicine but into what really is another human rights issue. (I'd pointed out another potential HIT-related human rights issue at the post "<a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html">UPMC as Proving Ground for IT Tests On Children</a>".) I would be interested in additional information on the Google lobbying issue, especially from those at Harvard and other academic centers who have been involved in the Google PHR initiative. I have shared these concerns with the American Medical Informatics Association (<a href="http://www.amia.org/">AMIA</a>) clinical information systems workgroup (cis-wg) and the people & organizational issues workgroup (poi-wg) as well. I hope the Consumer Watchdog allegations are not accurate, because if they are valid, the implications of national EHR grow increasingly unsettling.

Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At " Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle? " I expressed great concern about wh...

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