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Dentists for De-Identification

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A Start-Up Idea

[By Darrell K. Pruitt DDS]

1-darrellpruittAn early, shoestring proposal for a non-profit dedicated to common sense security solutions.

Why? if patients’ identities are unavailable, they cannot be hacked.

Recently, I’ve considered starting a non-profit dedicated to keeping patients’ identities off of dentists’ computers where they are far too easily fumbled thousands at a time. I think I might call it “Dentists for De-identification.” What do you think?

My son Ryan and I have discussed putting together an educational YouTube cartoon – comparing the cost, convenience and security of encrypted Protected Health Information (PHI), to storing PHI, including medical information, only on paper in bulky metal filing cabinets – leaving only nameless, unencrypted dental records on the computer. De-identification is the “other” HIPAA Safe Harbor, meaning if patients’ de-identified dental information is stolen or hacked, nobody has to be notified. And, since the patients’ nameless dental records remain unencrypted, de-ID should not slow down work flow like encryption does.

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eHRs

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One could call employing in-house reference numbers to re-connect patients’ digital dental information to paper-based PHI a hybrid solution to an otherwise intractable security problem. The solution is nothing new, and has a long history of success. For decades, police departments have been substituting in-house reference numbers for citizens’ names to protect the owners. I see no reason it cannot work for dental radiographs as well.

Depending on staff’s familiarity with the alphabet, pulling a patient’s thin paper record from a loud filing cabinet might even take less time than correctly typing in an encryption key (on the first try). What’s more, since there is a limit to the number of patients even the fastest dentists can treat in one day, 4000 or so active patients per dentist is a reasonable estimate of the number of records in a  busy dental practice – which is probably one third of the records in the average physician’s practice. Since the dental information remains digital and only a couple of sheets of paper are needed to reveal the patients’ reference number along with a brief medical history, very little filing space should be needed.

The problems with encryption don’t end with correctly entering the key. Once permitted access to encrypted ePHI, it will take much more time to de-crypt one radiograph than it takes to open a manila folder. Depending on the number of radiographs and other digital images – including complex cone-beam radiographs – a patients’ encrypted diagnostic history could require several minutes to view.

I would want to witness the De-ID non-profit professionally investigate whether de-identification indeed offers a cheaper and more secure solution to data breaches from dental offices. I think we all know by now that full disk encryption will never be the answer.

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Medical Charts

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Assessment 

Still too soon? Give it time. The FBI assures us that more massive data breaches are just around the corner.

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