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Health Data Breaches Multiplying

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YET – Fines Remain Rare

By Charles Ornstein @charlesornstein

[ProPublica]

Federal health watchdogs say they are cracking down on organizations that don’t protect the privacy and security of patient records, but data suggests otherwise.

***

Fines Remain Rare Even As Health Data Breaches Multiply

***

data

***

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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

***

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.

***

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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Enter the HIPAA Fear Mongers

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Fear of HIPAA Sells

[By Darrelkl K. Pruitt DDS]

“The HHS Office for Civil Rights (OCR) can show up at your door and ask to perform an audit on short notice, and your organization will need to be ready, or face fines of up to $50,000 per day for each regulatory provision violated.”

– Gene Kraemer [Customer Relationship Director at The Coding Institute]

http://www.audioeducator.com/hipaa-audits-and-enforcement-042412.html?utm_medium=email&utm_source=E99NAGAJ&utm_campaign=E99NAGAJ

The most successful of opportunistic HIPAA consultants are the scariest

As a dentist for almost 30 years, I’ve noticed that along with even rumors of mandate enforcement, ambitious compliance consultants’ fear-inspiring ads start interrupting happier thoughts. It happened with OSHA’s push into dentistry 20 years ago and we clearly see the aggressive sales pitches with HIPAA as well.

The scariest part of Gene Kraemer’s description of HIPAA’s tedious requirements and bankruptcy-level liabilities is that he is simply telling the truth. So if you are a HIPAA covered dentist, be scared.

On the other hand, if you don’t store or send your patients’ digital PHI – choosing instead to use the US Mail – you are increasingly fortunate in the dentistry market. For one thing, our patients are fed up with identity thefts, and paper dental records are the gold standard in security. In addition, nothing is holding down your competitors’ costs for HIPAA compliance and it is increasing much faster than the cost of postage.

De-identify now or lose computerization, Doc. If your patients’ PHI is not present it simply cannot be hacked by an identity thief. Guaranteed more secure than Cloud. Arguably more secure than even paper dental records.

Or … You can hire The Coding Institute.

You can bet Gene Kraemer isn’t someone who would hold down the cost of compliance.

 

From: Gene_Kraemer@mail.vresp.com

Subject: HIPAA Audits & Enforcement: New Penalties & Push for Compliance – Final Notice!

Good Morning,

The US Department of Health and Human Services (HHS) is currently implementing audits to meet requirements in the HITECH Act in the American Recovery and Reinvestment Act of 2009 (ARRA) for performing periodic audits of compliance with the HIPAA Privacy and Security Rules, and up to 150 random HIPAA compliance audits will be performed by the end of 2012.  While in the past, audits had been performed only at entities that had had a complaint filed against them, the new rule calls for audits whether or not there is a complaint.  This means, the HHS Office for Civil Rights (OCR) can show up at your door and ask to perform an audit on short notice, and your organization will need to be ready, or face fines of up to $50,000 per day for each regulatory provision violated.

Join us for this live audio conference on Tuesday, April 24, 2012 at 1 pm ET | 12 pm CT | 11 am MT | 10 am PT. This conference is being presented by Jim Sheldon-Dean, the founder and director of compliance services at Lewis Creek Systems, LLC, a Vermont-based consulting firm founded in 1982, providing information privacy and security regulatory compliance services to health care firms and businesses throughout the Northeast and nationally. He serves on the HIMSS Information Systems Security Workgroup, the Workgroup for Electronic Data Interchange Privacy and Security Workgroup, and co-chairs the WEDI HIPAA Updates sub-workgroup.  Sheldon-Dean is a participating member of the advisory board of Vermont Information Technology Leaders (VITL), and has participated in VITL’s Vermont Health Information Technology Plan working group, VITL’s Physician EMR adoption project, and the Security Workgroup of the New Hampshire/Vermont Strategic HIPAA Implementation Plan (NHVSHIP).

Highlights of the session :

• Fines and penalties for violations of the HIPAA regulations have been significantly increased and now include mandatory fines for willful negligence that begin at $10,000 minimum.

• HIPAA Audits have been few and far between in the past, but that’s now changing – the HHS will be auditing HIPAA covered entities and business associates even if there have been no complaints or problems reported.

• What HHS OCR is likely to ask you if you are selected for an audit, and what you’ll have to have prepared already when they do.

• The rules are that you need to comply with will be explained. Learn about the policies you can adopt that can help you come into compliance and be prepared for an audit.

• How the HIPAA rules have changed and how you may need to change. How you work to keep up with them.

• How having a good compliance process can help you stay compliant and respond to audits more easily.

• The documentation needed to survive an audit and avoid fines will be described.

• A discussion on what you’ll need to think about to deal with current and future threats to the security of patient information.

If interested, please click the following link to register and get your early bird discount : –

http://www.audioeducator.com/hipaa-audits-and-enforcement-042412.html?utm_medium=email&utm_source=E99NAGAJ&utm_campaign=E99NAGAJ

Please apply discount code “GENE20” at checkout to get your $20 discount on early registration.

Looking forward to having you onboard here.

Thanks,

Gene Kraemer

Customer Relationship Director

The Coding Institute LLC

2222 Sedwick Drive,

Durham, NC 27713

************************************************************************************8*************************

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Don’t Co-operate with eDR Vendors, Doc!

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My Opinion of eDRs and eDR  Vendors

By D. Kellus Pruitt DDS

Don’t cooperate with those you don’t trust, Doc.

eDR Stakeholders

If you allow Dentrix, the W. K. Kellogg Foundation, the ADA and other ambitious EDR stakeholders talk you into switching from paper dental records to digital before 2014, it will be the most regrettable business decision you have ever made.

PHI Breaches

Regardless if a data breach of your patients’ Protected Health Information (PHI) is your fault or not, it can easily cause bankruptcy, and the odds aren’t in your favor. According to a recent Redspin study, the number of breaches doubled between 2010 and 2011. (See “Health data breaches up 97% in 2011” by Diana Manos in Healthcare IT News, February 1, 2012).

http://www.healthcareitnews.com/news/health-data-breaches-97-percent-2011

Procrastination and Late Adopters

So even if unlike Americans who enjoy freedom, professionalism keeps you from publicly expressing an opinion, there’s never been a better time to drag your feet in our usual way. Besides, what have you got to lose by waiting? If consumers prefer EDRs, don’t you think we would see dentists touting their safety in their ads?

RedSpin

Daniel W. Berger, President and CEO of Redspin, is quoted in Diana Manos’ article: “Information security breach is the Achilles’ heel of PHI. Without further protective measures, data breaches will continue to increase and could derail the implementation, adoption and usage of electronic health records.” So why allow selfish EDR stakeholders who cannot be held accountable for harming your patients rush you into buying their favorite technology?

Note that the ineffective “further protective measures” will make EDRs even more expensive compared to paper dental records – allowing paper dentists to charge less than paperless practices, while still making more profit. Indeed, Doc. What have you got to lose by waiting?

Over the last 6 years, virtually all of my predictions about HIPAA have been right, and following the recent Redspin report, I feel even stronger about this one: The national failure of HIPAA will become noticeable in dentistry first.

OCR Culture

Not only is the Rule ineffective at protecting dental patients’ identities, but the tedious, mostly worthless compliancy requirements are so unreasonably time consuming and costly that no dentist can ever be 100% compliant. What’s more, eager HIPAA auditors working on commission to enforce the Office of Civil Rights’ “culture of compliance,” can find a dentist “willfully negligent.” Is that not subjective? The fines for such an auditor’s opinion are obscene. If you unfortunately experience a data breach, you don’t want to lose even more sleep over an audit that you cannot win, do you? Dentists don’t have to take this.

Dentistry Is Billing Simple

Unlike the complex administrative tasks in physicians’ offices, the business of dentistry is simple: Billing involves ten times fewer patients and CDT codes cover fees for procedures only involving the lower third of patients’ faces. Ledger cards, pegboards and lots of carbon paper have functioned adequately and safely for busy dental practices for decades. Besides, computers still haven’t shortened the time it takes to do a technique-sensitive filling in a squirmy kid’s mouth. If the front desk is the bottleneck rather than the speed of the dentist’s hands, someone needs to brush up on their alphabet skills.

If you think you might miss your computer, now is a perfect time to encourage dentistry’s leaders to consider de-identifying EDRs… Or if like me, you aren’t a HIPAA covered entity, we could wait a little longer if you’d like. Within a year, Americans will be noticeably seeking dentists who don’t put their PHI on computers.

Assessment

The hope for miracle discoveries derived from safely data-mining interoperable dental data doesn’t have to end like this, but I certainly don’t mind the windfall profits that expensive HIPAA regulations and patients’ fear of identity theft will bring to my practice.

Conclusion

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On e-Claim Only Dental Plans

About their Hidden Costs – I’m Talking PHI Breaches

By D. Kellus Pruitt DDS

If the rumor is true about Bluebell Ice Cream’s “e-claim-only” dental benefit plan that is to go into effect in March, how many in the east-central Texas town of Brenham (pop. 16,000) will be properly warned about the danger to themselves, their families and Bluebell officials’ reputations because of reckless policy?

Transmissions Risks

Each time their dentists send an electronic dental claim (e-claim) over the internet to insurance employees in Chicago as a favor to a patient – and especially the insurer – the Bluebell employee’s digital medical identity which is worth fifty bucks on the black market, rides along to destinations unknown. It’s my guess that very few Bluebell employees are yet aware of the increasing risk of medical identity theft from dentists’ e-claims – much less given the opportunity to opt out of the risk by simply visiting a dentist who still uses the telephone, fax and US Mail.

Security Risks Growing

It certainly won’t improve my popularity with 9 out of 10 dentists for saying this, but risks of identity theft from HIPAA-covered dental offices are climbing daily. In the introduction to a recent interview with Larry Ponemon, chairman and founder of the Ponemon Institute, GovernmentIT.com editor Tom Sullivan ominously described the ever-increasing risk of a massive “data spill” of perhaps millions of patients’ protected health information (PHI):

 “The street value of health information is 50 times greater than that of other data types. Even worse, the healthcare industry is among the weakest at protecting such information. With organized criminals trying to steal medical IDs, sloppy mistakes becoming more commonplace, mobile devices serving as single sign-on gateways to records and even bioterrorism now a factor, healthcare is ripe for some a wake-up call – one that just might come in the form a damaging ‘data spill.’” (See: “Q&A: How a health ‘data spill’ could be more damaging than what BP did to the Gulf.”

Tom Sullivan – Editor [December 05, 2011]

http://govhealthit.com/news/qa-how-health-data-spill-could-be-worse-what-bp-did-gulf?page=0,0

According to Dr. Ponemon:

“The basic issue, when you think about data theft not data loss – because it’s hard to know whether that lost data ultimately ends up in the hands of the cybercriminal and all of these bad things occur – but in the case of identity theft, the end goal has been historically to steal a person’s identity, and just like getting a financial record, getting a health record probably has your credit card, debit card, and payment information contained in that record.”

Of Credit Cards … and More!

But that’s not all. Credit cards are just chump change. He continues:

“The financial records are actually lucrative for the bad guy, but the health record is actually much, much more valuable item because it not only gives you the financial information but it also contains the health credential, and it’s very hard to detect a medical identity theft. What we’ve found in our studies is that medical identity theft is likely to be on the rise and, of course, there’s an awareness within the healthcare organizations that participate in our study that they’re starting to see this as more of a medical identity theft crime. It’s not just about stealing credit cards and buying goodies, it’s about stealing who you are, possibly getting medical treatment and, therefore, messing up your medical record.”

Dr. Ponemon suggests that the victim may not know about the theft until he or she “stumbles on something that alerts them their medical identity was stolen.” Perhaps something like death following anaphylactic shock from a medication that was once digitally highlighted as “Allergic to.” Understandably, Ponemon adds that respondents recognized altered medical histories as an emerging threat they believed was affecting the patients in their organizations. Such danger for dental patients is almost non-existent if their dentists simply don’t put PHI on office computers.

Should a data breach of Bluebell Ice Cream employees’ identities occur in Brenham or Chicago, which is more likely than not, the fact that electronic dental records do nothing to improve the quality of dental care won’t make Brenham citizens any happier with local Bluebell officials. 

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About [Health] Data Protection

What’s Your Back-up Plan – Doctor?

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As per a recent study, 32% of data is lost by human errors. However hardware, software, hacks and smack-downs are responsible for remaining 68% data loss.

Data protection gains major importance in data loss. It can be achieved by implementing data management successfully.

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Dictionary of Health Information Technology and Security

OCR Imposes Penalties for Employee’s Unauthorized Viewing of PHI

By Garfunkel Wild, PC

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Early in July, the Department of Health and Human Services Office of Civil Rights (“OCR”) entered into a settlement for $865,500 with UCLA Health System (“UCLAHS”) as a result of complaints alleging that UCLAHS employees repeatedly and without permissible reason looked at the electronic protected health information (“ePHI”) of celebrity patients.

Initial Complaints

Although the complaint was initially made by only two patients, in its investigation OCR determined that from 2005-2008 unauthorized employees of UCLAHS repeatedly looked at the ePHI of numerous other patients as well. In addition to paying the settlement, UCLAHS committed to a correction action plan that includes (1) implementation of policies and procedures; (2) robust training for employees; (3) a commitment to sanction offending employees; and (4) designation of an independent monitor to assess compliance over 3 years.

Assessment

This settlement is the fourth settlement in a year and highlights OCR’s increasing enforcement of violations to HIPAA Privacy and Security Rules. Failure to have an effective HIPAA compliance program can result in significant monetary penalties, and therefore, providers and business associates alike should be evaluating their HIPAA compliance programs to ensure that appropriate safeguards are in place.

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