HIPAA Blog

[ Friday, August 22, 2014 ]

 

Consumer EMR Q&A: Here's an interesting, if elementary, Q&A article from Kaiser Health on electronic medical records.

Jeff [8:28 AM]

[ Tuesday, August 19, 2014 ]

 

ICYMI: Rhode Island Hospital Pays Mass. AG for HIPAA Breach: In a rare cross-border reach, the Massachusetts attorney general fined a Rhode Island hospital (and the hospital paid the fine) for breaching the security of PHI of a bunch of Massachusetts residents.  The breach violated HIPAA, but also violated MA's stringent data encryption and breach law.  The MA statute purports to have a "long arm" reach (it applies to anyone who deals with the PHI of MA residents, regardless where the record-keeper is located), but it would be hard to the MA AG to achieve jurisdiction over actors in other states.  However, I suspect in this case the RI hospital gets MA Medicaid funds and otherwise may do business in MA, so they probably felt they had to play along. 

Jeff [1:42 PM]

[ Monday, August 18, 2014 ]

 

Community Health Systems: An APT hacker group got into Community Health System's database and stole names, SSNs and DOBs of 4.5 million patients of Community's physician network.  The good news: the hackers are usually looking for medical device development data, which they didn't get.  More good news: no credit card data got out.  But, it's still a big ole HIPAA breach. 

Jeff [1:21 PM]

[ Wednesday, August 13, 2014 ]

 

Weaponizing Your Breach Detection System: If you're a HIPAA covered entity, you need a breach detection system, even if it's just your normal access audit reviews plus your employees keeping their eyes and ears open for something funny.  The more sophisticated your systems and operations, the more formal your breach detection system should be.  For the bigger players, your breach detection system is probably not doing all it should.  Here's an interesting article on ways to change the focus, and thereby improve the product, of your breach detection system.

Jeff [4:10 PM]

[ Monday, August 11, 2014 ]

 

Baby Pictures = HIPAA Violation.  OK, this article has made a big splash, and it's generated a lot of talk in the HIPAAverse.  And it's generally accurate, but there's a lot unexplained around the margins.  Yes, baby pictures are PHI if the baby is/was a patient of the practice.  But a consent form is a pretty simple document, one that every covered entity should have as a handy and ready-to-use form, and it's simple to ask a parent/patient to sign it before you put their kid's picture up on the wall (it could even be part of the patient sign-in packet).  Pretty much everyone who provides you with a picture would be willing to do so. 

Jeff [2:15 PM]

[ Friday, August 01, 2014 ]

 

Hospital Accuses Mother of Patient of Violating HIPAA By Taking Pictures of Him During Appointment.  The hospital based its position on the fact that it has a policy that prohibits visitors from taking cell phone photos on hospital premises.  Of course, the mother is not a covered entity, and even if she was, as personal representative of her son, she'd be entitled to consent to the release of his PHI via the pictures.  But before condemning the hospital, keep this in mind: the hospital is also trying to prevent the mother from disclosing of the PHI of others besides the woman's son.  If her pictures include other patients, that could be a problem.  The hospital is reviewing its policies, and I suspect a reasonable accomodation will be reached.

Jeff [10:40 AM]

[ Thursday, July 31, 2014 ]

 

Phase 2 of OCR's Audit Program is Coming UpGood article by McDermott.

Jeff [10:40 PM]

[ Tuesday, July 29, 2014 ]

 

Medical Identity Theft: Just a quick example of how it can go wrong.  If you're a provider, seriously consider using the FTC "Red Flags Rule" materials to prevent medical identity theft: not only will your patients be safer, so will your pocketbook.  Don't forget that if you treat patient A and patient A has stolen B's identity, you'll end up billing B, and when B's insurance finds out, you'll have to reimburse the money; and A will likely be long gone at that point, and you'll be left holding the bag.

You may not be required to implement the FTC policies, but you certainly should consider them.

Jeff [11:09 AM]

 

Don't Text and Heal:  Texting and HIPAA don't go well together; as I've said many times, texting is insecure, impermanent, and ill-suited for record-keeping purposes.  Texting PHI by providers could result in improper medical record-keeping, because information that would be recorded in the medical record if it were emailed or telephoned does not get charted, and many texting platforms do not retain information for indefinite periods of time.  Texting also may turn the provider's communication into "telemedicine" under state law.  Texts are much less secure because they rarely are encrypted (like emails often are), and even if not encrypted (which isn't an actual requirement), they are much more easily accessible: anyone picking up your password-locked iPhone can see the first few words of recent texts without even unlocking the phone.  Unless you've carefully chosen a secure texting service, the risks are definitely not worth the convenience.

So far, there have been no HIPAA enforcement actions by OCR based on texting, but that's probably only because OCR has enough complaint-originated work to keep itself busy.  But other areas of HHS are closely looking at texting, and trying hard to get the industry to shape up.  In fact, CMS recently assigned an "e-level deficiency" to a nursing home that was texting lab results between doctors and nurses.  Both sender and recipient were authorized to receive the PHI, but the method of sending it, via unsecure texts, was sufficient to cause the deficiency.  The net result was a 10-part "Directed Plan of Correction" which included hiring an outside expert to train staff, revising policies and procedures, and notifying all residents of the issue.

This should be fair warning.  It is only a matter of time before OCR lays someone low for bad texting activities.  This nursing home had to incur some substantial costs (both financial and reputational) to fix this problem, but it's nothing to the 6- or 7-figure hammer OCR will likely lay down. 

Don't text.  Unless you've thoroughly analyzed the options and are prepared to defend yourself in case of a texting-related breach, it's hard to see how the benefits of convenience outweigh the risks.

Jeff [11:03 AM]

[ Monday, July 28, 2014 ]

 

Self Regional (Greenwood, SC) laptop theft: Two knuckelheads broke into a building and stole a laptop.  They've been caught, but said when they realized what they stole, they threw it into a lake.  Divers were not able to find the lakebottomed laptop.  Even though no harm has come to anyone, even though (if the crooks are telling the truth, a big "if") the data would likely be unrecoverable, it still must be reported. 

Obviously, the data was not encrypted.  If it had been, we wouldn't even know about this.  Go figure.

Jeff [12:33 PM]

[ Friday, July 25, 2014 ]

 

HIPAA on Offense: Yes, it happens

Jeff [12:31 PM]

[ Wednesday, July 23, 2014 ]

 

Sutter Health Data Breach Update: No proof of harm, no statutory damages.

As you know, someone threw a brick through a plate glass door and stole a desktop (!) computer from a Sutter Health location.  The desktop had protected health information on 4 million Sutter beneficiaries.  The California Confidentiality of Medical Information Act contains a statutory damages amount of $1,000 per person, which implies a potential $4 BILLION fine for Sutter.

Not so fast.  A circuit court in California has determined that, since there's no evidence the thief actually looked at the data (as opposed to acquiring and possessing it), there's no proof that the statute was violated.  As the court said, it's called "the "Confidentiality of Medical Information Act,' not the 'Possession of Medical Information Act.'"  Loss of peace of mind apparently isn't a damage. 

While this is the second time the court threw out a claim of breach where loss was certain but actual viewing or use wasn't, I suspect nothing will be settled here until the California Supreme Court (and possibly the US Supreme Court) rules.

Jeff [10:25 PM]

[ Saturday, July 19, 2014 ]

 

Vendini Settlement: I got a stray email on this, so thought someone might find it interesting.  Vendini, a ticketseller like Ticketmaster, apparently allowed a third party to view non-PHI personal information such as credit card data, and a class action suit was filed.  A settlement has been proposed.  About all you'll get is the actual cost of your credit monitoring or placing holds on your accounts, and the results of any actual identity theft such as overdraft charges.  I'm sure the lawyers will do well, though.

Jeff [8:34 AM]

[ Thursday, July 17, 2014 ]

 

Big Data in Healthcare: here's an interesting article.  This is all possible, but it's easy to see had this information could be used to the detriment of patients.  Privacy concerns obviously abound.

Hat tip: Alan Goldberg

Jeff [9:41 AM]

[ Monday, July 14, 2014 ]

 

Big Health Data Breaches Are Inevitable, and Are Coming: This article has popped up several places in my morning reading.  They are probably right; in fact, some big health data hacks have probably already occurred, but we just don't know about them yet because we don't yet know how the data is being used and aren't able to see it.  There are probably millions of individual instances of medical identity theft occurring every day, from the voluntary "sharing" of insurance by cooperative parties (your brother has insurance through his job but you don't so you go to a doctor and pretend to be him so that his insurance will pay for your care) to identity theft facilitated by insiders (a nurse or receptionist issues multiple Oxycontin prescriptions to a legitimate pain patient, but sends the extras to a friend who fills them and resells the pills) to pure identity theft (a hacker gains medical identities and sells them to people who use the unwitting victim's insurance to pay for their care). 

Medical identity theft can be much more lucrative that stealing credit card info, since the medical information is more persistent and the credit card info is more transitory (you can get a new credit card number, not a new medical history).  That said, you need a purchaser who needs healthcare to complete a medical identity theft, whereas credit card info can always be used immediately.

Jeff [12:45 PM]

[ Wednesday, July 09, 2014 ]

 

Malvern Group's weekly breach email is out.

Jeff [5:38 PM]

 

32,000,000 Victims: According to this report, 32 million Americans have been victims of EMR data breaches.  Some say this is an indictment of the EMR concept, but I think it's more of an acknowledgement that privacy/security is hard, and digitization of information has some risks.  Considering this many breaches as proof that EMRs are a bad idea ignores the benefits EMRs also bring.  It's important to consider this as an additional cost of digitization of records, and EMR evangelists do tend to ignore the costs.  But EMR haters can't ignore the benefits, either.

Balance. . . .

Jeff [4:57 PM]

 

InfoWeek Notices: yes, there are a lot of HIPAA complaints.

Jeff [4:19 PM]

[ Thursday, July 03, 2014 ]

 

Off Topic Slightly: A Goldman Sachs contractor meant to send some confidential data to someone at Goldman using their gs.com address but accidentally sent it to the same name at a gmail.com account. They've been unable to contact the account holder, and Google won't delete the email or divulge info about the account owner without a court order. More here: http://mobile.reuters.com/article/idUSKBN0F729I20140702?irpc=932


Jeff [9:02 AM]

[ Sunday, June 29, 2014 ]

 

University of Cincinnati Medical Center: Apparently a non-clinical employee of the hospital accessed a patient's medical record and learned that the pregnant patient had a sexually-transmitted disease.  The employee gave the information to the man who impregnated her; that man took to Facebook to taunt and ridicule her. The patient complained and the employee was fired; the patient has now sued.

Fun stuff: there's a possibility that disclosing to the baby-daddy would be fine, if the hospital knew that he was "involved in the care" of the pregnant woman.  But that's probably not going to be persuasive since the employee was not a clinical employee and had no business being in those medical records (perhaps she should not even have been able to access those records, depending on the scope of her job responsibilities). And I suspect the baby-daddy and the financial services employee had some personal connection, such that she should have known not to dig into medical records for improper reasons (assuming the hospital did good training, had good policies, etc.).

What's interesting is that OCR is taking an interest because the hospital did not notify OCR about the breach; however, the hospital says they did provide notice, and they have proof of it.  This could be a hole in OCR's reporting website.  Or it could be a confusion about names.

Hat tip: Jennifer Clemons

Jeff [10:37 AM]

[ Thursday, June 26, 2014 ]

 

Deep Security: Is your data network leaking data that makes itself more vulnerable to a targeted hack?  It seems to be the case with lots of hospital networks.  You're still more likely to suffer a HIPAA breach from a lost laptop, but this type of hack could cause you a whole lot more damage.

Jeff [9:12 AM]

[ Wednesday, June 25, 2014 ]

 

NRAD: a Long Island (NY) radiology practice has sent notices to almost 100,000 patients that a radiologist employee improperly accessed their personal information.  This is particularly interesting because HIPAA allows a covered entity to not send notice when the improper access is by an employee who might otherwise be allowed access to the data.  If the access was unintentional or done innocently, the radiology group might not have had to send the notice.  That implies that the practice thinks there's something wrong here.  Stay tuned. . . .

Jeff [9:22 AM]

 

Montana Hack: the computer system of the Montana State Department of Health was hacked, resulting in exposure of ID-theft type information. 

Jeff [9:16 AM]

[ Monday, June 23, 2014 ]

 

Parkview Health Fined $800,000: OK, this wasn't smart, but the fine seems awfully steep, especially since it doesn't appear that the records were accessed.  What happened?  Parkview had records from a retiring physician, apparently intending to give them to other physicians taking over those patients.  I guess some were left over -- 71 cardboard boxes full of them.  The hospital stacked the boxes up in the doctor's driveway, even though they knew she wasn't home.  Not a good idea.

Jeff [2:03 PM]

[ Monday, June 16, 2014 ]

 

Domino's data breach/data hostage issue: As this story illustrates, one of the current scary trends in data breaches is hackers who capture a business-critical database, encrypt it, and hold it for ransom; if you don't pay, you lose all your data.

What's really scary about this story is that Domino's has operations in France.  My respect for French cuisine may never recover

Jeff [12:49 PM]

[ Wednesday, June 11, 2014 ]

 

SAMHSA is Listening: I mentioned earlier that the Substance Abuse and Mental Health Services Administration is trying to figure out whether the "Part 2" rules are hindering the exchange of information necessary for coordination of care in the new interconnected world of HIEs and ACOs.  My favorite health privacy reporter, Theresa Defino, has an article (free registration required) on today's "listening session," where SAMHSA is trying to get constituents to give input. 

Jeff [4:43 PM]

 

Malvern Group's weekly HIPAA breach report is out.  I picked up a few of these specifically already, but there's always more.

Jeff [11:19 AM]

[ Tuesday, June 10, 2014 ]

 

Guest Blogger:  As you know, I occasionally allow a guest blogger or two to provide different perspectives.  Here's one:

Health IT Lag

by Michael Sculley, VP of Marketing, PracticeSuite


BitSight Technology, a security rating firm, reports that the healthcare industry needs to take a lesson from the recent data breaches experienced by Target and eBay. The BitSight report, “Will Healthcare Be the Next Retail?” warrants close attention. It analyzed security breaches and response times of four different industries: Pharmaceuticals and healthcare (healthcare), utilities, retail and finance.

The study was conducted for the year between April 1, 2013, and March 31, 2014. All sectors experienced security incidents. Finance had the fewest incidents and the fastest response time, about three-and-a-half days. Retail and utilities both responded in about four days. Healthcare had more security incidents, yet came in last in response time. It took five full days to respond to security breaches.

The fewest breaches and best response time was in the financial industry. That industry takes cybersecurity very seriously and goes beyond doing what is legally required. It takes extra steps to ensure the security of data. It also readily provides warnings to other industries whenever it becomes aware of potential security threats.

Unfortunately, neither healthcare nor pharmaceuticals view cybersecurity as seriously as they need to. It apparently has not received the appropriate attention from executives at the higher levels. Both industries need to spend more money and provide greater compensation for its data security professionals.

The two industries are in compliance with HIPAA regulations, but spend barely enough money to meet the requirements. Unfortunately, just because they are compliant does not mean they are secure.

The Bitsight report is similar to a recent SANS Institute report. That report emphasized that the healthcare industry has lagged far behind in its cybersecurity and warns that measures need to be taken to reduce risks. Breaches have become so frequent that the U.S. Department of Health & Human Services (HHS) is imposing heavy fines for a health care organization that has a compromised Internet-connected device.

The failure to take proper cybersecurity precautions can be expensive as the New York-Presbyterian Hospital recently discovered. HHS imposed a $3.3 million fine on the hospital. This is the largest penalty ever imposed for use of a compromised server in the health care industry.

____________________________

You can reach Michael at msculley@practicesuite.comPracticeSuite offers billing, practice management, and other medical software products.

Jeff [3:36 PM]

 

Access Health CT (Conn. Obamacare exchange) Data Breach: This, on the other hand, is a reportable breach: a backpack was found abandoned on a Hartford street.  It contained paperwork from the Connecticut Obamacare insurance exchange relating to 400 exchange customers, including names, social security numbers, birthdates, and other printed and handwritten information.  Apparently it was a call center employee's backpack.  They aren't supposed to take that information outside of the premises of the call center. 

It will be interesting to see if there is a fine levied here.

Jeff [10:58 AM]

 

Penn State-Hershey Hospital Breach: Should this have been reported?  A lab tech accessed PHI of 1800 patients via his home computer using a flash drive, and sent some PHI to two doctors via his personal email.  The flash drive wasn't encrypted, nor were the emails.

I'm pretty surprised this did not meet the "low threshold of compromise" standard for non-reporting.  The staff member was authorized to access the PHI, just not outside the security of the hospital's computing environment.  The flash drive wasn't encrypted, but wasn't lost or apparently outside the control of the tech.  The data was definitely PHI, but did not include social security numbers, so it's a low ID theft risk.  The emails were to physicians, presumably proper parties to receive the PHI (just not via unsecure email).  If the data is scrubbed from the tech's personal email account, and the doctors have secure accounts (or also scrub the data), where's the risk of compromise?  That someone snatched the PHI out of the ether while it was being emailed?  Possible, but a very low risk. 

The more I think about it, the more I think this should not have been reported.  This is much more likely to (i) unnecessarily worry patients who receive notices, and (ii) increase the likelihood of "alarm fatigue" by providing a false positive.  Fix the problem, fix your policies if you need to (prevent the use of flash drives or only allow encrypted ones), retrain the staff, sanction this employee, make this a teachable moment . . . but don't ring the alarm bell when it's not necessary.

Jeff [10:47 AM]

[ Monday, June 09, 2014 ]

 

University of Cincinnati Medical Center "Team No Hoes" Facebook Page: If true, I'm hoping this is just a "bad employee" problem.  But the UC Medical Center is being sued because a patient with a sexually-transmitted disease had her medical records posted on the hospital's "Team No Hoes" facebook page by a couple of hospital employees, allegedly at the urging of the patient's former boyfriend. 

I can't cast any judgment without more facts, but it sure sounds like a good time for UC to (i) review their employee training, sanctioning, and other policies, and (ii) review their social media policies.

Jeff [1:32 PM]

 

HIPAA and Mental Health: HIPAA causes a lot of issues as it tries to balance the right to privacy with the effective working of the healthcare system.  One area of acute issues is mental health, particularly involving adults.  Here's an article outlining the issues raised when a child with mental health issues reaches the age of 18, and his parents no longer are automatically treated as his "personal representatives."  Before a child reaches the age of majority (usually 18), his parents usually will have the right to access his records, communicate with his caregivers, and make medical decisions for him; but once he reaches 18, unless he gives his consent, the caregiver is limited in the information he can give to the parents, and the child gets to decide on his treatment.  The caregiver can still provide information to the parents as people "involved in the care of" the patient, but if the patient demands the caregiver keep the information secret, they must do so in most instances.  Plus, even if the caregiver could pass the information to the parents under the "involved in the care" exception, they are sometimes afraid to do so, since that decision could be challenged by the patient.

It's a difficult area where HIPAA's balancing act is going to leave some frustrated.  But I don't think the Murphy bill will help.

Jeff [1:26 PM]

[ Wednesday, June 04, 2014 ]

 

Securing Mobile Devices: InfoWeek has a great article on the importance of and ways to secure mobile medical devices, including not just phones and tablets, but other medical equipment that stores or transmit data.  One takeaway:

Enterprise mobile management best practices include:

Jeff [12:38 PM]

 

Malvern Group's weekly breach update is out.

Jeff [8:04 AM]

[ Tuesday, June 03, 2014 ]

 

The OIG's take on Big Data: A couple of interview clips with Daniel Levinson, the AG, on the risks and compliance issues posed by Big Data.  Brought to you by @HHCA.

Jeff [5:14 PM]

[ Monday, June 02, 2014 ]

 

Montana HHS Hack: apparently the Montana state Department of Health and Human Services got hacked, when they found malware on a server.  No determination of whether anything was improperly accessed or not. 

Jeff [10:44 AM]

[ Tuesday, May 27, 2014 ]

 

"Be Khat Bell."  OK, this is completely off-topic, but a pretty cool thing happened to me this weekend. 

A little back story first.  Last December, I drove to Omaha to bring my oldest daughter home from Creighton University.  She spent the spring semester at Loyola-Chicago's campus in Rome, so needed to move out of her apartment completely over Christmas break.  Gina played volleyball through high school and has played club volleyball in college, and we're a volleyball family: I coached Gina in 7th and 8th grades, and have coached my youngest daughter, Mary, since 3rd grade (she's about to enter 8th).  As luck would have it, the night I would be in Omaha picking Gina up was the first night of the regional round of the NCAA volleyball tournament (wherein the Sweet 16 would become the Final Four), with the University of Nebraska hosting one of the 4 sites.  Again, as luck would have it, that Friday night would see the University of Texas play American University, and Nebraska play University of San Diego.  I attended law school at UT, and Gina attended several overnight volleyball camps at UT, so we're definitely fans of Jerritt Elliott's UT volleyball program.  And since Lincoln is about an hour's drive from Omaha, we decided to go watch some volleyball in the middle of packing up.  StubHub delivered great tickets (the view from our seats is below), and we got to see UT beat American and Nebraska beat USD.  (We were driving home the next day when the UT-Nebraska game started, but got home in time to see UT beat Nebraska; unfortunately, they lost to Wisconsin in the semifinals.)




The games were a blast.  One of Gina's good friends, Creighton club volleyball teammates, and honorary Drummond daughter, Reana Lee, is from Hawaii, as is Sarah Palmer on the UT team.  Of course everyone in Hawaii knows each other, so we talked to Sarah's parents after UT's win (actually, Sarah and Reana played volleyball together in Hawaii and the families know each other).

But back to the story.  During the UT match, I was intrigued by one of the UT players, Khat Bell.  I noticed that whenever Khat was on the sidelines and not on the court (she's a front-row player, but is replaced with a defensive specialist when she rotates off the front row), instead of standing with her teammates watching and cheering on the girls on the court, she was crouched down, like a wide receiver, ready to sprint out onto the court.  Sometimes she'd even put one hand down, like a sprinter.  The other girls on the sidelines laughed, cheered, high-fived, but Khat was poised, like a lion or a jaguar, (or some other "big cat"), her face stressed and serious.  Forget the cheering, forget the celebrating, she only wanted one thing: to get back on the court, pound some volleyballs, and kill some sets.  I found myself watching her rather than the points, to see if she would lighten up, but she never did.  She didn't care what happened on the last point, good or bad: she wanted to be out there, on the court, winning the next point.

This spring, my youngest, Mary, played club volleyball for the first time.  Mary's very hard on herself, frets over past mistakes, and tries to find fault or blame on every bad play (and most good ones too).  After a bad play, she loses energy, and it's obvious that she's fretting, worrying about, and focusing on the last play, not concentrating on the next.  You can read it in her face.  Between matches at one early tournament, I pointed out to her that she was spending too much time focusing on the last point, and it was costing her.  I told her the story of watching Khat Bell on the sidelines.  Khat didn't care whether her last play on the court was a good one or a bad one.  She didn't care if her teammates were playing well or poorly without her.  She didn't care about fault or blame.  She just wanted to get back into the game and play the next point.  And that's what I encouraged Mary to do: forget the last point, and focus on the next. 

I told her, "You've got to find your inner Khat Bell.  You've got to be that person who only looks forward.  You've got to be Khat Bell."

During the rest of the season, one of the things I constantly yelled at her from the sidelines was, "Be Khat" or "Be Khat Bell."  I'd crouch down like a wide receiver about to sprint off at the snap of the ball, so if she didn't hear me, she'd see what I was encouraging her to do.  I'm her dad, so of course she didn't pay any attention to me, or at least pretended she didn't.

Fast foward to last weekend.  Club season is over, and now Mary is trying beach volleyball.  She normally trains on Tuesdays afternoons at The Sandbar in the Deep Ellum part of Dallas, but she's going to miss a few Tuesdays for summer vacation and is making up those training sessions with some Thursday and Sunday practices.  Gina and I took Mary there this past Sunday, and we stayed to watch them train.  Shortly after they started, a tall, sleek athlete sauntered in, with a burnt orange top and black spandex with the UT longhorn on the sides.  Guess who?


If the next best thing to being Khat Bell is being next to Khat Bell, then Mary got there this Memorial Day weekend.  Maybe she'll listen to me now. . . .

Jeff [2:48 PM]

[ Thursday, May 22, 2014 ]

 

KC Hospital Data Breach: Research Medical Center and Midwest Women's Healthcare Specialists made the mistake of dumping patient records without shredding them.  The harm was compounded when they were put in an open dumpster, and the wind blew them down the street and (eventually) into the hands of a TV news reporter. Uh oh.

Jeff [1:41 PM]

[ Wednesday, May 21, 2014 ]

 

Psychotherapy Notes: Under HIPAA, individuals have a right to access almost all of their PHI.  One big exception is psychotherapy notes, which are pretty narrowly defined to exclude diagnosis information, treatment start and stop times, medications, and any other information kept in the regular medical record.  These notes are treated differently because they are often intended for the benefit of the therapist, rather than the patient, and may contain information that, if exposed to the patient, might hinder the therapy.  Thus, the exception allows the therapist to keep her own notes and not have to worry about censoring them, in case the patient asked for a copy.

Boston's Beth Israel Deaconess hospital is now allowing patients to review their therapist's notes, and it's causing a bit of an uproar in the psychotherapist community.  It will be interesting to see how this plays out.

Jeff [5:33 PM]

 

Malvern Group's recent breach report is up.

Jeff [11:41 AM]

 

Social Media Tips: Any casual observer of HIPAA issues knows that social media poses a special risk to healthcare providers.  As a business, you want to have a good social media presence (Facebook page, maybe a Twitter feed) that promotes your business; the fact that you happen to be a healthcare provider doesn't change the business need, but does require special precautions to ensure that you don't inadvertently disclose PHI or violate HIPAA. 

Here's a good, generalized list of social media tips for any business.  In addition, HIPAA covered entities should also, at a minimum, have social media rules built into their policies and procedures, have regular and intensive training on the risks and do's/don't's of social media use, actively manage any social media projects and programs, and quickly respond to any complaints or concerns.

Jeff [11:40 AM]

[ Wednesday, May 14, 2014 ]

 

Malvern Group's weekly HIPAA data breach report is up.

Jeff [2:57 PM]

 

Walgreens Dismissed: Here's a good example of OCR dismissing a HIPAA privacy complaint, because the covered entity had good, if not perfect, prtections in place.

Jeff [7:34 AM]

[ Tuesday, May 13, 2014 ]

 

State Data Breach Laws: Kentucky adopts one, Florida revises its.  Don't forget, whenever you analyze a possible breach situation to see if you have a HIPAA reporting obligation, don't forget to check applicable state law; you may have a different or additional reporting requirement.

Jeff [1:04 PM]

[ Monday, May 12, 2014 ]

 

SAMHSA Seeking Input: The Substance Abuse and Mental Health Services Administration is looking for public input regarding the protection of alcohol and substance abuse treatment records.  Affectionately knows and the "Part 2 Rules," part 2 of 42 CFR (as opposed to part 160 and 164 of 45 CFR, where the HIPAA Privacy and Security rules are) imposes brutally strict nondisclosure rules on federally-supported substance abuse treatment facilities. 

42 CFR disclosures are much more limited than 45 CFR disclosures.  However, with more integrated care (including HIEs and ACOs), it's becoming harder and harder for substance abuse facilities to comply with the strict Part 2 requirements, while also providing coordinated, quality care.  SAMHSA is looking for public comment on how to keep appropriate protections while allowing appropriate data sharing.

More information here.

Jeff [4:27 PM]

[ Wednesday, May 07, 2014 ]

 

Malvern Group's weekly data breach report is up.

Jeff [11:05 AM]

[ Tuesday, May 06, 2014 ]

 

World's Smallest Data Breach: UMass Memorial may win the prize here.  It's still reportable, though. 

Jeff [8:57 AM]

[ Wednesday, April 30, 2014 ]

 

Boston Medical Center: the hospital fired its transcription vendor, because it found that the vendor made PHI available on its physician-access website without password protection.  Obviously the physicians need to be able to access the transcriptions to review and sign off, but appropriate protections must be in place.  Firing the vendor probably gives the covered entity hospital a possible defense against an OCR fine (assuming they didn't/shouldn't have known about the problem earlier).

Jeff [6:42 PM]

 

Malvern Associates' weekly data breach report is out.

Jeff [7:26 AM]

[ Tuesday, April 22, 2014 ]

 

Recent Enforcement News: OCR announces two new substantial fines: $1.7 million in one case and $250 in another, both involving unencrypted computers.

Jeff [3:04 PM]

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