Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, has a letter to the editor in the New York Times:
Re “Privacy Issue Complicates Push to Link Medical Data†(news article, Jan. 18):
Consumer groups and some members of Congress rightly express concern that President Obama’s plan to stimulate the use of information technology in health care presents challenges to individual privacy unless there are strong safeguards.
These security features are required for electronic health record products to be certified by the Certification Commission for Healthcare Information Technology.
Among the criteria for certification are the ability to restrict viewing privileges to some users or groups of users, and to identify certain information as confidential and limit the number of people who can see it.
Strong encryption when sending personal information over the Internet is a keystone requirement, as is the ability to audit who views a record and when.
These features would ensure that the technology is ready, but that doesn’t guarantee that they will be used to their fullest extent by health care organizations; for that, enforcement is necessary.
Legal and regulatory protections are the province of our leaders in government and in the health field. Certification ensures that electronic records do not become the weak link in the chain of privacy protection.
North Plains, Ore., Jan. 21, 2009
Unfortunately, the protections he describes — as well as certification — may offer a false sense of security. In the past year, we have seen large data breaches in both the financial and business sectors (RBS WorldPay, Hannaford, Heartland Payment Systems). In the Hannaford and Heartland breaches, both entities were compliant with industry standards (PCI) and had been certified as being compliant. Despite that, attackers were able to access databases. We have also seen how a large medically related database — Express Scripts — may have been accessed by cybercriminals who may have acquired the Social Security numbers and prescription information on as many as 50 million individuals. Earlier last year, we learned that WellPoint, the largest commercial insurer, had their members’ records accessible via the web for over a year to anyone who knew where to look.
The public and Congress should not view certification by the Certification Commission for Healthcare Information Technology as any kind of genuine reassurance that our health information details are truly secure. It’s a piece of the solution, but does not go far enough.
Meaningful legislation must also:
- define a right to privacy and specify what kinds of information constitute protected information regardless of what type of entity is in possession of, or custody of, the information. For example, HIPAA’s failure to include nursing homes as covered entities was just that — a failure. We have seen many cases of ID theft involving nursing home residents who are vulnerable to theft of their information.
- prohibit certain practices such as sharing of patient data with pharmaceutical companies or marketing firms without the express written consent of the patient. HIPAA permissions to share patient data for “operations” needs to be clarified and restricted.
- require the elimination of any portion of Social Security numbers in databases that are networked.
- bar, without exception, outsourcing patient data outside of the U.S.
- require notification to patients of any privacy or security breach involving their information, even if the breach is deemed unlikely to lead to lead to financial fraud or medical ID theft.
- require a federal agency to conduct periodic security audits of commercial insurers, hospitals, and government agencies that maintain large databases containing PHI.
A bit unwieldy? Yes, but there is no unringing the bell once the data have gotten out.