Despite new HIPAA Business Associate Agreement (BAA) regulations going into effect in 2013, many healthcare organizations are still encountering the occasional cloud service provider who refuses to sign a BAA. Although they may have a logical explanation, any refusal to sign a BAA should be seen as a red flag.
Here’s the logic from their angle. There are still many cloud vendors who view themselves more as conduits of Personal Health Information (PHI). They feel their role is more akin to that of a mailman. They’re merely transporting data to others and have no real access to the actual contents.
If the data is encrypted and cannot be read, or If they don’t touch the actual PHI data at all, the cloud service vendor will argue that HIPAA regulations do not apply to them and possibly refuse to sign a BAA.
Fair enough, right? If the data is encrypted and the vendor doesn’t hold the encryption key, what’s the problem? Well, here’s the problem.
File this in the unlikely yet not improbable category. Let’s say that the PHI data wasn’t properly encrypted before it was sent into the cloud or unencrypted data was mistakenly transferred over to the cloud service provider. If the cloud provider has refused to sign a BAA, this jeopardizes your HIPAA compliance and could potentially result in a fine anywhere from $50,000 to $1.5 million.
This is why those in the healthcare sector must move on from any cloud provider that is reluctant to sign a BAA. They are basically refusing to be complaint since the new HIPAA Omnibus Rule clearly defines a business associate as anyone who creates, receives, maintains, or transmits PHI on behalf of a covered entity. By refusing to share accountability for HIPAA compliance, they’re a liability to your organization that you just can’t afford.
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When it comes to staying on top of industry trends, those in the healthcare sector utilizing cloud computing will undoubtedly have an advantage over those slow to adapt to change. The Internet is more widely used now by both patients and those providing health services.
Today’s patient desires anytime/anywhere access to health-related information and physicians may need access to digitized health data such as MRI scans, ultrasound images, or mammograms. Patient information must also be accessed for clinical decision-making such as potential prescription drug interactions or the American Recovery and Reinvestment Act of 2009 (ARRA) funded community health information exchanges (HIEs) that enable health providers and insurers to share a patient’s medical records with his or her permission. The cloud supports all of these.
In many ways, cloud computing levels the playing field as its affordable benefits are available to anyone from a small physician’s office or non-profit to large organizations or insurers. This fosters an all-inclusive collaboration that isn’t restricted to only large institutional players.
Major Benefits of the Cloud for the Healthcare Sector
Security – Ironically, the biggest concern most healthcare entities have about taking to the cloud is one of its biggest strengths. Recent updates have made CSPs as responsible and liable for HIPAA compliance as the healthcare institutions that hire them. CSPs must ensure that data is encrypted, backed up, easily recoverable, and secured with permission-based access.
Costs – Reduced costs are an incentive for healthcare entities to take to the cloud. Costs are dramatically cut since the cloud moves everything into a virtual environment, eliminating the need for costly hardware, software, maintenance, data center space, and IT labor. Pay-as- you-use fees requiring little-to-no capital investment replace these often overwhelming up-front capital expenses.
Scalability – With the 2015 HER conversion deadline nearing, and the fact that health service providers are generally required to maintain patient medical records for at least six years, it’s easy to anticipate that managing such a high volume of patient data will inevitably stress any on-site IT infrastructure. But the cloud presents a scalable alternative where additional server or storage capacity is available as needed.
Mobility – The cloud improves a physician’s ability to remotely access readily available patient information. This enables even the busiest physician to review a patient’s medical records or test results even after they leave the office.
Sharing – Cloud computing keeps physicians better connected to not just their patients but their colleagues as well. Patients will notice benefits to medical professionals being able to share patient information online – for example, referrals to specialists will be more timely, there will be less paperwork to fill out with each office visit, and no unnecessary repeat diagnostic tests.
Are You Ready for This Transition?
The transition to cloud computing is underway in the industry. For healthcare service providers, it is no longer a question of if they will transition to the cloud, but when they can start benefiting from its potential savings and all of its capabilities.
Healthcare is a heavily regulated industry and cloud computing will continue to evolve to meet the industry’s growing security requirements and regulatory mandates. Many legitimate CSPs familiar with the healthcare sector already have strict security protocols in place to comply with regulations and will not hesitate to sign a BAA when asked. It is best to choose a CSP cautiously. Avoid any CSP who refuses to sign a BAA and carefully evaluate even those who do to get a feel for their stability, level of service, and delivery on promises.
Taking care of people – not your IT infrastructure – is your core service. Why not put the money being spent right now on hardware, software and equipment back into patient care while actually strengthening patient data integrity and security? Contact us today if you’d like to learn more about HIPAA compliant cloud-based technology.
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In the healthcare sector, the storing and sharing of sensitive digitized patient data has become a significant undertaking and is a heavy burden on resources. Preparation for a complete conversion from paper medical records to electronic health records (EHR) by 2015 has independent practitioners and small healthcare entities making significant investments in equipment, hardware and software, and tech-savvy personnel. Rather than focusing on the delivery of core patient care services, they must now worry about IT infrastructure issues, underlying network constraints and data center accessibility as well. This is problematic as very few medical offices or small health service organizations can afford to employ dedicated IT staff.
In this context, it is obvious that cloud-based solutions, which consolidate and outsource computing resources to external entities, would provide substantial relief to healthcare service providers. Data stored in the cloud is available on-demand and requires no expensive equipment, physical home or hired staff to manage and maintain it.
But while other business sectors have fully embraced the cloud for cheaper, more flexible, scalable and secure computing, many in the healthcare sector have yet to entertain putting patient data into the cloud. HIPAA-driven security and privacy concerns have been a serious deterrent.
This is about to change. Recent modifications to the HIPAA Privacy, Security, Enforcement and Breach Rules have made it clearer that data center operators are to be classified as business associates under HIPAA. This means cloud-service providers are required by law to report and respond to data breaches and uphold their obligation to properly protect and secure patient info.
These modifications are a game changer because they now assure covered entities such as doctor offices, hospitals, and health insurers that they can remain HIPAA compliant while adopting cloud technology.
Cloud Computing in Healthcare Sector Projected to Grow
According to recent report by the research firm Markets and Markets, although the healthcare sector has been notoriously slow when it comes to adopting new technology trends, the cloud computing market in this sector is projected to grow to $5.4 billion by 2017.
Breaking Down HIPAA and the Cloud
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was upgraded in 2009 with the Health Information Technology for Economic and Clinical Health (HITECH) ruling addressing the growing use of digitized medical records. HITECH was introduced to provide federal funding to deploy HER and establish a protocol for protecting the electronic storage and transmission of Protected Health Information (PHI). [PHI is defined as any information obtained, used or disclosed in the course of providing a healthcare service–treatment, payment, operations or medical records–that can be used to identify an individual.]
Compliance with HIPAA requires the reporting of any potential unauthorized PHI access. Because any impermissible access, use, or disclosure of PHI can severely damage an organization’s reputation, as well as levy penalties varying from $100 to $50,000 for first time offenders, it is understandable that many in the healthcare industry have chosen to avoid migrating patient data to the cloud unless they’re absolutely certain that a cloud-service provider (CSP) is HIPAA compliant.
Cloud-Service Providers as HIPAA Business Associates
Over the past five years, there has been much confusion whether cloud-service providers were classified as business associates (BAs) under HIPAA. The Department of Health and Human Services holds BAs accountable for certain required privacy and security obligations to protect PHI data, upholding them to a signed Business Associate Agreement (BAA). If confidential health data is compromised, the Associate is liable for responsibilities on their end.
The HIPAA privacy rule defines a BA as “a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity.”
Since most CSPs “maintain” PHI on behalf of either the covered entity or another BA that subcontracts them, one would assume they’d be deemed a BA themselves. But that hasn’t always been the case due to some ambiguous language that originally accompanied the regulation, language that was only just recently modified to expand the scope of BAs as defined by HIPAA.
As you can see, this language easily leaves “access on a routine basis” up to interpretation. For instance, although it states that HIPAA requires those accessing PHI data on a routine basis be treated as BAs, some CSPs felt they were mere “conduits” of protected data – not very different than courier services or postal services, having only random or infrequent access to public health information as they transport/share it with others. These CSPs would often argue that a signed BAA wasn’t necessary, thus avoiding the added due diligence or security control requirements and liability.
Take a high-volume Platform-as-a-Service (PaaS) for example. Here the CSPs primary role is to provide storage services that enable the covered healthcare entity’s staff, such as a doctor’s office, to routinely look at data stored remotely. While the CSP providing the PaaS bears responsibility for maintenance and upgrades to the hardware, software and the operating system, they don’t touch the actual PHI data all that much. Therefore, a CSP offering PaaS doesn’t necessarily have the same level of PHI access as a cloud provider using Software-as-a-Service (SaaS) who must grant their personnel daily access to PHI.
A similar argument could be made for a CSP who maintains encrypted PHI for a covered healthcare entity but doesn’t hold the encryption key.
This uncertainty was the reason for much of the healthcare sector’s reluctance to take to the cloud. If a cloud-service provider (CSP) didn’t feel the need to sign a BAA, and the patient info they managed was breached, the covered healthcare entity, not the CSP, would be fined.
The new HIPAA Omnibus Rule further clarifies that BAs and subcontractors of BAs are directly liable for compliance with certain HIPAA Privacy and Security Requirements. This has calmed skeptics, resulting in a healthcare industry now actively looking to cloud-based solutions.
Protecting personal information and cloud security are a must by 2015. CLICK HERE for a free network assessment and choose Cognoscape for your HIPAA compliant managed IT services.
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Prioritizing Security & Privacy in Healthcare Sector
Physician offices, hospitals and health insurers take practical steps each day to protect private patient health information (PHI) and comply with HIPAA regulations. Anyone interacting with patients and regularly accessing or discussing confidential medical records is obligated to adhere to certain requirements to uphold privacy and security.
For example, employees must be mindful of what is said aloud pertaining to an individual patient. Doors must be closed when patient conditions, treatments and procedures are discussed in person or over the phone. Staff should never leave voice mails with specifics about patient health conditions or test results. Even simple acts like summoning patients from the waiting room must be carried out with patient discretion in mind.
Failure to do this can result in a reported HIPAA breach that can be accompanied by potentially heavy monetary fines and often-irreparable reputation damage. The industry’s need to prioritize the integrity of patient data is even more pronounced in this time of flux within the healthcare sector.
Transitioning to the Electronic Age
Healthcare service providers today are in the process of converting all paper medical records to electronic health records (EHRs) or electronic medical records (EMRs) to meet the meaningful use requirements outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). The ARRA incentivizes the healthcare sector to accelerate the adoption of enterprise-wide electronic medical data by 2015 or face possible penalties.
We are entering a period in our history where volumes of confidential patient health information (PHI) will be stored, shared, and accessed electronically for the very first time ever. There has never been a more critical time for healthcare service providers to ensure that patient rights are protected, confidential information is safeguarded, and this transition from the immovable locked file cabinets to today’s electronic-system is completely HIPAA compliant and secure.
How HIPAA Breaches Most Commonly Happen
The U.S. Department of Health’s Office of Civil Rights found that there have been 21 million HIPAA security breaches since 2009. These breaches have resulted in an average of 2,769 records being lost or stolen per breach. Among them:
48% were stolen medical files
48% were stolen billing and insurance records
20% were stolen prescription details
13% were stolen monthly statements
24% were stolen patient billing/payment details
19% were stolen payment details
During this period, 66 percent of the reported large-scale HIPPA violations were due to the physical loss or theft of electronic equipment or storage media such as a laptop or flash drive that held unencrypted PHI. Another 8 percent of the large-scale HIPAA breach incidents were the result of hacking and cybercrime.
Based on the above findings alone, one can come to the obvious conclusion that storing such unencrypted data on a physical hard drive or any portable storage media device elevates the risk of an HIPAA breach. Therefore, eliminating the need to store or transfer this data on equipment such as laptops or flash drives should significantly minimize the risk of many of the HIPAA violations reported today.
Cybercrime is a growing threat within the healthcare sector since the industry has been slow to adopt new technology. According to the Identity Theft Resource Center, there were 17 reported financial industry data breaches in 2012 compared to a reported 154 healthcare industry breaches during the same time frame. The aging technology commonly used by healthcare service providers is rife with software and security flaws making it susceptible to data breaches resulting from hacking and other cyber-attacks.
Data thieves view private medical records as a high valued commodity – a gateway to identity theft. Safeguarding this data is challenging. With the shift to electronic records, data thieves have upped their game, finding new ways to gain unauthorized access to patient data by exposing vulnerabilities.
Defending against cybercrime requires constant monitoring for intrusion attempts and security upgrades. In this era where the volume of stored data is increasing, new cyber threats seemingly surface every day, and there is continuous demand to comply with regulations; healthcare service providers securing their own infrastructure will inevitably become overburdened and more vulnerable to attacks and HIPAA breaches.
The Case for Moving Data to the Cloud
Although many healthcare service providers have shown a reluctance to abandon their in-house IT infrastructure and security measures, on premise data center attacks are proving to be more prevalent, costly, and difficult to rebound from.
Healthcare providers who have resisted the cloud due to privacy and security concerns could be making a grave mistake. Increasing evidence suggests that the cloud can actually enhance data security. It does this while also freeing up manpower and budget dollars that can be better allocated toward the principle objective of improving patient care.
Proactive Remote Monitoring
Leading cloud-service providers offer an around-the-clock remote monitoring service that maximizes uptime while monitoring each node in the cloud infrastructure, each access point, and the data center platform as a whole. This is an extremely important function that detects and addresses potential issues before they become serious breach incidents. Metrics are collected and alerts are triggered whenever faulty conditions such as a data backup failure or an authorized attempt to access data are detected.
CLICK HERE for a free network assessment and see how your sensitive information can remain secure in the cloud.
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Cloud is establishing a foothold in the industry as the data management system of choice for many healthcare service providers. This means cloud security continues to evolve for the better. However, you must still choose a cloud-service provider wisely and ensure that patient data is secure at all levels of workflow.
We’ve compiled a list of several things you should ask your cloud-service provider regarding EHRs and PHI data.
Who has access to this data and the systems supporting it?
Any cloud service provider should be able to tell you who has access to the physical storage facility, the hardware, operating systems and data.
Is there an audit trail and can unauthorized access to patient data be easily verified?
Is there an auditing mechanism in place tracking all PHI-related system activities, warnings and failures? Any unusual system activity such as suspected unauthorized access should be easily detectable.
Is the data password-protected and accessible to only those authorized?
Are users prompted to enter a unique username and password with each log on? Do active logged-in sessions time out after periods of inactivity?
Is the data encrypted? Is it only viewable to those with proper authentication or accessing it through an application?
Is SSL-based encryption performed at the application level when healthcare sites and the data center communicate? This ensures end-to-end protection from the service access point to the data center and prevents any unauthorized network provider employee from accessing the data. Data also can’t be read while in transit to an end user’s viewing software over the Internet.
What kinds of backup processes are in place to ensure business continuity?
How often is data backed up and what is the method of backup to reduce data loss? Are copies made on removable media and stored off-site if a disaster impacts the data center? Are the two copies continuously synchronized? What authentication processes are in place to ensure data integrity?
How are the threats of viruses and Trojans handled?
Is there anti-virus software running every time files and disks are scanned or accessed? Is the anti-virus software frequently updated with the latest virus signature databases?
What Kind of Physical Security Exists at the Data Center?
Is security at the data center manned 24-hours with appropriate identification required and recorded with each visit? Are security cameras, motion detectors or alarms present throughout the facility?
The necessary investment to buy and maintain physical equipment, hardware and software, and supply personnel with the continuous training they need to deliver top-level data security is unaffordable and overtaxes the resources of smaller healthcare entities. Converting to cloud-based services enable practices and companies of any size to achieve industry-leading HIPAA compliant data security while benefiting from a slew of cost-efficient benefits that liberate them from security problems – bringing them back to caring for patients, not patient technology.
If you’re interested in a cloud-service provider who follows the administrative simplifications referenced under HIPAA, and can satisfactorily assure the safeguarding of electronic patient health information, contact us today.
Call (214)377-4884 or CLICK HERE for a free network assessment.
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