Perhaps Hospitals Don't Care Much That EHRs Can Be Dangerous, Because EHRs Lets them Attract 'Good Paying Customers' And Exclude the Old and Poor

This comes as no surprise to me. I believe it may help explain hospital's cavalier attitudes towards the risks of today's commercial health IT.

It's all about money.

We already knew that (for example, see my Feb. 2011 post "Does EHR-Incited Upcoding (Also Known as 'Fraud') Need Investigation by CMS, And Could it Explain HIT Irrational Exuberance?"), but the following news adds to the pecuniary motivations:

Kaiser Health News

Critics say hospitals cherry pick best-paying patients
By Phil Galewitz
KHN Staff Writer

Feb 05, 2012

When the oversized postcard arrived last August from Provena St. Joseph Medical Center promoting a lung cancer screening for current or former smokers over 55, Steven Boyd wondered how the hospital had found him.

Boyd, 59, of Joliet, Ill., had smoked for decades, as had his wife, Karol.

Provena didn't send the mailing to everyone who lived near the hospital, just those who had a stronger likelihood of having smoked based on their age, income, insurance status and other demographic criteria.

The nonprofit center is one of a growing number of hospitals using their patients' health and financial records to help pitch their most lucrative services, such as cancer, heart and orthopedic care. As part of these direct mail campaigns, they are also buying detailed information about local residents compiled by consumer marketing firms — everything from age, income and marital status to shopping habits and whether they have children or pets at home.

Hospitals say they are promoting needed services, such as cancer screenings and cholesterol tests, but they often use the data to target patients with private health insurance, which typically pay higher rates than government coverage. At an industry conference last year, Provena Health marketing executive Lisa Lagger said such efforts had helped attract higher-paying patients, including those covered by "profitable Blue Cross and less Medicare."

Not to mention helping exclude those covered by Medicaid, or the uninsured.

Strategy Draws Fire

While the strategies are increasing revenues, they are drawing fire from patient advocates and privacy groups, who criticize the hospitals for using private medical records to pursue profits.

I don't recall anywhere on the releases at area hospitals saying they would be using their own clinical data for marketing purposes (which likely involve third party contractors). It might be in the fine print, however. I also don't recall any place to sign and give informed consent to the use of experimental medical devices such as the EHR's used to collect the marketing data, either, but that's addressed elsewhere on this blog such as here.

Doug Heller, executive director of Consumer Watchdog, a California-based consumer advocacy group, says he is bothered by efforts to "cherry pick" the best-paying patients.

"When marketing is picking and choosing based on people's financial status, it is inherently discriminating against patients who have every right and need for medical information," Heller says. "This is another example of how our health system has gone off the rails."

I would go beyond "off the rails." How about, straight to perverse? EHR data is used to attract paying customers and then expose them to risk of being maimed due to the disruptive nature of the HIT itself.

Deven McGraw, director of the health privacy project at the Center for Democracy and Technology in Washington, says federal law allows hospitals to use confidential medical records to inform patients about things that may help them.

"If it's technically legal, we can do it, and who gives a damn about the ethics?" is what is being expressed here.

"You want health providers to communicate to patients about health options that may be beneficial to their health," McGraw says. "But sometimes this is about generating business for a new piece of equipment that the hospital just bought."

Using such information for marketing "creeps closer to the line," between what is legal and what is not, she says.

And helping recoup the costs of that hundred-million dollar EHR setup, too.

... Tess Niehaus, vice president of marketing at St. Anthony’s Medical Center in St. Louis, says the approach has been quite successful and makes no apologies for going after the most lucrative business.

"We are here to serve everybody but we market for good paying patients because it preserves our ability to serve everyone," she says. [And the ability to proffer generous executive salaries and raises - ed.]

"Good paying patients?" Does that imply there are bad paying patients? (Might those "bad paying patients" be predominantly the elderly and/or minorities?)

While the practice is legal, most people would be shocked to know their records may be shared with nonmedical personnel and outside firms to help hospitals attract business, says Pam Dixon, executive director of the World Privacy Forum, an advocacy group based in California. "I am really bothered by the overabundance of information that is flowing that is unnecessary and risky," she says.

As I've written before, don't worry, your most sensitive data's safe in the hands of the extremely skilled health IT professionals at most hospitals.

While hospitals may profit from offering cholesterol tests and mammograms, the big payoff is in what those screenings may lead to – additional tests and procedures, including surgery.

"It's all about downstream revenue," says Patrick Kane, senior vice president of marketing at Cape Cod Healthcare in Massachusetts who used such approaches at Wellmont Health System in Kingsport, Tenn. "The old adage in business is that it’s easier to sell an existing customer new services, rather than find a new customer."

So much for medical professionalism and conservatism. At least Mr. Kane admits it's all about money.

... Provena's Lagger says the approach boosted the system's bottom line so it could serve people regardless of insurance status. "This is a means to an end," she says.

The ends don't always justify the means, but that may be a hard concept for some in today's amoral culture to understand.

... Much of the expertise for such campaigns is provided by three consulting firms -- CPM Marketing of Madison, Wis., Medseek of Birmingham Ala. and New York-based Thomson Reuters. They typically charge hospitals $100,000 a year or more.

CPM, which merged in November with Denver, Colo.-based HealthGrades, a health ratings firm, added 100 new hospitals last year to give it a total of 400. Medseek works with more than 250 hospitals and Thomson Reuters, with 150.

Remember Darrin Stevens on Bewitched? "Larry, I've got a great idea for a new campaign! Let's troll for patients using their private data! Never mind that I have donkey ears today... that darn mother in law of mine, Endora!"

The targeting worked in the case of Boyd, who called the number on the back and scheduled the CT scan a few days later. The $169 test showed his lungs were clear, but found potential blockages in coronary arteries that his Provena-affiliated doctor is monitoring.

"In hindsight, I’m glad I had the test," he says.

No mention of patients who had unnecessary testing and interventions that led to bad outcomes ... or patients injured by the very EHR systems that make such marketing possible.

-- SS

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2011 Closes on a Note of Electronic Medical Record Privacy Breach Shame

At my Oct. 2011 post "Still More Electronic Medical Data Chaos, Pandemonium, Bedlam, Tumult and Maelstrom: But Don't Worry, Your Data is Secure" and others in this query link on medical record privacy, http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy I wrote:

"Don't worry, your medical data's safe."

Joseph Conn of ModernHealthcare.com apparently disagrees (with my sarcasm, that is) and states the obvious outright. I post his story with few comments and several emphases which are mine:

Year closes on a note of breach shame
Modern Healthcare
Dec. 2012

Three-eighty. Three-eighty. Do I hear four hundred?

With 2011 winding down, there are now 380 major data breaches involving 500 or more patients' records listed on the "wall of shame" website kept by HHS' Office for Civil Rights.

So far, from the first wall postings in September 2009 through the latest on Dec. 8 this year, there have been 18,059,831 "individuals affected," and even that massive number is an undercount of the breach problem.

First, the civil rights office hasn't yet released the records of tens of thousands of breaches it has received under a federal reporting mandate on breaches affecting fewer than 500 patients per incident. I've been asking for electronic copies of those records since June. I hope to hear soon on an appeal of a decision last fall by HHS, claiming that the civil rights office can hide those reports while it "investigates" an estimated 30,000 or more breaches they describe.

Second, even the OCR's posted numbers are low.

A Nov. 4 public notice on a breach reported by the UCLA Health System states that "some personal information on 16,288 patients" was stolen, but the wall of shame lists the "individuals affected" in the UCLA incident as 2,761.

UCLA spokeswoman Dale Tate said in an e-mail that the nearly six-times-larger number in its notice "represents the number of individuals who had some information on the hard drive," while the 2,761 figure sent to the OCR "represents the number of people that met the specific criteria" under the federal breach notification rule.

Under the federal rule, Tate says, "the information for these individuals could possibly cause more than a minimal amount of financial, reputational or other harm." Information on the rest of the individuals, Tate said, did not meet the criteria.

Not to get too harpy, but this breach stuff is long past being ridiculous.

The lawyers are already all over it, and maybe that's what it will take for the industry to finally start addressing the problem. Brian Kabateck, a California lawyer, thinks so.

In the past three months, his Los Angeles law firm has filed a pair class-action breach suits against two of the most highly regarded healthcare systems in the state, University of California, Los Angeles and Stanford, as well as one of the latter's business associates, Multi-Specialty Collection Services.

"I think this is a short blip on the radar," Kabateck said. As the settlement costs pile up, he said, "I think big institutions are going to learn—five years from now, these lawsuits are going to be obsolete."

Class-action lawsuits are needed as much for health IT risk and safety issues causing near-misses, injuries and death as for security breaches, I note.

I think five years is highly overoptimistic as well on the breach issue, considering the degree of "institutional learning" that's occurred on how to do health IT "right" over the past ~ three decades, and considering that the breaches that are increasing, not decreasing, in intensity and severity across all industry sectors. That includes industry sectors far better equipped to manage IT security than hospitals.

Right now, though, Kabateck says, "This is not to the level of being an epidemic, but it's close."

I think it is epidemic.

Rather than being a miracle that will revolutionize medicine, health IT is like any other information and communication technology (ICT): it has unintended consequences (UC's) that can dilute or even negate its advantages. The issue of damaged medical record privacy, confidentiality and security is but one UC of health IT.

-- SS

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Still More Electronic Medical Data Chaos, Pandemonium, Bedlam, Tumult and Maelstrom: But Don't Worry, Your Data is Secure

Case 1. Tumult

October 5, 2011
New York Times
Patient Data Landed Online After a Series of Missteps

By KEVIN SACK

Private medical data for nearly 20,000 emergency room patients at California’s prestigious Stanford Hospital were exposed to public view for nearly a year because a billing contractor’s marketing agent sent the electronic spreadsheet to a job prospect as part of a skills test, the hospital and contractors confirmed this week. The applicant then sought help by unwittingly posting the confidential data on a tutoring Web site. [Got all that? - ed.]

In an e-mail sent to a victim of the breach, the billing contractor, Joe Anthony Reyna, president of Multi-Specialty Collection Services in Los Angeles, explained that his marketing vendor, Frank Corcino, had received the data directly from Stanford Hospital, converted it to a new spreadsheet and then forwarded it to a woman he was considering for a short-term job.

The position was with Mr. Corcino’s one-man shop, Corcino & Associates, Mr. Reyna wrote in the e-mail, which was authenticated by his lawyer, Ellyn L. Sternfield. The job applicant apparently was challenged to convert the spreadsheet — which included names, admission dates, diagnosis codes and billing charges — into a bar graph and charts, Stanford Hospital officials said.

Not knowing that she had been given real patient data, the applicant posted it as an attachment to a request for help on studentoffortune.com [I wrote about that earlier here - ed.], which allows students to solicit paid assistance with their work. First posted on Sept. 9, 2010, the spreadsheet remained on the site until a patient discovered it on Aug. 22 and notified Stanford.

My, how electronic data can travel when mishandled. Try that trick with 20,000 paper charts ...

The hospital, located on the campus of Stanford University in Palo Alto, demanded that the spreadsheet be removed, and the Web site quickly complied. Pressed for time, the job prospect wound up completing the assignment herself and, in the end, did not get hired, Ms. Sternfield said.

Ironically, this was all for naught.

Mr. Corcino, in his first public statement, attributed the breach to “a chain of mistakes which are far too easy to make when handling electronic data.”

Far too easy to make - especially by the dyscompetent.

... Breaches of private medical data have become distressingly commonplace, with two substantial ones disclosed in the last week alone. [We don't know the details of those yet; that's for next week - ed.]

Case 2: Pandemonium (from same NYT article)

In Orlando, officials with Florida Hospital reported that three employees had improperly combed through emergency department records of 2,252 patients, apparently to forward information about accident victims to lawyers. The employees were fired, and law enforcement officials are investigating.

Trolling for Torts - is this a new EMR TV game contestant show? Perhaps it could be followed by "Trolling for Tarts?"


Case 3: Bedlam (from the same NYT article)

Meanwhile, Science Applications International Corporation disclosed that computer backup tapes containing medical data for 4.9 million military patients [that number also amounts to almost 2% of the total U.S. population - ed.] had been stolen from an employee’s car in San Antonio. The data included Social Security numbers, clinical notes, laboratory test results and prescriptions. The company said the risk of harm was low because retrieving data from the tapes would require specialized knowledge, software and hardware. [Who's to say the theft was not by someone with that specialization, or someone paid by same to steal the tapes? - ed.]

The Texas breach is by far the largest since September 2009, when a new federal law began requiring disclosures of medical privacy violations involving at least 500 people. Some 330 such episodes have been tallied, including four others that affected more than one million people each.

We'd all be buried in stray clinical paper by now if it weren't for computers. Thank god for them!

Officials at the Department of Health and Human Services said the new reporting requirements had exposed deep vulnerabilities and encouraged renewed vigilance.

Exposed to whom? The blind, deaf and dumb?

“We’re moving in the right direction in terms of a culture of compliance,” said Leon Rodriguez, director of the department’s Office for Civil Rights, which investigates medical privacy cases. “Are there still a lot of problems out there? Yeah, my sense is there are still a lot of problems.”

The Titanic was moving in the right direction - towards New York Harbor, in fact, when it met a little unexpected obstacle. Perhaps a culture of brains would be better than a culture of compliance...

The Stanford breach was notable for the duration of public exposure, and for spotlighting the vulnerability created by a medical provider’s business relationships with outside parties.

Last week, lawyers filed suit in state court in Los Angeles, seeking certification as a class action and $20 million in damages from Stanford Hospital & Clinics and Multi-Specialty Collection Services, which is known as MSCS.

$20 million might hurt a bit, and might help motivate the organization to hire better and/or more appropriate clinical information management expertise - in house where it belongs (see below).

The threat of liability set off a predictable round of finger-pointing.

In written responses to questions, Lisa Lapin, Stanford University’s assistant vice president for university communications, said, “MSCS bears the complete and sole responsibility for the breach.”

It's their fault, not ours.

Ms. Lapin said the hospital had sent the data in encrypted form to Mr. Corcino, who requested it on behalf of MSCS to analyze a strategy for improving billing collections. She said Mr. Corcino had regularly represented himself as MSCS’s executive vice president and had been Stanford’s “primary contact” during a seven-year relationship. MSCS, a five-person firm that audits hospital accounts to maximize reimbursement, possessed the passwords to unencrypt the data, she said.

It was all about money and outsourcing.

“This mishandling of private patient information was in complete contravention of the law and of the requirements of MSCS’s contract and is shockingly irresponsible,” the hospital said in a statement.

It is foolish to believe that someone else can run critical aspects of your business, and it is even more foolish to believe that it is OK for someone else to run critical aspects of your business.

Ms. Sternfield, Mr. Reyna’s lawyer, said Mr. Corcino had never been an MSCS employee, but rather was paid a monthly fee to drum up business, typically in face-to-face meetings with health care executives. Mr. Reyna, she said, had no knowledge that the Stanford data had been sent to Mr. Corcino, or that he had passed it on.

Mr. Corcino was not authorized to use an MSCS title, Ms. Sternfield said, but she declined to say whether Mr. Reyna was aware of the practice. She acknowledged that Mr. Corcino sometimes used an MSCS e-mail account.

In his e-mail to the breach victim, who shared it with The Times, Mr. Reyna wrote that Stanford had sent the file to Mr. Corcino “for a potential MSCS project that would audit paid accounts to verify that the reimbursement was correct.”

For his part, Mr. Corcino said in a statement that he was an independent contractor but was “the marketing face of the company,” and that MSCS “allowed me to use the title of executive vice president.” He wrote: “Stanford sent the file to me at MSCS, and I imported the data into a spreadsheet that was forwarded to the job applicant as part of a skills test. I did not intend to provide any personal health information in the file. This was a marketing project.”

Without explaining how or why he sent the data to the applicant, Mr. Corcino said MSCS had not trained him properly and faulted Stanford for sending him private information that he did not need. That, he said, was the “first link in a chain of mistakes.”

“I regret that Stanford released a file containing unnecessary information,” Mr. Corcino said, “that MSCS did not have an appropriate training and audit system for the handling of electronic data and that I was not more careful with the file. While Stanford and MSCS left the information in the file I received, it was my mistake to not catch its inclusion and remove the data.” ... The hospital has terminated its relationship with MSCS, and Mr. Reyna has done the same with Mr. Corcino.

Even I can't follow all that. This will be one convoluted court case...

Stanford Hospital has reassured affected patients that the posted spreadsheet did not contain Social Security numbers, birthdates or credit card numbers, and has offered free identity theft protection services. The hospital said it had not uncovered any misuse of the exposed data.

Yet, that is. (Is it no wonder that sedatives are among the most highly-prescribed medications?)

Moving from the NYT article:

Case 4: Tumult (I'm running out of descriptors)

A large class action lawsuit again Health Net and IBM:

California Legal
Westlaw Journal Insurance Coverage

Health Net’s, IBM’s negligence compromised medical data, suit says

June 7 (Westlaw Journals) - Health Net Inc. and IBM face a class-action lawsuit seeking $5 million in damages over the loss of computer storage devices that held the medical histories, financial data and Social Security numbers of 2 million people.

Health Net Policyholder Alana Bournas’ class-action complaint in the U.S. District Court for the Eastern District of California alleges that the insurer and IBM breached their duty of confidentiality and negligently allowed the release of highly personal and confidential information of millions of Health Net employees and policyholders.

The complaint alleges violation of California’s Confidentiality of Medical Information Act, Cal. Civ. Code § 56; Cal. Civ. Code § 1798.2, which concerns the unauthorized disclosure of customer records; Cal. Bus. & Prof. Code § 17200, the state’s unfair-competition law; and public disclosure of private facts.

Companies will either pay the going price for competent employees, or pay for the mistakes of incompetent ones. It would probably be better for society, however, to do the former habitually.

The suit says IBM agreed to manage Health Net’s information technology database for five years beginning in 2008.

IBM informed Health Net Jan. 21 that it had lost nine disk drives containing the confidential information of 2 million people, including Health Net policyholders and employees.

Health Net failed to alert the victims of the breach until March 14, the complaint says.

IBM allegedly also failed to encrypt the data, thereby enabling anyone who possesses the hard drives to easily access the confidential information. This puts the victims at an increased risk of identity theft and “other unauthorized uses of plaintiff and class members’ personal information” the suit says.

Encryption, a feature now built into mainstream OS's by Microsoft and Apple? (Oh wait...IBM...)

Health Net’s attempt to compensate the victims by providing two years of free credit monitoring services through TransUnion is an inadequate remedy for the defendant’s conduct, Bournas says. This “remedy” fails to address unauthorized disclosures of medical information, and the monitoring services only protect against new account fraud but do not address fraudulent activity with existing accounts, the suit says.

These executives apparently can't even get the fix straight.

Moreover, the complaint says, Health Net has previously been accused of a similar breach of confidential information. In 2009 it lost the same types of records of nearly 1.5 million people and waited six months before notifying the victims. In settling the state of Connecticut’s lawsuit stemming from that security breach, the company promised “to enhance security procedures and training,” the suit says.

What can I say?

The current breach could have been avoided had Health Net and IBM taken proper precautions and implemented security policies to maintain consumers’ confidential data, according to Bournas. Therefore, the protections granted under California law require that Health Net be penalized for its negligence, she says.

The plaintiff notes that millions of people entrusted Health Net with their private data.

“At best, defendants’ actions allowed this private information to go astray. At worst, the private information is being viewed, sold, resold, and used for illegitimate and illegal purposes,” the complaint says.

The suit is seeking injunctive relief, compensatory damages, declaratory relief, and attorney fees and costs.

Bournas v. Health Net Inc., No. 2_11-CV-01262, complaint filed (E.D. Cal. May 11, 2011).

I would revise that to say "The current breach could have been avoided had Health Net and IBM hired personnel in adequate numbers with the qualifications and true gravitas (and not laid them off, of course) to maintain consumers’ confidential data."

Case 5: Maelstrom (I am reaching to the bottom of the barrel for such descriptors).

Wellpoint recently settled class-action suit in CA.

AMA news
By Pamela Lewis Dolan, amednews staff.
Posted Aug. 1, 2011.

WellPoint reaches tentative accord in data breach suit

It is the second settlement to come from lawsuits claiming that the company failed to protect the privacy of individual insurance applicants online.

WellPoint has reached a preliminary settlement that will, if approved, bring an end to a class-action lawsuit filed more than a year ago.

The lawsuit, filed in the Superior Court of the State of California, involves the potential exposure of data belonging to more than 600,000 individual health insurance applicants on a company-run website that allowed insurance applicants to track their applications.

The situation came to light when an applicant to WellPoint-owned Anthem Blue Cross of California sued the company in March 2010. The applicant was able to manipulate the web address within the site to gain access to other applicants' information, including names, addresses, dates of birth, Social Security numbers and health and financial information.

In other words, probably changing a simple number in the URL brought up someone else's records. Good going there, Wellpoint. What were the programmers thinking? (Were they thinking?)

When the suit was filed, the company said an upgrade to the system caused the information to become exposed. The company said a third-party vendor validated that all security measures were in place when, in fact, they were not. Changes were made to the system soon after the situation was discovered.

Blame someone else, yet again.

In addition to the class-action suit, the company was sued by Indiana Attorney General Greg Zoeller in July 2010. The suit, filed in Marion County Civil Superior Court, alleged that the company violated the Indiana Disclosure of Security Breach Act by failing to notify Zoeller, and the 32,051 Indiana residents affected by the incident, in a timely manner. That suit was settled in early July, when WellPoint agreed to pay a $100,000 fine. As part of the settlement, WellPoint admitted it had a security breach and failed to properly notify the attorney general's office as required by law.

Gevalt.

Under the preliminary settlement in the California class-action matter, WellPoint agreed to offer credit monitoring for two years to all affected individuals. Class members are eligible to receive reimbursement for identity theft losses of up to $50,000 per incident, as well as additional time to file identity theft claims until May 31, 2016. Those making identity theft claims are eligible for an additional five years of credit monitoring. The company also will donate a total of $250,000 to two nonprofit organizations whose efforts are directed at protecting consumers' privacy on the Internet.

It might have been cheaper and better for goodwill not to outsource a vital function...those third-party vendors can really hurt you. (I'd really like to know - was this "third party vendor" domestic, or overseas?)

WellPoint did not admit wrongdoing in the case, nor was it found guilty. A fairness hearing is scheduled for November, and the courts then will decide whether to approve the settlement.

Large corporations are immune from such formalities as admitting wrongdoing or being found guilty.

-----------------------

But don't worry. Your medical data's safe.

Sort of. See also:

• "Networked EMR's and Healthcare Information Security: Practical When Massive IT Security Breaches Continue?",

• "Networked, Interoperable, Secure National Medical Records a Castle in the Sky?",

• "Operation Aurora And a Widespread Reluctance to Discuss IT Flaws: Is Universal Healthcare IT Really a Good Idea in 2010?",

• "Medical data breach of the week - but your EMR data is secure, trust us, we're IT experts",

• "Insurers Test Data Profiles to Identify Risky Clients",

• and others

-- SS

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HHS rule would give government everybody’s health records?

I really don't like the sound of this in the Washington Examiner. It contains many warnings of the kind I've written about here at HC Renewal regarding EHR systems, data privacy, confidentiality and security, coding madness, and (especially in the proposed rule) computational alchemy - a belief that one can turn unreliable data into "gold":

HHS rule would give government everybody’s health records
By: Rep. Tim Huelskamp
09/23/11 3:29 PM
OpEd Contributor

It’s been said a thousand times: Congress had to pass President Obama’s health care law in order to find out what’s in it. But, despite the repetitiveness, the level of shock from each new discovery never seems to recede.

This time, America is learning about the federal government’s plan to collect and aggregate confidential patient records for every one of us.

In a proposed rule from Secretary Kathleen Sebelius and the Department of Health and Human Services (HHS), the federal government is demanding insurance companies submit detailed health care information about their patients.

(See Proposed Rule: Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment, Volume 76, page 41930. Proposed rule docket ID is HHS-OS-2011-0022 http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/pdf/2011-17609.pdf)

The HHS has proposed the federal government pursue one of three paths to obtain this sensitive information: A “centralized approach” wherein insurers’ data go directly to Washington; an “intermediate state-level approach” in which insurers give the information to the 50 states; or a “distributed approach” in which health insurance companies crunch the numbers according to federal bureaucrat edict.

It’s par for the course with the federal government, but abstract terms are used to distract from the real objectives of this idea: no matter which “option” is chosen, government bureaucrats would have access to the health records of every American - including you.

There are major problems with any one of these three “options.” First is the obvious breach of patient confidentiality. The federal government does not exactly have a stellar track record when it comes to managing private information about its citizens.

Why should we trust that the federal government would somehow keep all patient records confidential? In one case, a government employee’s laptop containing information about 26.5 million veterans and their spouses was stolen from the employee’s home.

There's also the HHS contractor who lost a laptop containing medical information about nearly 50,000 Medicare beneficiaries. And, we cannot forget when the USDA's computer system was compromised and information and photos of 26,000 employees, contractors, and retirees potentially accessed. [I've written about this issue frequently on this blog - ed.]

The second concern is the government compulsion to seize details about private business practices. Certainly many health insurance companies defended and advocated for the president’s health care law, but they likely did not know this was part of the bargain.

They are being asked to provide proprietary information to governments for purposes that will undermine their competitiveness. Obama and Sebelius made such a big deal about Americans being able to keep the coverage they have under ObamaCare; with these provisions, such private insurance may cease to exist if insurers are required to divulge their business models.

Certainly businesses have lost confidential data like the federal government has, but the power of the market can punish the private sector. A victim can fire a health insurance company; he cannot fire a bureaucrat.

What happens to the federal government if it loses a laptop full of patient data or business information? What recourse do individual citizens have against an inept bureaucrat who leaves the computer unlocked? Imagine a Wikileaks-sized disclosure of every Americans’ health histories. The results could be devastating - embarrassing - even Orwellian.

With its extensive rule-making decrees, ObamaCare has been an exercise in creating authority out of thin air at the expense of individuals’ rights, freedoms, and liberties.

The ability of the federal government to spy on, review, and approve individuals’ private patient-doctor interactions is an excessive power-grab.

Like other discoveries that have occurred since the law’s passage, this one leaves us scratching our heads as to the necessity not just of this provision, but the entire law.

The HHS attempts to justify its proposal on the grounds that it has to be able to compare performance. No matter what the explanation is, however, this type of data collection is an egregious violation of patient-doctor confidentiality and business privacy. It is like J. Edgar Hoover in a lab coat.

And, no matter what assurances Obama, Sebelius and their unelected and unaccountable HHS bureaucrats make about protections and safeguards of data, too many people already know what can result when their confidential information gets into the wrong hands, either intentionally or unintentionally.

Republican Tim Huelskamp represents the first congressional district of Kansas.

While the word "de-identified" is in the proposed rule, I don't have great confidence in such assurances (for instance, see my Oct. 2009 post "Health IT Vendors Trafficking in Patient Data?").

I don't believe additional commentary is needed.

Hat tip - Drudge Report.

-- SS

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Another Episode of "But Don't Worry, Your Records are Safe..."

Oops!

NHS trust sends data CD to landfill

By Wesley Johnson

Friday, 16 September 2011

The personal information of 1.6 million people has been put at risk after a CD was sent to a landfill site by an NHS trust by mistake, a watchdog said.

The Eastern and Coastal Kent Primary Care Trust put the CD, which contained the name, address, date of birth, NHS number and GP of about 1.6 million people, in a filing cabinet during an office move.

But no one told staff who sent the cabinet to the landfill site and it has not been recovered, the Information Commissioner's Office said.

... An undertaking signed by the trust's chief executive Ann Sutton read: "The Information Commissioner was provided with a report by the data controller informing that a filing cabinet containing personal data had been sent to landfill during a move of office premises.

"The filing cabinet contained a CD holding the address, date of birth, NHS number and GP practice code of approximately 1.6 million individuals.

Read the whole article. They promise to be more careful - next time.

The trust said it would now take action to bring in clear policies and procedures for when moving office, improve staff training and boost security against unauthorised and unlawful processing, accidental loss, destruction and damage of personal records.

That is reassuring - I guess.

-- SS

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New way to get kids interested in medicine: post confidential medical records on a homework site?

Was this a new way to get kids interested in medical careers?

Or was it an accident due to the highest levels of negligence associated with lowest/cheapest standards in hiring for mission critical roles?

Patient Data Posted Online in Major Breach of Privacy
New York Times
Sept. 8, 2011
Kevin Sack

A medical privacy breach at Stanford University’s hospital in Palo Alto, Calif., led to the public posting of medical records for 20,000 emergency room patients, including names and diagnosis codes, on a commercial Web site for nearly a year, the hospital has confirmed.

Since discovering the breach last month, the hospital has been investigating how a detailed spreadsheet made its way from one of its vendors, a billing contractor identified as Multi-Specialty Collection Services, to a Web site called “Student of Fortune,” which allows students to solicit paid assistance with their school work. Gary Migdol, a spokesman for Stanford Hospital and Clinics, said the spreadsheet first appeared on the site on Sept. 9, 2010, as an attachment to a question about how to convert the data into a bar graph.

To teach the kids to be medical bean counters at an early age, perhaps?

Even as government regulators strengthen oversight by requiring public reporting of breaches and imposing heavy fines, experts on medical security said the Stanford incident spotlights the persistent vulnerability posed by legions of outside contractors who gain access to private data.

In the Oct. 2009 post "Private medical records offered for sale" I wrote about how such data was for sale by onion-like layers contractors - cheap.

The spreadsheet contained names, diagnosis codes, account numbers, admission and discharge dates, and billing charges for patients seen at Stanford Hospital’s emergency room during a six-month period in 2009, Mr. Migdol said. It did not include Social Security numbers, birthdates, credit-card accounts or other information used to perpetrate identity theft, he said, but the hospital is offering free identity protection services to affected patients.

(Partial) luck prevailed - this time.

The breach was discovered by a patient and reported to the hospital on Aug. 22, according to a letter written four days later to affected patients by Diane Meyer, Stanford Hospital’s chief privacy officer. The hospital took “aggressive steps,” [i.e., its CIO made a quick, panicky phone call - ed.] and the Web site removed the post the next day, Ms. Meyer wrote. It also notified state and federal agencies, Mr. Migdol said.

Perhaps "aggressive steps" should have been taken before private medical data was published on a kid's homework site?

“It is clearly disturbing when this information gets public,” he said. “It is our intent 100 percent of the time to keep this information confidential and private, and we work hard every day to ensure that.”

Would "Master of the Obvious" (a favorite line of my early medical mentor, cardiothoracic surgeon/polymath Dr. Victor P. Satinsky, be too kind a response to this statement?

Diane Dobson, of Santa Clara, Calif., said her “jaw dropped” on Saturday when she intercepted the letter from Ms. Meyer addressed to her 21-year-old son, who she said received emergency psychiatric treatment at Stanford in 2009. Ms. Dobson said it could have been disastrous if her son, who lives at home, had learned that his name was linked online to a diagnosis for psychosis.

“My son, I can tell you, is fragile and confused enough that this would have sent him over the edge,” Ms. Dobson said. “Everyone with an electronic medical record is at risk, and that means everyone.”

My sympathies go out to this mother and her son. Her concerns show that cavalier attitudes towards EMR's can lead to catastrophe beyond identity theft or career damage.

The incident at Stanford, while egregious in its details, is far from rare. Records compiled by the Department of Health and Human Services reveal that personal medical data for more than 11 million people has been improperly exposed during the last two years alone ... The major breaches — a disconcerting log of stolen laptops, hacked networks, unencrypted records, misdirected mailings, missing files and wayward e-mails — took place in 44 states.

I'm certain there is an increasing amount of critical medical data being withheld by patients as publicity about these breaches become more well-known.

The breaches at Stanford reinforce that even the most prestigious medical centers are not immune to risk.

Massachusetts General Hospital in Boston, which trains Harvard medical students, agreed this year to pay a $1 million federal fine after an employee left paper medical records on a subway train while commuting to work. The pages contained the names of 192 patients, and diagnoses for about a third of them, including for H.I.V./AIDS. They were never recovered.

I note these are both pioneers in electronic health records. Imagine what might be happening at Podunk Hollow General Hospital...

Mr. Migdol said the hospital had concluded that “there is no employee from Stanford Hospital who has done anything impermissible.” He said he expected the federal Department of Health and Human Services to conduct its own investigation. Susan McAndrew, deputy director of health information privacy for the department’s Office of Civil Rights, said she could not discuss whether an investigation was in progress ... Bryan Cline, a vice president with the Health Information Trust Alliance, a nonprofit company that establishes privacy guidelines for health care providers, said that nearly 20 percent of breaches were perpetrated by outside contractors, accounting for more than half of all the records exposed.

When you start to outsource mission critical data, you should probably be prepared to take responsibility for whomever you outsource it to.

The vendor, identified by Mr. Migdol as Multi-Specialty Collection Services LLC, based in Los Angeles, could not be reached for comment. Mr. Migdol said the company created the spreadsheet as part of a billing-and-payment analysis for the hospital. He said the hospital immediately suspended its relationship with the contractor and received written certification that previous files would be destroyed or returned securely.

Apparently someone there with access to the spreadsheet was less than careful about keeping it away from children. One wonders if they would have been more careful with pornography...

“We’re still kind of caught in the pre-high-tech trust model instead of the insurance model,” Mr. Cline said. “Health care providers say, ‘I’m going to have some contract language and then just trust that you’ll protect my data because if you don’t I’m going to sue you.’ That just doesn’t work, as we can see. You have to do due diligence, something to assure yourself that the people you’re giving your data to can be trusted.”

I'd say we're still in the stone age with respect to our irrational exuberance about health IT. See my series of articles on these issues at these query links: computer security, medical record privacy, medical record confidentiality.

A fundamental set of rules in today's hire-on-the-cheap, keep-staffing-minimal environment is this:

1. If you want information to be kept secure, don't place it on a computer.
2. If you place the information on a computer, don't place the computer on a network.
3. If you place the computer on a network, the information is no longer secure.

In our current culture I do not believe these issues to be easily remediable, but hiring the truly best and brightest (after satisfactory scores in a very hard test in critical thinking skills) into IT roles - including design, implementation, and management - might be a start.

-- SS

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Blogscan: UK unencrypted laptop health breach affects more than 8.6 million records

From the blog "Australian Health Information Technology":

Who Needs Hackers When There Are Accidents Like This? The PCEHR [Personally Controlled Electronic Health Record - ed.] Won’t Avoid Hacker Attention I Suspect.

The following popped up a little while ago.

By Dom Nicastro

Think the United States has its problems with securing patient health information?

We’re not alone.

London Health Programmes, a medical research organization based at the NHS North Central London health authority, has reported missing an unencrypted laptop containing information of 8.63 million patients and 18 million hospital visits, operations and procedures, according to today’s issue of The Sun.

The data does not include names, “but patients could be identified from postcodes and details such as gender, age and ethnic origin,” according to the newspaper. Information on the laptop included records of cancer, HIV, mental illness and abortions.

The computer was one of 20 lost, and officials have since recovered eight. The research organization “only just” reported the missing laptops to police although they went missing three weeks ago, according to the newspaper.

The Information Commissioner’s Office, Great Britain’s independent authority that promotes data privacy for individuals, has issued a statement regarding the laptop theft:

“Any allegation that sensitive personal information has been compromised is concerning and we will now make inquiries to establish the full facts of this alleged data breach.”

More here with a gruesome list of UK breaches.

http://blogs.hcpro.com/hipaa/2011/06/unencrypted-laptop-health-breach-affects-more-than-8-million-records/

Clearly this sort of incident is made more significant when material like this is appearing regularly.

We've posted numerous times at Healthcare Renewal on the impossible dream of electronic medical record privacy, security and confidentiality. See blog query links here and here.

-- SS

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Medical Data Breach of the Month Department: Health Net Once Again a Star in the Healthcare Renewal Theatre

I have written frequently about the breaches of electronic information security, such as at my posts:

"Networked EMR's and Healthcare Information Security: Practical When Massive IT Security Breaches Continue?"

"Networked, Interoperable, Secure National Medical Records a Castle in the Sky?"

"Operation Aurora And a Widespread Reluctance to Discuss IT Flaws: Is Universal Healthcare IT Really a Good Idea in 2010?"

Medical data breach of the week - but your EMR data is secure, trust us, we're IT experts

and others.

This latest medical information breach only affected a mere 2 million people this time.

Perhaps we should go for 20 million next time?

And then - there were substantial delays in notification (to give identity thieves time to get rich?)

Health Net Delays Notification of Data Breach Involving 2 Million People

By: Brian T. Horowitz
2011-03-16

Insurer Health Net waited until March 14 to disclose a data breach discovered on Jan. 21 involving the loss of nine server drives and the data of 2 million customers, employees and health care providers.

Health Net, a provider of health insurance to about 6 million people across the United States, has come under fire for reporting the loss of nine server drives at its data center in Rancho Cordova, Calif., nearly two months after it occurred.

More than 2 million Health Net members, employees and health care providers may have been affected by the data breach, including about 845,000 California policyholders, according to The San Francisco Chronicle. California regulators are investigating the breach, the newspaper reports.

How did this happen?

The insurer found out about the security lapse on Jan. 21, when IBM, which manages the company's IT infrastructure, informed Health Net that it was unable to locate server drives, according to a recording on Health Net's data breach hotline (855-434-8081).

These drives perhaps are of a new technology, with motorized robotic legs that allow them to walk away.

Or perhaps the drives were like this, where the round drive platter stacks perform double duty as wheels:

A "mobile" hard drive. Click to enlarge.

The drives just rolled away - to the tune of Steppenwolf's "Born to be Wild" ...

These drives were just Born to be Wild! Click to play.

Get your motor runnin' ... head out on the highway ...

The health benefits provider began its investigation at that time and learned that the nine drives included personal information for former and current Health Net members, employees and health care providers. The company didn't report the breach to the public until March 14.

Gee, thanks.

Health Net spokesman Brad Kieffer declined eWEEK's request for additional information on the breach but said, "We continue investigating unaccounted for server drives, and out of an abundance of caution we are notifying our members."

"Abundance of caution" and an almost 2-month delay do not belong in the same news story.

... "Given the size and type of data lost, this is a serious breach, and those affected should have been notified and protected immediately when IBM notified Health Net of the loss," Rob Enderle, principal analyst for the Enderle Group, wrote in an e-mail to eWEEK.

Indeed.

"While the delay was likely due to the belief that these drives were either misplaced or reused and not logged and the hope they would turn up on a maintenance rotation, the exposure to those that may have been compromised is excessive, and for an insurance company not to immediately mitigate this exposure—unforgivable," Enderle said.

"Hope/keeping your fingers crossed" and "due diligence/corporate responsibility" also do not belong in the same paragraph.

Information included names, addresses, health information, Social Security numbers and/or financial information, Health Net reports. .

All the news that's fit to print.

The Health Net breach could be the most serious health care data breach since 2008, when incidents affected 2.2 million people at the University of Utah and 2.1 million people at the University of Miami, according to the San Francisco Chronicle report.

Since 2008, eh, way back when, ancient history, when dinosaurs ruled the earth?

In May 2009, Health Net suffered another security breach in which a portable disk drive holding the medical and financial data on 1.5 million members disappeared from its Connecticut headquarters.

The portable disk drives must have robotic legs, too.

Data breach penalties for Health Net could be severe, according to Enderle.

Perhaps that's why they were crossing their fingers hoping the drives would turn up somehow?

Finally, I note that this company has also been busy in recent years making a name for themselves in the Healthcare Renewal Theatre in other ways. They're stars! See http://hcrenewal.blogspot.com/search/label/Health%20Net

-- SS

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Insurers Test Data Profiles to Identify Risky Clients

Stories like this one today at the WSJ disturb me.

“Insurers Test Data Profiles to Identify Risky Clients”
Wall Street Journal
Nov. 19, 2010

From that story:

Life insurers are testing an intensely personal new use for the vast dossiers of data being amassed about Americans: predicting people’s longevity.

Insurers have long used blood and urine tests to assess people’s health—a costly process. Today, however, data-gathering companies have such extensive files on most U.S. consumers—online shopping details, catalog purchases, magazine subscriptions, leisure activities and information from social-networking sites—that some insurers are exploring whether data can reveal nearly as much about a person as a lab analysis of their bodily fluids.

In one of the biggest tests, the U.S. arm of British insurer Aviva PLC looked at 60,000 recent insurance applicants. It found that a new, “predictive modeling” system, based partly on consumer-marketing data, was “persuasive” in its ability to mimic traditional techniques.

The research heralds a remarkable [alarming? -ed.] expansion of the use of consumer-marketing data, which is traditionally used for advertising purposes.

Read the entire article.

The reason I find this article disturbing is that it can and probably should be looked at as another example of technophiles and opportunists with no knowledge of (or lack of caring about) Social Informatics, a decades-old discipline with a focus on studying the unintended consequences of new information and communications technologies (ICT's), enabling our society to move one step closer to centralized control.

Social Informatics (SI) refers to the body of research and study that examines social aspects of computerization, including the roles of information technology in social and organizational change, the uses of information technologies in social contexts, and the ways that the social organization of information technologies is influenced by social forces and social practices.

Stories such as the above WSJ story, and others in their running series on Internet privacy, also dampen my enthusiasm about the possibility that electronic medical information will be kept private, confidential and secure.

-- SS

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