Archive for August, 2009

Long term costs for a breach of just 499 records could be as high as $100,798

Saturday, August 29th, 2009

According a study performed by The Ponemon institute, which is also quoted by the Department of Health and Human Services in the Interim Final Ruling on Breach Notification, the total cost of a data breach is an average of $202 per record (of which an $152 pertains to indirect cost including abnormal turnover or churn of existing and future customers).  A breach of just 499 records could cost $100,798 over the long term. The same report states that health care and financial services are the two industries experiencing the highest average rate of churn. It should be noted that, according to the same study, lost or stolen laptops/mobile devices account for 35% of all data breaches.

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Laptop and mobile device encryption technology is readily available.  Implementing encryption in other vulnerable areas such as file shares, removable storage, and even e-mail greatly reduces the potential for invoking your breach notification plan. By reducing the availability of unsecured protected health information (PHI) in your IT systems you can greatly reduce the chances of having to notify individuals in case of a breach.

Getting started with encryption

Tuesday, August 25th, 2009

Encryption can be intidating. The technology is filled with technical security jargon like encryption keys, hash, key length, etc. In most organizations the least common denominators are often devices  used the most – laptops, tablet PCs, and desktop computers. These devices are used to work with patient data and store information that is the most vulnerable to theft, misuse, and unauthorized access. These devices are often serviced and replaced. How many times have you replaced a broken hard drive? How many computers have you replaced in the last 3 years?

Fortunately, the most vulnerable devices are the easiest secure. If you have serveral computers you would like to secure, or if you have a tablet or laptop that you use when you travel, installing Whole Disk Encryption (WDE) software such as PGP Whole Disk Encryption is an easy way to get started.

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WDE simply encrypts your entire hard drive. After installing the software you can encrypt your entire hard drive. The software operates in the background while you work and does not affect your computer’s performance. It may take several hours for your hard drive be become encrypted. After completion, you will need to enter a password every time your computer boots. If your computer is stolen the thief will not be able to access your computer because the password will not be known to him/her. More importantly, your hard drive will not be able to be analyzed by forensic or other hard drive reading software. All your data will essentially become “scrambled” to anyone trying to view the contents of your hard drive.

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It’s important that you understand technologies that WILL NOT protect your information:

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- File deletion – deleting files on your hard drive does not erase them permanently. When you “delete” a file on your computer you are simply removing the pointer to the data in the hard drive’s directory. Until your data is overwritten by new data the old data remains on the hard drive and is able to be retrieved by even the most rudimentary tools on the Internet.

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- Password protecting files – Using password protection features in Microsoft Word, Excel, and even Quickbooks does not protect your information. It simply forces you to enter a password before viewing the data. There are many tools that are available that can easily recover these passwords. In addition, passwords don’t encrypt data. They are a method of very basic access control. If you password protect your document it can easily be recovered by data recovery and simple forensics applications.

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- Screen saver passwords – Although these should be used and activated when you’re away from your powered-on computer, they do not protect your data. A simple restart of the computer will bypass screen saver passwords.

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- Computer passwords – Computer passwords should be set so that you are prompted to enter a password when you start up your computer. However, these can easily be recovered by many programs found on the Internet. They also don’t encrypt the contents of your hard drive.

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- BIOS passwords – Most PCs have an option to set BIOS passwords. BIOS is a small program in every computer that runs very briefly when you turn your computer on. BIOS tells the computer the most basic information about your computer such as the amount of memory in your computer, size of hard drive, number of hard drivers, etc. This information is used to load your operating system (Microsoft Windows, Apple MAC OS, etc). A setting in BIOS could be made to require a BIOS password before your computer even loads Windows. Although it may be deterent to the casual unauthorized user, such as a snooping co-worker, BIOS passwords are easily reset by anyone with rudimentary technical skills. Sometimes it may require that the computer be opened and certain buttons are pressed inside the computer. But it can easily be defeated. And BIOS passwords do not encrypt data.

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FileVault in the System Preferences under Security
Image via Wikipedia

- Apple FileVault, Windows EFS – These are useful options for encrypting data. In both cases (Apple

and Windows) these are only file-level encryption technologies. Apple’s FileVault is superior because it encrypts your entire user profile. Windows EFS is complex to maintain and restore in case you switch computers. However, these technologies encrypt only certain files or directories. If you accidentally move information out of the encrypted directories that information will not be encrypted. These also don’t prevent basic access to the operating system of the computer. For example, if your Mac is stolen and you enable FileVault the thief can still access your computer.

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Although installing whole disk encryption on a few computers is acceptable, deploying individual encryption applications on many computers is not efficient or recommended.  Installing software like PGP Whole Disk Encryption on many computers without a central management system could present administrative challenges of manually maintaining encryption keys and leaves open the possibility of not being able to access encrypted computers after an employee leaves. Vendors like PGP offer a management console that can take away the administrative burden  of maintaining many computers. Before deploying WDE refer to an expert that can set up your environment so you can properly manage your encrypted computers centrally.


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Protected Health Information – What is it?

Monday, August 24th, 2009

The term Protected Health Information (PHI) has its roots in the term “Individually Identifiable Information” that was first used in the context of privacy regulation in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

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HIPAA explicitly defines this Information as “…any information, including demographic information collected from an individual, that–”(A) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and ”(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and–”(i) identifies the individual; or ”(ii) with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.”

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Protected  Health Information takes that definition and applies and electronic twist to it. The Interim Final Rule on Breach Notification for Unsecured Protected Health Information on page 4 of the preamble defines protected health information as:  “individually identifiable health information held or transmitted in any form or medium by HIPAA covered entities and business associates, subject to certain limited exceptions”.

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“Subject to certain limited exceptions” can be interpreted to mean additional exclusions listed in Standards for Privacy of Individually Identifiable Health Information; Final Rule, 45 CFR Parts 160 and 164, ss 164.501. Exclusions as written are an employer in its role as a covered entity (covered entities are employers as well) and education records specified in the Family Education Rights and Privacy Act, 20 U.S.C. 1232g.

‘individually
identifiable health information’ means any information, including demographic
information collected from an individual, that–
“(A) is created or received by a health care provider, health plan, employer, or
health care clearinghouse; and
“(B) relates to the past, present, or future physical or mental health or condition of
an individual, the provision of health care to an individual, or the past, present, or
future payment for the provision of health care to an individual, and–
“(i) identifies the individual; or
“(ii) with respect to which there is a reasonable basis to believe that the information
can be used to identify the individual

HHS Ruling on Encryption – ARRA/HITECH ACT subsection 13402

Monday, August 24th, 2009

On Thursday, August 20th, 2009, the U.S. Department of Health and Human Services (HHS) issued the Interim Final Rule on Breach Notification.

An important part the interim final rule is the decision that encryption is the only acceptable technology to make protected health information (essentially, patient records) “unusable, unreadable, or indecipherable to unauthorized individuals”. The preamble to the rule explains that even though other methods (such as access control) can continue to be used, if a breach occurs and the protected health information is disclosed to unauthorized individuals a breach notification is required.

Breach notifications are essentially categorized as “under 500″ and “over 500″ records. If a breach occurred to under 500 records then covered entities must maintain a log of the breach and notify the patients. If a breach over 500 records has occurred then not only patients need to be notified but also major media outlet and HHS. In addition, a hotline must be established so that people can call and obtain more information about the breach (notification procedures are specified in the HITECH Act, Section 13402). HHS can issue fines and attorneys general of each state are empowered to pursue these types of breaches on a criminal level.

The government is clearly serious about patient record privacy to encourage covered entities to move paper records to electronic records as part of its overall healthcare reform efforts.