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My Favorite Health IT Quotes of 2016

December 20, 2016
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Talking about FHIR, ransomware, blockchain, and information blocking

For the past several years, I have taken the time during the holiday season to reflect back on the past year by picking my 10 favorite quotes from stories I have written during the year. I often find these quotes help to illuminate some of the major trends of the period and they can be thought provoking as well. Doing this also makes me realize how many smart and inspirational people I get to interview every year. So without further ado, here is my Top 10 List for 2016, in no particular order.

1. At the 2016 PHI Protection Network Conference in Philadelphia early this year, I got to see a great talk by Meredith Phillips, chief information privacy & security officer at Henry Ford Health System in Michigan. Here is a quote from her about data breaches that stayed with me: “What I preach to our executives is that it is not about the data; it is about the people. Behind every line of data and medical record number there is a person. We do what we do because of the person, not the data. That’s what makes us passionate. When you get on the phone with patient whose information has been breached, and hear them cry, or how they feel violated, that is not a piece of data, that is a person.”

2. What would you say if you had to make an “elevator pitch” in just three to five minutes to the President of the United States about what to focus on in terms of the nation’s healthcare system? That was the question put to panelists at a Sept. 26 meeting of the National Academy of Medicine. (I bet they were not picturing a President Trump at the time!) Jonathan Perlin, M.D., chief medical officer of Hospital Corporation of America (HCA), responded: “It’s all about the data. With meaningful use, the president, if you will, has bought the car and now it is time to drive it,” said Perlin, who before joining HCA in 2006 was CEO of the Veterans Health Administration. “The president's opportunity is not to drive on a slow toll road but to realize the vision of a fast superhighway.”

3. I had a chance to interview Geisinger Health System Chief Clinical Informatics Officer Alistair Erskine, M.D., about his perception of the value of the FHIR (Fast Healthcare Interoperability Resources) standard in the realm of interoperability. He compared the concept to a vendor-neutral archive for imaging: “We’d have a vendor-neutral app store for EHRs and portals. A developer, whether they have a relationship with a vendor or not, could develop apps and use FHIR to communicate with the various databases without having to rewrite their software each time. Also, people are saying, ‘I don’t want to have to write my thing in Epic or Cerner. I want to write it in Python, PHP, or Java and use data services to attach it to the big monolithic system of record.’”

4. Another trend we have seen this year is more health systems setting up centers of innovation to encourage entrepreneurship internally and in their communities. Carla Small, director of innovation at Boston Children’s Hospital, told me that innovation is taking place all the time in hospitals, but often there is no vehicle to enable it to happen. “In our case, clinicians are innovative in pediatrics because they are having to do workarounds. Historically the enterprise of an academic medical center is not an agile environment for pushing these things out, so people get frustrated,” she said. “Institutions are starting to see success with startups, as we have. Some of our digital health initiatives have turned out to be revenue generators for the institution. Sitting on know-how and not doing anything with it just doesn’t make sense.”

5. One of my favorite interviews last year was Steven Keating, a Ph.D. candidate in the Massachusetts Institute of Technology (MIT) Media Lab and Mechanical Engineering, who was diagnosed with a baseball-sized brain tumor a few years ago. He was being treated at different hospitals for chemo, proton radiation and surgery, and the hospital EHRs were not speaking to each other. “I would do an MRI at Mount Auburn, another hospital, and if Brigham & Women’s wanted to access it, they sent me in my car with a CD to pick it up and drive back,” he said incredulously. “Even though a lot of these hospitals are using supposedly compliant systems, they are using different installed versions of Epic, so they can’t talk to each other. All these problems I came across are very logistically silly. How come we can use online banking to track all our financial information, but for hospital data, which our lives are depending on, we are still faxing things?”

6. People studying new technology trends in healthcare have mentioned that blockchain, a core component of the digital currency bitcoin, could have an important role to play in healthcare. I spoke to Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing blockchain application platforms. He said that what we have today is a bunch of disparate data silos. “With the blockchain, you could have a complete, full accurate history of a patient from beginning to end across multiple different systems. This becomes the interoperability model for how EMRs should work.”

7. I saw a great talk this year by Vivian Lee, Ph.D., M.D., M.B.A., senior vice president for health sciences and dean of the School of Medicine of University of Utah and CEO of University of Utah Health Care in Salt Lake City. She described how in 2012, the University of Utah became the first health system to post patient satisfaction ratings and full reviews online. She said this is part of a larger effort to use data and transparency to engage providers and push transformation forward. “We are tapping into the intrinsic motivation of physicians. They are fundamentally driven to outperform, to be the top in their class,” she said. “The best thing is that we created a patient-centered culture motivated by this intrinsic drive. It hasn’t been top down. We have engaged patients, listened to patients. They are our partners in transformation.”

8. At the 2015 Health Datapalooza, the “GetMyHealthData” initiative was launched with the idea that a concerted effort to enlist people to ask for their health data would unlock consumer demand. This year’s Health Datapalooza featured a one-year report back to the conference, and it was ominous. “We thought if we pulled on the rope, it would unravel the knots in the system,” said Christine Bechtel, coordinator of GetMyHealthData. “What we found was that when we pulled, there was an elephant sitting on the other end of the rope.” People got messages that they could have their data if they asked correctly or letters asking why they wanted it. Not a single healthcare organization was able to send data to a health app at a patient’s request. “We saw them being charged high fees that stood in the way of data access,” Bechtel said.

9. In 2015, Bray Patrick-Lake, who is director of stakeholder engagement for the Clinical Trial Transformation Initiative at Duke University and a co-chair of the working group designing the Precision Medicine Initiative at NIH, posted on Twitter a photo of her pile of paper records and disks with the title: “Here’s my worthless longitudinal health record. Patients need interoperable EHRs today.” She was asked at a panel session at this year’s Health Datapalooza if she had one wish granted, what would it be. “Send one person from an EHR vendor to jail for info blocking,” she said.

10. In a moving speech to the Health Datapalooza conference in Washington, D.C., Vice President Joe Biden tied the health data liberation movement to both the cancer moonshot effort he is charged with leading as well as his own son’s battle with cancer. “Today most cancer centers don’t have an easy way or motivation to share data. We have to change this.” He said it was extremely frustrating that his son’s imaging data couldn’t be sent from Walter Reed Hospital in Washington, D.C., to MD Anderson electronically because they were on different systems, and disks had to be sent back and forth. When the administration authorized all the HITECH funding, Biden said, “we didn’t realize five companies would create their own silos. What the heck are we doing?”




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Florida Provider Pays $500K to Settle Potential HIPAA Violations

December 12, 2018
by Heather Landi, Associate Editor
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Florida-based Advanced Care Hospitalists PL (ACH) has agreed to pay $500,000 to the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) to settle potential HIPAA compliance failures, including sharing protected health information with an unknown vendor without a business associate agreement.

ACH provides contracted internal medicine physicians to hospitals and nursing homes in west central Florida. ACH provided services to more than 20,000 patients annually and employed between 39 and 46 individuals during the relevant timeframe, according to OCR officials.

Between November 2011 and June 2012, ACH engaged the services of an individual that claimed to be a representative of a company named Doctor’s First Choice Billings, Inc. (First Choice). The individual provided medical billing services to ACH using First Choice’s name and website, but allegedly without the knowledge or permission of First Choice’s owner, according to OCR officials in a press release published last week.

A local hospital contacted ACH on February 11, 2014 and notified the organization that patient information was viewable on the First Choice website, including names, dates of birth and social security numbers. In response, ACH was able to identify at least 400 affected individuals and asked First Choice to remove the protected health information from its website. ACH filed a breach notification report with OCR on April 11, 2014, stating that 400 individuals were affected; however, after further investigation, ACH filed a supplemental breach report stating that an additional 8,855 patients could have been affected.

According to OCR’s investigation, ACH never entered into a business associate agreement with the individual providing medical billing services to ACH, as required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, and failed to adopt any policy requiring business associate agreements until April 2014. 

“Although ACH had been in operation since 2005, it had not conducted a risk analysis or implemented security measures or any other written HIPAA policies or procedures before 2014. The HIPAA Rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s electronic protected health information,” OCR officials stated in a press release.

In a statement, OCR Director Roger Severino said, “This case is especially troubling because the practice allowed the names and social security numbers of thousands of its patients to be exposed on the internet after it failed to follow basic security requirements under HIPAA.”

In addition to the monetary settlement, ACH will undertake a robust corrective action plan that includes the adoption of business associate agreements, a complete enterprise-wide risk analysis, and comprehensive policies and procedures to comply with the HIPAA Rules. 

In a separate case announced this week, a Colorado-based hospital, Pagosa Springs Medical Center, will pay OCR $111,400 to settle potential HIPAA violations after the hospital failed to terminate a former employee’s access to electronic protected health information (PHI).

Pagosa Springs Medical Center (PSMC) is a critical access hospital, that at the time of OCR’s investigation, provided more than 17,000 hospital and clinic visits annually and employs more than 175 individuals.

The settlement resolves a complaint alleging that a former PSMC employee continued to have remote access to PSMC’s web-based scheduling calendar, which contained patients’ electronic protected health information (ePHI), after separation of employment, according to OCR.

OCR’s investigation revealed that PSMC impermissibly disclosed the ePHI of 557 individuals to its former employee and to the web-based scheduling calendar vendor without a HIPAA required business associate agreement in place. 

The hospital also agreed to adopt a substantial corrective action plan as part of the settlement, and, as part of that plan, PSMC has agreed to update its security management and business associate agreement, policies and procedures, and train its workforce members regarding the same.

“It’s common sense that former employees should immediately lose access to protected patient information upon their separation from employment,” Severino said in a statement. “This case underscores the need for covered entities to always be aware of who has access to their ePHI and who doesn’t.”

Covered entities that do not have or follow procedures to terminate information access privileges upon employee separation risk a HIPAA enforcement action. Covered entities must also evaluate relationships with vendors to ensure that business associate agreements are in place with all business associates before disclosing protected health information. 


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Eye Center in California Switches EHR Vendor Following Ransomware Incident

December 11, 2018
by Rajiv Leventhal, Managing Editor
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Redwood Eye Center, an ophthalmology practice in Vallejo, Calif., has notified more than 16,000 patients that its EHR (electronic health record) hosting vendor experienced a ransomware attack in September.

In the notification to the impacted patients, the center’s officials explained that the third-party vendor that hosts and stores Redwood’s electronic patient records, Illinois-based IT Lighthouse, experienced a data security incident which affected records pertaining to Redwood patients. Officials also said that IT Lighthouse hired a computer forensics company to help them after the ransomware attack, and Redwood worked with the vendor to restore access to our patient information.

Redwood’s investigation determined that the incident may have involved patient information, including patient names, addresses, dates of birth, health insurance information, and medical treatment information.

Notably, Redwood will be changing its EMR hosting vendor, according to its officials. Per the notice, “Redwood has taken affirmative steps to prevent a similar situation from arising in the future. These steps include changing medical records hosting vendors and enhancing the security of patient information.”

Ransomware attacks in the healthcare sector continue to be a problem, but at the same time, they have diminished substantially compared to the same time period last year, as cyber attackers move on to more profitable activities, such as cryptojacking, according to a recent report from cybersecurity firm Cryptonite.

Related Insights For: Cybersecurity


Report: 30 Percent of Healthcare Databases Exposed Online

December 10, 2018
by Heather Landi, Associate Editor
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Hackers are using the Dark Web to buy and sell personally identifiable information (PII) stolen from healthcare organizations, and exposed databases are a vulnerable attack surface for healthcare organizations, according to a new cybersecurity research report.

A research report from IntSights, “Chronic [Cyber] Pain: Exposed & Misconfigured Databases in the Healthcare Industry,” gives an account of how hackers are tracking down healthcare personally identifiable information (PII) data on the Dark Web and where in the attack surface healthcare organizations are most vulnerable.

The report explores a key area of the healthcare attack surface, which is often the easiest to avoid—exposed databases. It’s not only old or outdated databases that get breached, but also newly established platforms that are vulnerable due to misconfiguration and/or open access, the report authors note.

Healthcare organizations have been increasingly targeted by threat actors over the past few years and their most sought-after asset is their data. As healthcare organizations attempt to move data online and increase accessibility for authorized users, they’ve dramatically increased their attack surface, providing cybercriminals with new vectors to steal personally identifiable information (PII), according to the report. Yet, these organizations have not prioritized investments in cybersecurity tools or procedures.

Healthcare budgets are tight, the report authors note, and if there’s an opportunity to purchase a new MRI machine versus make a new IT or cybersecurity hire, the new MRI machine often wins out. Healthcare organizations need to carefully balance accessibility and protection.

In this report, cyber researchers set out to show that the healthcare industry as a whole is vulnerable, not due to a specific product or system, but due to lack of process, training and cybersecurity best practices. “While many other industries suffer from similar deficiencies, healthcare organizations are particularly at risk because of the sensitivity of PII and medical data,” the report states.

The researchers chose a couple of popular technologies for handling medical records, including known and widely used commercial databases, legacy services still in use today, and new sites or protocols that try to mitigate some of the vulnerabilities of past methods. The purpose of the research was to demonstrate that hackers can easily find access to sensitive data in each state: at rest, in transit or in use.

The researchers note that the tactics used were pretty simple: Google searches, reading technical documentation of the aforementioned technologies, subdomain enumeration, and some educated guessing about the combination of sites, systems and data. “All of the examples presented here were freely accessible, and required no intrusive methods to obtain. Simply knowing where to look (like the IP address, name or protocol of the service used) was often enough to access the data,” the report authors wrote.

The researchers spent 90 hours researching and evaluated 50 database. Among the findings outlined in the report, 15 databases were found exposed, so the researchers estimate about 30 percent of databases are exposed. The researchers found 1.5 million patient records exposed, at a rate of about 16,687 medical records discovered per hour.

The estimated black-market price per medical record is $1 per record. The researchers concluded that hackers can find a large number of records in just a few hours of work, and this data can be used to make money in a variety of ways. If a hacker can find records at a rate of 16,687 per hour and works 40 hours a week, that hacker can make an annual salary of $33 million, according to the researchers.

“It’s also important to note that PII and medical data is harder to make money with compared to other data, like credit card info. Cybercriminals tend to be lazy, and it’s much quicker to try using a stolen credit card to make a fraudulent purchase than to buy PII data and run a phishing or extortion campaign. This may lessen the value of PII data in the eyes of some cybercriminals; however, PII data has a longer shelf-life and can be used for more sophisticated and more successful campaigns,” IntSights security researcher and report author Ariel Ainhoren wrote.

The researchers used an example of hospital using a FTP server. “FTP is a very old and known way to share files across the Internet. It is also a scarcely protected protocol that has no encryption built in, and only asks you for a username and password combination, which can be brute forced or sniffed

by network scanners very easily,” Ainhoren wrote. “Here we found a hospital in the U.S. that has its FTP server exposed. FTP’s usually hold records and backup data, and are kept open to enable backup to a remote site. It could be a neglected backup procedure left open by IT that the hospital doesn’t even know exists.”

According to the report, hackers have three main motivations for targeting healthcare organizations and medical data:

  • State-Sponsored APTs Targeting Critical Infrastructure: APTs are more sophisticated and are usually more difficult to stop. They will attempt to infiltrate a network to test tools and techniques to set the stage for a larger, future attack, or to obtain information on a specific individual’s medical condition.
  • Attackers Seeking Personal Data: Attackers seeking personal data can use it in multiple ways. They can create and sell PII lists, they can blackmail individuals or organizations in exchange for the data, or they can use it as a basis for further fraud, like phishing, Smishing, or scam calls.
  • Attackers Taking Control of Medical Devices for Ransom: Attackers targeting vulnerable infrastructure won’t usually target healthcare databases, but will target medical IT equipment and infrastructure to spread malware that exploits specific vulnerabilities and demands a ransom to release the infected devices. Since medical devices tend to be updated infrequently (or not at all), this provides a relatively easy target for hackers to take control.

The report also offers a few general best practices for evaluating if a healthcare organization’s data is exposed and/or at risk:

  • Use Multi-Factor Authentication for Web Applications: If you’re using a system that only needs a username and password to login, you’re making it significantly easier to access. Make sure you have MFA setup to reduce unauthorized access.
  • Tighter Access Control to Resources: Limit the number of credentials to each party accessing the database. Additionally, limit specific parties’ access to only the information they need. This will minimize your chance of being exploited through a 3rd party, and if you are, will limit the damage of that breach.
  • Monitor for Big or Unusual Database Reads: These may be an indication that a hacker or unauthorized party is stealing information. It’s a good idea to setup limits on database reads and make sure requests for big database reads involve some sort of manual review or confirmation.
  • Limit Database Access to Specific IP Ranges: Mapping out the organizations that need access to your data is not an easy task. But it will give you tighter control on who’s accessing your data and enable you to track and identify anomalous activity. You can even tie specific credentials to specific IP ranges to further limit access and track strange behavior more closely.


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