Risk
8/22/2011
12:04 PM
50%
50%

EHR Data In Cloud Needs Strong Security Trail

Presenters at a recent Legal EHR Summit warn healthcare providers to press their vendors for clear answers on security.

Healthcare Innovators
Slideshow: Healthcare Innovators
(click image for larger view andfor full slideshow)
With healthcare's unique information security requirements, the growth of cloud-based electronic health records (EHRs) is raising a number of new issues regarding data stewardship and organizational responsibility.

According to Gerard Nussbaum, director of technology services at management consultancy Kurt Salmon Associates, the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules do not specify whether a provider using a cloud-based EHR owns data in the medical records or if the information belongs to the service host. Speaking last week at the American Health Information Management Association (AHIMA) Legal EHR Summit in Chicago, Nussbaum recommended that healthcare providers explicitly negotiate data usage in contracts, particularly in case of a breach.

"Nothing is secure from breaches," noted Nussbaum, an attorney. Knowing this, he said it's best to "iron out up front" what each party's legal responsibility is in the event of a breach, such as who must notify individuals whose data may have been compromised.

Health information management consultant Sandra Nunn, who participated in a panel discussion on managing health information in the cloud, said she wants her clients to reach a clear understanding with their vendors about whether information will be sequestered in the cloud if there is a breach and whether there will be an easily accessible audit trail.

"Having multiple cloud vendors can complicate your situation," Nunn said. She surmised that it might be a good idea for providers to ask their vendors once or twice a year to create an audit log just to make sure it's possible.

This soon could become more urgent, based on a recent proposal from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR). In what is being called the "accounting for disclosures" rule, OCR has proposed changing existing HIPAA privacy standards to require "covered entities" to produce disclosure reports within 30 days of a patient's request, rather than the current 60 days.

Another panel member, Daniel Orenstein, senior VP and general counsel of EHR and physician business services provider Athenahealth, Watertown, Mass., said that he has never actually seen a patient request an accounting for disclosures. It would take a good amount a work on the provider end to compile the information, but EHRs are capable, whether in the cloud or on a local server. "We certainly can produce it," Orenstein said.

Athenahealth did not submit formal comments to HHS on the proposed accounting rule, according to Orenstein, but the company, which long has offered remotely hosted services, is emblematic of the way the health IT industry is shifting, particularly for small physician practices. A month ago, Athenahealth announced plans to acquire Proxsys, a provider of care-coordination services that links physicians and hospitals via the cloud, to beef up its health information exchange capabilities.

Because of this trend, Nussbaum said due diligence must be an ongoing process. Providers should, for example, be aware of how they would get their data back should they stop using a cloud-based EHR or simply switch vendors.

He recommended walking away from any vendor that refuses to run a security audit because it suggests that the vendor is not serious about transparency. "You have to do the security audit one way or another," Nussbaum said, even if it is through a third party.

Nussbaum also said to avoid "shrinkwrap" licenses that don't take into account individual customers' needs in HIPAA business associates agreements.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
Register for Dark Reading Newsletters
Dark Reading Live EVENTS
INsecurity - For the Defenders of Enterprise Security
A Dark Reading Conference
While red team conferences focus primarily on new vulnerabilities and security researchers, INsecurity puts security execution, protection, and operations center stage. The primary speakers will be CISOs and leaders in security defense; the blue team will be the focus.
White Papers
Video
Cartoon Contest
Write a Caption, Win a Starbucks Card! Click Here
Latest Comment: No, no, no! Have a Unix CRON do the pop-up reminders!
Current Issue
Security Vulnerabilities: The Next Wave
Just when you thought it was safe, researchers have unveiled a new round of IT security flaws. Is your enterprise ready?
Flash Poll
The Impact of a Security Breach 2017
The Impact of a Security Breach 2017
Despite the escalation of cybersecurity staffing and technology, enterprises continue to suffer data breaches and compromises at an alarming rate. How do these breaches occur? How are enterprises responding, and what is the impact of these compromises on the business? This report offers new data on the frequency of data breaches, the losses they cause, and the steps that organizations are taking to prevent them in the future.
Slideshows
Twitter Feed
Dark Reading - Bug Report
Bug Report
Enterprise Vulnerabilities
From DHS/US-CERT's National Vulnerability Database
CVE-2017-0290
Published: 2017-05-09
NScript in mpengine in Microsoft Malware Protection Engine with Engine Version before 1.1.13704.0, as used in Windows Defender and other products, allows remote attackers to execute arbitrary code or cause a denial of service (type confusion and application crash) via crafted JavaScript code within ...

CVE-2016-10369
Published: 2017-05-08
unixsocket.c in lxterminal through 0.3.0 insecurely uses /tmp for a socket file, allowing a local user to cause a denial of service (preventing terminal launch), or possibly have other impact (bypassing terminal access control).

CVE-2016-8202
Published: 2017-05-08
A privilege escalation vulnerability in Brocade Fibre Channel SAN products running Brocade Fabric OS (FOS) releases earlier than v7.4.1d and v8.0.1b could allow an authenticated attacker to elevate the privileges of user accounts accessing the system via command line interface. With affected version...

CVE-2016-8209
Published: 2017-05-08
Improper checks for unusual or exceptional conditions in Brocade NetIron 05.8.00 and later releases up to and including 06.1.00, when the Management Module is continuously scanned on port 22, may allow attackers to cause a denial of service (crash and reload) of the management module.

CVE-2017-0890
Published: 2017-05-08
Nextcloud Server before 11.0.3 is vulnerable to an inadequate escaping leading to a XSS vulnerability in the search module. To be exploitable a user has to write or paste malicious content into the search dialogue.