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Federal agencies charged with building a secure health information technology infrastructure are not doing enough to implement the proper security measures needed to protect sensitive patient information, according to two audits released this week.

The audits, conducted by the Department of Health and Human Services Office of Inspector General (OIG), examined health IT security standards, compliance with the Health Insurance Portability and Accountability Act (HIPAA), and network vulnerabilities at hospitals, as well as security policies and procedures at the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Both reports, which were issued simultaneously, give a sobering view of the federal government's efforts to keep computerized patient data secure at a time when billions of dollars are being spent on incentive programs that will accelerate the adoption of electronic health records.

In the audit, Nationwide Rollup Review of the Centers for Medicare & Medicaid Services Health Insurance Portability and Accountability Act of 1996 Oversight, OIG examined CMS' oversight and enforcement of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 Security Rule, and found CMS lax in its efforts to ensure that covered entities, such as hospitals, adhered to the Security Rule.

To carry out its investigation, OIG audited seven hospitals in California, Georgia, Illinois, Massachusetts, Missouri, New York, and Texas.

At these seven hospitals, OIG identified 151 vulnerabilities in the systems and controls intended to protect electronic protected health information (ePHI). Of these vulnerabilities, 124 were categorized as high impact.

Additionally, the seven hospitals had 38 access control vulnerabilities involving domain controllers, servers, workstations, and mass storage media used to receive, maintain, or transmit ePHI.

"The vulnerabilities included inadequate password settings, computers that did not log users off after periods of inactivity, unencrypted laptops containing ePHI, and excessive access to root folders," the audit said.

The report went on to say that five hospitals had 15 wireless access vulnerabilities, which included ineffective encryption and no firewall separating wireless from internal wired networks.

According to OIG, at one hospital unauthorized access to systems and beneficiaries' personal data occurred without the hospitals' knowledge.

"These audits disclosed numerous internal control weaknesses at the hospitals and further demonstrated the need for greater oversight by CMS," the report said.

Both the Social Security Act and the Security Rule require a covered entity, defined as a health plan, health care clearinghouse, or health care provider that transmits health information electronically, to ensure the confidentiality, integrity, and availability of the information, protect against any reasonably anticipated security risks, and protect against unauthorized use of health information.

In its recommendations, OIG urged the Department's Office for Civil Rights (OCR) to continue the compliance review process that CMS began in 2009 and implement procedures for conducting compliance reviews to ensure that Security Rule controls are in place to protect heath information at covered entities.

In another report, Audit of Information Technology Security Included in Health Information Technology Standards, ONC was taken to task for not doing enough to implement proper security measures to protect sensitive patient information.

After an extensive review of ONC's process for creating and adopting interoperability specifications, and performing fieldwork at ONC's headquarters from June to August 2009, and February to August 2010, OIG found that there were "no HIT standards that included general IT security controls."

When considering prior audits at Medicare contractors, state Medicaid agencies, and hospitals where a lack of general IT security controls were also found, OIG concluded that security weaknesses in the health IT infrastructure "raise concern about the effectiveness of IT security for HIT if general IT security controls are not addressed."

ONC endorsed OIG's four recommendations outlined below:

-- Broaden its focus from interoperability specifications to include well-developed general IT security controls for supporting systems, networks, and infrastructures.

-- Use its leadership role to provide guidance to the health industry on established general IT security standards and IT industry security best practices.

-- Emphasize to the medical community the importance of general IT security.

-- Coordinate its work with CMS and OCR to add general IT security controls where applicable.

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