In a letter to the Office of Civil Rights (OCR) in the Department of Health and Human Services (HHS), Deborah Peel, MD, founder and chair of Patient Privacy Rights, said, "Health providers will benefit from such guidance as they consider moving to cloud services, and patients will benefit by knowing which data privacy and security protections should be in place."
Peel's letter cites the HHS' settlement with Phoenix Cardiac Surgery in April 2012 to illustrate the challenges that can arise when providers move to the cloud. In that case, the practice was fined $100,000 for managing appointments using a Web-based calendar that was publicly available.
Today, healthcare providers' use of cloud services goes far beyond that. Electronic health records, billing data, medical images and many other types of healthcare information are now stored on remote servers. According to an Optum Institute report published last March, nearly 60% of responding CIOs from organizations that had an EHR and a health information exchange said they planned to invest in "cloud-based open systems."
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Despite the burgeoning use of the cloud to store and manage information, however, Peel could not cite evidence that this shift has led to an increase in security breaches or that cloud storage is inherently less secure than onsite storage of data. "I don't know whether there are any studies of that," she told InformationWeek Healthcare.
What is known, she added, is that "the healthcare industry has the worst security practices of any industry. Eighty percent of hospitals still don't even encrypt data. Hospitals are not putting the money into data protection."
The key issue with cloud storage, she said, is that "there's no way of telling which services are following best practices for state-of-the-art comprehensive security and privacy."
For example, she pointed out, remote servers can be located anywhere. "We don't even know whether they're in the U.S. We have no way of knowing what happens inside the cloud servers, whether the owners of the cloud service snoop in the information or not, and there's no certification or auditing of these systems to verify whether they do what they say they do in a contract."
Even worse, she pointed out, many contracts between cloud service firms and healthcare providers lack even basic security protections. For example, the HIPAA law mandates that cloud services sign business associate agreements requiring them to adhere to the same security and privacy rules that HIPAA-covered entities must comply with. But many providers do not ensure that this provision is in their contracts.
Under the guidance that Peel's group is seeking, the OCR would urge cloud companies to provide:
-- A secure infrastructure, including data encryption and audit controls
-- Security standards consistent with standards required of federal agencies
-- Privacy of protected health information, based on standards for appropriate use, disclosure and safeguarding of individually identifiable information
-- Business associate agreements -- something that OCR has already called for.
Eventually, Peel said, her group wants the government to introduce a certification system for cloud computing, similar to the EHR certification it requires for showing Meaningful Use. Such certification, which could be performed by HHS or by private entities authorized by HHS, would incorporate the guidance elements in Peel's letter. It would also include other requirements set forth in a "trust framework" that her group plans to release within the next few weeks.
Patient Privacy Rights developed and validated the trust framework with the help of Microsoft and PwC and tested it on HealthVault, according to Peel. "We have some tools that could be used to assess every kind of platform, application or system so that some kind of ranking or rating could be created for how well they comply with what the public expects. We have 15 major principles broken down into auditable criteria, such as what nation the servers are in."
Initially, Peel noted, Patient Privacy Rights will release the framework for purposes of discussion, research and self-evaluation by cloud services and healthcare providers. The criteria in the framework, she said, could apply to anybody who stores healthcare information remotely, even on a website.
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