Saturday, October 24, 2015

Sutter Health Incident Illustrates Email Risks

Sutter Health's revelation that a former employee inappropriately sent patient information to a personal email account in violation of the organization's policy is yet another reminder of the privacy risks posed by email communication.

In a Sept. 11 statement, the California healthcare delivery system says the billing documents for 2,582 patients that were inappropriately emailed included names, dates of birth, insurance identification numbers, dates of services and billing codes. For one patient, compromised information also included a driver's license number. For another, the a driver's license number and Social Security number were included.

Sutter Health includes 24 hospitals, 27 ambulatory care facilities and a network of more than 5,000 physicians in Northern California. Previously, the organization reported three other breaches, including a 2011 breach involving the theft of an unencrypted desktop computer containing information on 4.1 million patients.

The organization says it discovered the email-related incident during a review of the former employee's email activity and computer access. Sutter launched an investigation on Aug. 27 after the organization learned of possible "improper conduct" by the former employee, who worked at Sutter Physician Services, which handles billing for Sutter Health's physician medical foundations.

Most of the patients whose data was involved in the April 26, 2013, incident reside in the greater Sacramento region and are patients of Sacramento-based Sutter Medical Foundation, Sutter Health says. The California healthcare provider says it has no evidence that any of the patient information was misused or disclosed to others. But it's offering affected patients are being offered free credit monitoring services for one year.

Taking Precautions

Sending any confidential information to a personal email account is strictly prohibited. Sutter Health now has sophisticated software that helps block confidential information from leaving the organization unless appropriate safeguards are in place to securely send the information. Employees are also required to annually acknowledge and sign Sutter Health's confidentiality agreement, which states that the employees agree to abide by and protect Sutter Health's confidential data.  You must work hard at protecting patient information, including implementing new technologies to enhance protection. I cannot provide specific details of those technologies - that's among your safety efforts.

Common Problem

Unfortunately, privacy breaches involving unsecured email - as well as text messages - are a common problem in the healthcare arena, security experts say.  My experience is that doctors and medical practice employees send PHI through unsecure e-mail all the time.

Besides implementing encrypted email communication healthcare entities can take other steps to safeguard patient information. For example, they can use data loss prevention programs that scan emails and documents containing sensitive data, such as Social Security numbers, before they're transmitted, security experts say. Depending on the technology, the sensitive data can either be blocked from transmission or automatically encrypted.

When doctors have privileges in multiple hospitals, it is easy to use free webmail for communications wherever they are. Even if you have a secure e-mail server in your practice that allows for secure messaging within your organization, sending a message to someone else using webmail is not secure. 

Employees and clinicians need to be educated on the secure methods for sending communication involving PHI.

More Guidance Needed?

At a recent annual HIPAA security conference hosted by OCR and the National Institute of Standards and Technology, OCR officials acknowledged that incidents involving unsecure email are likely underreported to the agency.  We are seeing a lot of different problems with the transmission of electronic PHI, OCR director said during a question-and-answer session with attendees.

While communication between healthcare providers that involves the sharing of PHI should be secured using encryption or other safeguards, patients can request that their doctors electronically send them their records without using encryption or other secure methods, as long the individuals are made aware of the risks.

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