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Take Two and Call me in the Morning: U.S. Hospitals Need an Information Governance Remedy

Wednesday, April 11th, 2012

Given the vast amount of sensitive information and legal exposure faced by hospitals today it’s a mystery why these organizations aren’t taking advantage of enabling technologies to minimize risk. Both HIPPA and the HITECH Act are often achieved by manual, ad hoc methods, which are hazardous at best. In the past, state and federal auditing environments have not been very aggressive in ensuring compliance, but that is changing. While many hospitals have invested in high tech records management systems (EMR/EHR), those systems do not encompass the entire information and data environment within a hospital. Sensitive information often finds its way into and onto systems outside the reach of EMR/EHR systems, bringing with it increased exposure to security breach and legal liability.

This information overload often metastasizes into email (both hospital and personal), attachments, portable storage devices, file, web and development servers, desktops and laptops, home or affiliated practice’s computers and mobile devices such as iPads and smart phones. These avenues for the dissemination and receipt of information expand the information governance challenge and data security risks. Surprisingly, the feedback from the healthcare sector suggests that hospitals rarely get sued in federal court.

One place hospitals do not want to be is the “Wall of Shame,” otherwise known as the HHS website that has detailed 281 Health Insurance Portability and Accountability Act (HIPAA) security violations that have affected more than 500 individuals as of June 9, 2011. Overall, physical theft and loss accounted for about 63% of the reported breaches. Unauthorized access / disclosure accounted for another 16%, while hacking was only 6%. While Software Advice reasons these statistics seem to indicate that physical theft has been the reason for the majority of breaches, it should also be considered that due to the lack of data loss prevention technology, many hospitals are unaware of breaches that have occurred and therefore cannot report on them.

There are a myriad of reasons hospitals aren’t landing on the front page of the newspaper with the same frequency as other businesses and government agencies when it comes to security breach, and document retention and eDiscovery blunders. But, the underlying contagion is not contained and it certainly is not benign. Feedback from the field reveals some alarming symptoms of the unhealthy state of healthcare information governance, including:

  • uncontrolled .pst files
  • exploding storage growth
  • missing or incomplete data retention rules
  • doctors/nurses storing and sending sensitive data via their personal email, iPads and smartphones
  • encryption rules that rely on individuals to determine what to encrypt
  • data backup policies that differ from data retention and information governance rules
  • little to no compliance training
  • and many times non-existent data loss prevention efforts.

This results in the need for more storage, while creating larger legal liability, an indefensible eDiscovery posture, and the risk of breach.

The reason this problem remains latent in most hospitals is because they are not yet feeling the pain of the problem from massive and multiple lawsuits, large invoices from outside law firms or the operational challenges/costs incurred from searching through many mountains of dispersed data.  The symptoms are observable, the pathology is present, the problem is real and the pain is about to acutely present itself as more states begin to deeply embrace eDiscovery requirements and government regulators increase audit frequency and fine amounts. Another less talked about reason hospitals have not had the same pressure to search and produce their data pursuant to litigation is due to cases being settled before they even get to the discovery stage. The lack of well-developed information governance practices leads to cases being settled too soon, for too much money when they otherwise may not have needed to settle at all.

The Patient’s Symptoms Were Treated, but the Patient’s Data Still Needs Medicine

What is still unclear is why hospitals, given their compliance requirements and tightening IT budgets, aren’t archiving, classifying, and protecting their data with the same type of innovation they are demonstrating in their cutting edge patient care technology. In this realm, two opposite ends of the IT innovation spectrum seem to co-exist in the hospital’s data environment. This dichotomy leaves much of a hospital’s data unprotected, unorganized and uncontrolled. Hospitals are experiencing increasing data security breaches and often are not aware that a breach or data loss has occurred. As more patient data is created and copied in electronic format, used in and exposed by an increasing number of systems and delivered on emerging mobile platforms, the legal and audit risks are compounding on top of a faulty or missing information governance foundation.

Many hospitals have no retention schedules or data classification rules applied to existing information, which often results in a checkbox compliance mentality and a keep-everything-forever practice. Additionally, many hospitals have no ability to apply a comprehensive legal hold across different data sources and lack technology to stop or alert them when there has been a breach.

Information Governance and Data Health in Hospitals

With the mandated push for paper to be converted to digital records, many hospitals are now evaluating the interplay of their various information management and distribution systems. They must consider the newly scanned legacy data (or soon to be scanned), and if they have been operating without an archive, they must now look to implement a searchable repository where they can collectively apply document retention and records management while decreasing the amount of storage needed to retain the data.  We are beginning to see internal counsel leading the way to make this initiative happen across business units. Different departments are coming together to pool resources in tight economic and high regulation times that require collaboration.  We are at the beginning of a widespread movement in the healthcare industry for archiving, data classification and data loss prevention as hospitals link their increasing compliance and data loss requirements with the need to optimize and minimize storage costs. Finally, it comes as no surprise that the amount of data hospitals are generating is crippling their infrastructures, breaking budgets and serving as the primary motivator for change absent lawsuits and audits.

These factors are bringing together various stakeholders into the information governance conversation, helping to paint a very clear picture that putting in place a comprehensive information governance solution is in the entire hospital’s best interest. The symptoms are clear, the problem is treatable, the prescription for information governance is well proven. Hospitals can begin this process by calling an information governance meeting with key stakeholders and pursuing an agenda set around examining their data map and assessing areas of security vulnerability, as well as auditing the present state of compliance with regulations for the healthcare industry.

Editor’s note: This post was co-authored with Eric Heck, Healthcare Account Manager at Symantec.  Eric has over 25 years of experience in applying technology to emerging business challenges, and currently works with healthcare providers and hospitals to manage the evolving threat landscape of compliance, security, data loss and information governance within operational, regulatory and budgetary constraints.