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Could the Drive to Value-Based Healthcare Undermine Security?

Posted on November 27, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As we all know, the healthcare industry’s move toward value-based healthcare is forcing providers to make some big changes. In fact, a recent report by peer60 found that 64% of hospitals responding cited oncoming value-based reimbursement as their top challenge. Meanwhile, only 30% could say the same of improving information security according to peer60, which recently surveyed 320 hospital leaders.

Now, the difference in concern over the two issues can be chalked up, at least in part, to the design of the survey. Obviously, there’s a good chance that a survey of CIOs would generate different results. But as the report’s authors noted, the survey might also have exposed a troublesome gap in priorities between health IT and the rest of the hospital C-suite.

It’s hardly surprising hospital leaders are focused on the life-and-death effects of a major change in payment policy. Ultimately, if a hospital can’t stay in business, protecting data won’t be an issue anymore. But if a hospital keeps its doors open, protecting patient data must be given a great deal of attention.

If there is a substantial gap between CIOs and their colleagues on security, my guess is that the reasons include the following:

  • Assuming CIOs can handle things:  Lamentable though it may be, less-savvy healthcare leaders may think of security as a tech-heavy problem that doesn’t concern them on a day-to-day level.
  • Managing by emergency:  Though they might not admit it publicly, reactive health executives may see security problems as only worth addressing when something needs fixing.
  • Fear of knowing what needs to be done:  Any intelligent, educated health exec knows that they can’t afford to let security be compromised, but they don’t want to face up to the time, money and energy it takes to do infosec right.
  • Overconfidence in existing security measures:  After approving the investment of tens or even hundreds of millions on health IT, non-tech health leaders may find it hard to believe that perfect security isn’t “built in” and complete.

I guess the upshot of all of this is that even sophisticated healthcare executives may have dysfunctional beliefs about health data security. And it’s not surprising that health leaders with limited technical backgrounds may prefer to attack problems they do understand.

Ultimately, this suggests to me that CIOs and other HIT leaders still have a lot of ‘splaining to do. To do their best with security challenges, health IT execs need the support from the entire leadership team, and that will mean educating their peers on some painful realities of the trade.

After all, if security is to be an organization-wide process — not just a few patches and HIPAA training sessions — it has to be ingrained in everything employees do. And that may mean some vigorous exchanges of views on how security fosters value.

The Future Of…Healthcare Security

Posted on March 13, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Security is on the top of mind of most healthcare boards. I think the instruction from these boards to CIOs is simple: Keep Us Out of the News!

That’s an order that’s much easier said than done. If Google and Anthem can’t stay out of the news because of a breach, then a hospital or doctor’s office is fighting an uphill battle. Still don’t believe me, check out this visualization of internet attacks. It’s pretty scary stuff.

The reality is that you don’t really win a security battle. You can just defend against attacks as well as possible with the limited resources you have available. What is clear is that while still limited, healthcare will be investing more resources in security and privacy than they’ve ever done before.

The future of effective security in healthcare is going to be organizations who bake security into everything they do. Instead of hiring a chief security officer that worries about and advocates for security, we need a culture of security in healthcare organizations. This starts at the top where the leader is always asking about how we’re addressing security. That leadership will then trickle down into the culture of a company.

Let’s also be clear that security doesn’t have to be at odds with innovation and technology. In fact, technology can take our approach to security and privacy to the next level. Tell me how you knew who read the chart in a paper chart world? Oh yes, that sign out sheet that people always forgot to sign. Oh wait, the fingerprints on the chart were checked. It’s almost ludicrous to think about. Let’s be real. In the paper chart world we put in processes to try to avoid the wrong people getting their hands on the chart, but we really had no idea who saw it. The opposite is true in an EHR world. We know exactly who saw what and who changed what and when and where (Note: Some EHR are better than others at this, but a few lawsuits will get them all up to par on it).

The reality is that technology can take security and privacy to another level that we could have never dreamed. We can implement granular access controls that are hard and fast and monitored and audited. That’s a powerful part of the future of security and privacy in healthcare. Remember that many of the healthcare breaches come from people who have a username and password and not from some outside hacker.

A culture of security and privacy embraces the ability to track when and what happens to every piece of PHI in their organization. Plus, this culture has to be built into the procurement process, the implementation process, the training process, etc. Gone are the days of the chief security officer scapegoat. Technology is going to show very clearly who is responsible.

While I’ve described a rosy future built around a culture of privacy and security, I’m not naive. The future of healthcare security also includes a large number of organizations who continue to live a security life of “ignorance is bliss.” These people will pay lip service to privacy and security, but won’t actually address the culture change that’s needed to address privacy and security. They’ll continue the “Just Enough Culture of HIPAA Compliance.”

In the future we’ll have to be careful to not include one organization’s ignorance in a broad description of healthcare in general. A great example of this can be learned from the Sutter Health breach. In this incident, Sutter Health CPMC found the breach during a proactive audit of their EHR. Here’s the lesson learned from that breach:

The other lesson we need to take from this HIPAA breach notification is that we shouldn’t be so quick to judge an organization that proactively discovers a breach. If we’re too punitive with healthcare organizations that find and effectively address a breach like this, then organizations will stop finding and reporting these issues. We should want healthcare organizations that have a culture and privacy and security. Part of that culture is that they’re going to sometimes catch bad actors which they need to correct.

Healthcare IT software like EHRs have a great ability to track everything that’s done and they’re only going to get better at doing it. That’s a good thing and healthcare information security and privacy will benefit from it. We should encourage rather than ridicule organizations like CPMC for their proactive efforts to take care of the privacy of their patients’ information. I hope we see more organizations like Sutter Health who take a proactive approach to the security and privacy of healthcare information.

In fact the title of the blog post linked above is a warning for the future of healthcare IT: “Will Hospitals Be At Risk for HIPAA Audits If They Don’t Have HIPAA Violations?”

Security and privacy will be part of the fabric of everything we do in healthcare IT. We can’t ignore them. In order for patients to trust these healthcare apps, security will have to be a feature. Those in healthcare IT that don’t include security as a feature will be on shaky ground.