Over the past few months i've been spending more time with customers in the health care industry. Globally we are seeing an increase in security breaches of patient data, just look at the following examples of data loss in the last month alone...
- UK medics have lost the personal records of nearly 12,000 NHS patients in just eight months. Also a hospital worker was suspended after it was discovered he had sent a file containing payslip details for EVERY member of staff to his home e-mail account.
- Personal information about more than 600 patients of the Fraser Health Authority in British Columbia is contained in a laptop stolen from Burnaby General Hospital.
- University of Rochester Medical Center says a doctor misplaced and still hasn't found a computer flash drive containing personal patient information including names, birth dates, and the diagnosis for more than 800 patients.
- Lost or stolen: dozens of NHS and council computers with personal data. In total, 60 PCs, six laptops and 11 USB sticks were lost while 14 PCs, 50 laptops, 7 computer hard drives and four mobile phones were stolen.
- The security of personal health information of up to 1,000 people could have been compromised when a laptop was stolen from Yale Medical School.
- Car burglars in the past week have made off with personal records of 4,000 patients of a Portland psychologist and the names and Social Security numbers of 2,900 jobless Multnomah County residents.
- Portland psychologist's laptop stolen; 4,000 patients face possible identity breach. The laptop contained clinical evaluations, with patients' full names, diagnoses and Social Security numbers. The laptop was password protected; however, there was a disk in the CD drive containing a partial backup of the hard drive. The disk was apparently unencrypted.
- The confidential health information of about 1,600 patients of Texas Children's Hospital is at risk after a doctor's laptop containing clinical and demographic information was stolen.
"Using IRM to encrypt and control access to patient data at the file level means no matter where the file is stored, it is always protected."
|These are alarming numbers! As more and more medical and health care organizations are being mandated to move to electronic systems for storing your confidential medical information, these incidents are only going to rise. The modern world is full of new technology designed to make sharing information easier, networks are getting faster, storage devices bigger and threats to your data are increasing at the same rate. A recent study found that attempted attacks on health care organizations increased from an average of 6,500 per health care client per day in the first nine months of 2009 to an average of 13,400 per client per day in the last three months of 2009. As the UK's Liberal Democrat Robert Brown, said: "These are frightening figures. Central government, local councils, NHS boards and the police hold a great deal of information on all of us. Our data is in their hands and we need to know they are taking this responsibility seriously... Liberal Democrats called for an urgent review into data loss in January. I want to know what the government have done since then and why the situation has not improved."
|Not improved? I'd like to know why it seems to be getting worse... This increase in activity is taking place in parallel to new laws trying to protect your information. Recent changes to legal acts, such as the Health Insurance Portability and Accountability (HIPAA) act in the US, define that health information must be secured and typically the key word is encryption. As an article on recent HIPAA changes in SC magazine mentions; "In the past, companies offered hard drives that used strong encryption. However, analysis showed that strong encryption was used but only to protect the password and not the data that was stored on the devices. The actual data stored on the hard drive was encrypted with an encryption algorithm developed by the company, which proved to be anything but strong. This illustrates the potential pitfalls of choosing any type of encryption package -- a lack of strong, secure encryption. Obviously, some encryption programs do a better job of protecting data than others, but how can a company choose the right one?"
"The government is not in control of the situation. They need to get a grip on this right now."
Robert Brown MSP, Spokesperson on Justice
Encryption is a key method to securing information, so much so, that the HIPAA regulations say if your patient information is encrypted, you avoid fines and requirements to publicly notify government of any breach of data. So how do you choose the right way to use encryption? Start by looking at the way data is lost, it falls into a few common areas. Firstly the loss or theft of devices on which the information is stored, DVD's lost in the post, stolen laptops and mislaid USB data devices seem to dominate the news. Then every so often someone accidentally emails patient data to the wrong recipient or posts files online insecurely. Secondly look at the type of format the lost information is stored in;
- Database exports/backups
- Unstructured documents such as spreadsheets, PDF's, or emails
So many incidents involve the loss of laptops and storage devices that contain database backups or documents and emails that have either inadequate encryption or none at all.
Are there no decent technologies to address these problems?
Quite the opposite, now more than ever there are many products designed to address these issues by implementing encryption and access controls. Lets look at some of the solutions from Oracle which could significantly improve the security of patient information and massively reduce the risk of health care organizations being fined and publicly embarrassed.
Before I go into any detail, look at the diagram above which highlights patient information typically lives in three places. The database, the application or in a document. To ensure we use encryption and security effectively, we need to put solutions at all three areas. I'm only going to cover specific Oracle encryption technologies in the rest of this article. It is common sense the following should be part of a complete medical data security solution that uses identity & access management solutions, browser to application server network encryption (SSL over HTTPS) and other well known methods of information security.
Encrypting data at rest
Hard disk encryption is often touted as the answer to protecting data at rest. However in practice this addresses only a small area of the problem. When it comes to databases, performance is key. So encrypting the disks on which the medical databases reside can significantly impact system performance. Performance is everything in health care, timely access to patient data can be a matter of life and death. However with the Oracle database, encryption can be used within the database platform itself and here we can really reduce the impact of performance. Transparent Data Encryption
(TDE) applied at the table space (the files which store information) has a minimal impact on performance and more importantly does not affect the ability to compress the data. The last thing you want is to start encrypting your database information to find that your previously effective compression is now useless and results in a doubling of the database storage requirements.
But encrypting the data in the database doesn't help when physicians are downloading spreadsheets of patient data from health applications and storing them on USB devices and laptops which are easily lost or stolen. Of course this is where Information Rights Management (IRM) comes into play. Using IRM to encrypt and control access to patient data at the file level means no matter where the file is stored, it is always protected.
Encrypting data in transit
In transit usually means when information is being transferred across a network. Encrypting database backups on DVD's and using IRM to protect files stored on USB keys falls under data at rest requirements. The same set of technologies in the Oracle database that protect information whilst it resides on the disks can also be applied as the database transmits information to the application over the network
. Configuring the encryption
of information on the network in the Oracle database is easy and requires no change to the application! Protecting patient information couldn't be easier.
Does IRM fit into securing data in transit? Of course, if the file is encrypted with IRM it doesn't matter how it is transferred over the network, it is always encrypted. As an attachment to an email, accidentally hosted on a public website or even stored in the database, IRM protected files are always secured no matter where they live or how they are transferred.
Encrypting data in use
Rarely do we see anyone discuss data in use. What do I mean by "in use
"? When you access the health care application and look at a patient record, when you have open a spreadsheet or PDF and are printing it, copy and pasting it into other documents. This is a massive area of data loss and one that very few technologies can address. Mostly we see solutions about protecting information as it moves from the health systems to the users. Ensuring as it resides on storage devices and moves across networks, encryption and access controls provide security. Yet this leaves a gaping hole, how do you ensure people are allowed to use patient data in a secure manner?
Two technologies really help in this regard. Data loss prevention (DLP) technologies are a great way to detect the movement of patient information as it crosses application, network and storage boundaries. I might want to copy my patient records to a USB key or email the information to my home computer. DLP does a great job of detecting this activity, yet it is limited to only blocking and preventing it from taking place. In health care this is a serious problem, stopping people getting access to and using patient information can prevent the physician from delivering care. The last thing you want to stop is a surgeon being able to access critical information when someone's life depends on it.
Again IRM steps in to provide a solution. IRM combined with DLP can both detect and secure the use of patient data. IRM delivers some functionality that significantly improves the ability to protect patient data.
- IRM documents are never decrypted back to their original form. Unlike document security technologies such as PGP, IRM controls access to the document at all times and the files are never decrypted to disk.
- The clipboard is under total control, so patient data remains inside the document and cannot be copied into social networks, other documents or applications.
- Screen shots are prevent with IRM technology, so images of patient data cannot easily be copied or reproduced insecurely.
- Printing is also controlled, so many incidents of patient data loss have been from physical, paper copies of the information. IRM can prevent documents from being printed and therefore this exposure is prevented.