Continuing our thoughts on how disclosures of private or confidential information may adversely impact the institution and the persons affected by such disclosure, we now focus on something near and dear to lawyers’ hearts: paper shredding.

Many businesses regularly shred documents they no longer need to protect them from disclosure. While this may secure the information contained in those documents, an additional concern exists for HIPAA-covered entities, such as hospitals, medical providers or their business associates. Often, those documents might consist of old medical records, charts, notes, or other information containing protected health information (“PHI”) specifically protected from disclosure under HIPAA.  

Shredding frequently is done by outsourced vendors.  They shred what is provided to them and then resell it as fill, packaging material or for other recyclable-type uses. But shredding alone may not be sufficient to secure data under HIPAA. This can cause a HIPAA headache, as suggested by recent occurrences overseas.  A gift-wrapping company owner in England discovered protected health data (including names of patients) from a local hospital on the shredding she used for work. In another situation being investigated by British authorities, an outsourced medical transcription company in India disclosed shredded health data. Although those situations occurred abroad, they could just as easily happen in the U.S., or occur outside the U.S. but affect information involving U.S. citizens.

If a data breach is discovered by the unauthorized disclosure of PHI through shredding or otherwise, under the American Recovery and Reinvestment Act of 2009 (“ARRA”), covered-entities and business associates must notify those affected by the disclosure of unsecured PHI within 60 days after a breach. If the breach involves disclosure of PHI for over 500 persons, a covered-entity and/or a business associate must also notify Department of Health and Human Services and the media. “Unsecured” under ARRA means any data not rendered unusable, unreasonable or indecipherable. Thus, an individual’s name legible on a snippet of shredded paper together with some health information may be enough to trigger ARRA’s disclosure requirements and constitute a HIPAA violation. For more information about data breaches under HIPAA, click here.

We therefore remind HIPAA-covered entities to ensure that their vendors are compliant with the HIPAA security requirements, that they have appropriate business associate agreements where necessary, and that they actively monitor compliance with those agreements.

In a key step toward developing a proposed U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services has announced that Iowa’s Medicaid program is the first to receive federal matching funds for planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (ARRA).

 

ARRA was signed into law by President Obama on February 17, 2009. Among its various parts, ARRA includes provisions for the improvement of our nation’s health care through health information technology (also known as Health IT or HIT), Medicare and Medicaid Health IT provisions which provide incentives and support for the adoption of certified electronic health records (EHRs); and provisions to expand, enforce, and enhance the privacy and security safeguards required by HIPAA. The proposed goal of a switch to EHRs is to improve the quality of health care for individuals, make care more efficient by making it easier for providers treating a patient to coordinate care, and make it easier for individual patients to access the information they need to make decisions about their own health care. Responsibility for implementing this program falls to the National Coordinator for Health Information Technology, a position currently filled by Dr. David Blumenthal at the Department of Health and Human Services (“HHS”). In furtherance of this goal, Mr. Blumenthal recently announced $80 million in grants to develop a HIT workforce. Additionally, the HHS has created a helpful website on the topic of health information technology with links to resources on privacy issues.

In discussing the approximately $1.16 million in federal matching funds Iowa will receive, Cindy Mann, director of the Center for Medicaid and State Operations at CMS said, “While Iowa is the first state to receive approval of its plan for implementing the Recovery Act’s EHR incentive program, a number of other states have submitted plans as well, meaningful and interoperable use of EHRs in Medicaid will increase health care efficiency, reduce medical errors and improve quality-outcomes and patient satisfaction within and across the states.”   As the first state to receive federal funding, Iowa will use the funds to focus on planning, information gathering, analysis, and assessment with respect HIT and the use of EHR within the state.  

A HIT Infrastructure is likely to raise a range of new issues involving the handling of sensitive personal information. For instance, anytime extensive personal and medical information is placed in electronic form, the chance of a data breach or information misuse rises significantly. This is especially true given the recent growth in the area of medical identity theft. Additionally, as some commentators have reported, physicians, hospitals, and clinics have all expressed concerns regarding the technical feasibility of the system, potential for patient mix-ups, as well as the extensive cost to make the switch to EHR. How such a system would affect employers and group health plan administration remains unclear.  

With such an emphasis on a switch to EHR, and billions of federal dollars fueling the conversion, all businesses, particularly health care providers, need to be consider how they will be affected by the new HIT infrastructure. 

Based on recent events, the University of East Anglia likely will agree that data privacy and security requires a comprehensive approach, as data breaches are not limited to incidents involving personal information and identity theft. In fact, the effects of a breach to an organization’s information systems involving confidential company information can be far worse on the organization as a whole than if the breach involved personal information.

Take, for example, a report by The New York Times reporter Lauren Morello concerning a breach involving thousands of emails and documents of the Climatic Research Unit (CRU) at University of East Anglia. Apparently, hackers obtained and posted on the Internet emails and documents calling into question some of the positions about climate change and global warming held by the CRU. Whatever the truth or perception of the information contained in the posted emails and documents, the CRU surely is in an uncomfortable position of having to defend its statements and address their context. 

Last month we reported a data breach involving personal information of a different kind – ethics investigations of members of the United States Congress. Again, while not the kind of personal information that would lead to identity theft, or require notification be sent to the affected individuals, it is the kind of information that could have significant adverse consequences for the institution and the persons affected.

For this reason, organizations need to address "information risk" on an organization-wide basis, making sure that their written information security programs take into account how information of any kind, maintained in any medium by the organization, can, if misused, caused the organization harm. While remedies may be available through the criminal justice system or civil litigation under such laws as the Computer Fraud and Abuse Act, avoiding the breach in the first place obviously is preferred.

More companies are becoming a part of the social networking community – setting up Facebook pages, “friending” their employees and customers, and so on. Businesses use these sites for a variety of purposes including marketing; client, employee and government relations; and community involvement. With lawmaking bodies and courts just beginning to struggle with the range of issues these new media create, companies should exercise caution and monitor the legal, technical, and other developments that may affect their involvement.

Companies already a part of (or thinking of joining) the social networking community should consider the effects on employee relations. In theory, the risks inherent in interactions between/among the company and/or its employees in a social networking environment are similar to risks the company faces in more traditional workplace settings such as the office or company-sponsored events. Online media, however, create some interesting questions:

  • Are all of your employees aware of the company site so as not to feel left out?
  • Do employees feel as if they must participate on the site – such as accepting other employees as “friends,” or agreeing with company posts? Do they need to be compensated for participation?
  • Does a supervisor accepting some employees as friends and not others raise discrimination risks and morale concerns?
  • Are employees free to dissent from company positions on its site? How far can employees go? Disciplining or terminating an individual’s employment with the company for activity on the company’s site or some other online social media can be risky on a number of grounds – such as under whistleblower laws (e.g., Sarbanes-Oxley and state/local laws), the National Labor Relations Act, and anti-discrimination and anti-retaliation laws.
  • Does active company management of the site constitute monitoring of employee communications?
  • How does the company handle the information about employees (and their dependents, friends and others) it may have access to as part of the employees’ participation in the network?

For sure, there are many areas about which companies need to think through as they consider their direct participation in the social networking community – the services of the social network provider, promoting the company’s presence in the community, consumer protection, copyright protections, and so on. Even the list above only begins to scratch the surface of the range of employment law issues that arise when an employer participates in this media.

914335The Genetic Information Nondiscrimination Act (GINA) [pdf], signed into law in May 2008, prohibits discrimination by health insurers and employers based on individuals’ genetic information. Genetic information includes the results of genetic tests to determine whether someone is at increased risk of acquiring a condition (such as some forms of breast cancer) in the future, as well as an individual’s family medical history. It is family medical history information that presents the biggest challenge for employers.

In its announcement about the effective date of the regulations, the Equal Employment Opportunity Commission Acting Chair Stuart J. Ishimaru writes: 

GINA affirms the principle central to all employment discrimination laws – that all people have the right to be judged according to their ability to do a job, not on stereotypical assumptions . . . No one should be denied a job or the right to be treated fairly in the workplace based on fears that he or she may develop some condition in the future.

Specifically, the law prohibits the use of genetic information in making employment decisions, restricts the acquisition of genetic information by employers and others, imposes strict confidentiality requirements, and prohibits retaliation against individuals who oppose actions made unlawful by GINA or who participate in proceedings to vindicate rights under the law or aid others in doing so. The same remedies, including compensatory and punitive damages, are available under Title II of GINA as are available under Title VII of the Civil Rights Act and the ADA.

Acting Vice Chair Christine Griffin said,

Title II of GINA is an ideal complement to the ADA Amendments Act. With both laws now effective, American workers are protected if they experience discrimination because of their disability or because of impairments they may develop.

To date, employers’ only regulatory guidance for the employment provisions of GINA (Title II) is a Notice of Proposed Rulemaking, published by the EEOC March 2, 2009. For health plans, which are subject to Title I of GINA, interim final regulations become effective for plan years beginning on and after December 7, 2009.

Employers should be reviewing their employment practices and health plans and wellness plans for compliance with GINA as soon as possible.

Click here for more information about how GINA affects employers.

Click here for more information about how GINA affects health plans. 

Click here for more information about how GINA affects wellness programs.

Click here for information about the new Equal Employment Opportunity Poster that includes information about GINA.

“Cloud computing” takes many forms, but, fundamentally, it is a computer network system that allows consumers, businesses, and other entities to store data off-site and manage it with third-party-owned software accessed through the Internet. Files and software are stored centrally on a network to which end users can connect to access their files using computers that are less powerful and sophisticated than those we use today.  This technology reduces the need for expensive multiple servers and PCs with enough capacity to store massive data and application files. Some believe the PC of the future will need simply the capacity to connect to a web browser for the user to access his or her applications and files.

For more information on how cloud computing works, click here. For information on the FTC investigation of cloud computing, click here.

If you are not already computing in a cloud, you likely will be hearing more about “cloud computing” soon. Last month, for example, the City Council for the City of Los Angeles voted to move city employee e-mail and other applications from city computer networks to a cloud service provider – in this case, Google Inc. City officials cite significant cost savings (which they estimate to be in the millions) as one of the reasons for the switch. They acknowledged that concerns over data privacy, security and management remain.

We’ll agree that significant cost savings can be achieved through, among other things, reduced infrastructure. Questions and concerns many have with cloud computing, however, relate to the privacy, security and management of the information in the cloud. These include:

  • What if the cloud starts to rain – a cloud computing data breach – who is responsible for notifying affected persons (and bearing the costs)?
  • Which company owns the data placed in the cloud?
  • If the data in the cloud is employee e-mail, is the employer still permitted to access and monitor email communications? Will new policies/notices be needed?
  • Will company proprietary information be safe?
  • Who has access to the data? Who should have access?
  • Is the cloud service provider a business associate under HIPAA, prepared to comply with the HITECH Act? What other legal compliance requirements are there?
  • Do we still need to maintain a back-up of data in the cloud?
  • Where is the data stored? Is it in the United States, or in a foreign country subject to different data security standards? Does one location as opposed to another provide better access or security? What if data is stored in multiple places, will we be able to locate what we need when we need it?
  • How big is the cloud? How much can we store?
  • What if the cloud goes down? How do we get our data and access the applications needed to run our business?
  • How do we move between clouds? Can our data be held captive when contract negotiations fall through?
  • Can we put our clients’ data in the cloud? Do we have to tell them where it is?
  • What happens to the data if the cloud service provider or the cloud customer goes out of business?
  • Will applications in the cloud work the same way, be as flexible, and respond with the same speed as those on current PCs?

Organizations such as the Cloud Security Alliance have been formed to grapple with some of these issues. Indeed, the City of Los Angeles has had to respond to some of these concerns. So, while cloud computing may yield substantial cost savings and appear tempting, these and other questions and concerns should be addressed before moving in that direction.

Massachusetts Seal

The Massachusetts Office of Consumer Affairs and Business Regulations (OCABR) announced on November 4, 2009, the filing of final regulations (pdf) with the Secretary of State’s office, the final step before the regulations take effect March 1, 2010.

The final regulations differ slightly from the version of the regulations issued in August 2009, which made significant revisions to the earlier version of the rules.

OCABR clarified in the final regulations that:

  • those who store personal information must comply, and
  • until March 1, 2012, contracts with service providers will be deemed to satisfy the contract requirement, even if the contract does not require the service provider to maintain appropriate safeguards, as long as the contract was entered into no later than March 1, 2010. However, it is recommended that contracts with service providers be amended as soon as possible to require appropriate safeguards, as there may be similar requirements under federal or applicable state law (such as HIPAA or data security laws in Maryland, Oregon or Nevada). 

While the regulations have had a number of changes, the written information security program requirement remains, along with a number of other safeguards for personal information that require immediate attention. 

A checklist for the final regulations can be found here (pdf). 

The Baltimore Sun reports that Baltimore police are investigating a security breach at Mercy Medical Center that left certain patient records open to possible identity theft. According to the article, affected former patients were sent a letter informing them that their personal patient records may have been accessed by a former employee in order to apply for credit cards and loans. A Maryland state law that became effective in 2008 would require Mercy Medical Center to notify these individuals promptly in the event of such a breach. 

This case is yet another example of personal information being accessed for improper purposes by hospital staff and demonstrates the need for hospitals to establish strict privacy controls and notification procedures.

Today, Connecticut Attorney General Richard Blumenthal announced his office will investigate a data breach that occurred in late August that affected approximately 18,817 Connecticut health care professionals. The American Medical Association reported earlier that this breach involved the personal information, including Social Security numbers, of an estimated 850,000 physicians nationwide. What is most troubling about this breach is that it probably was avoidable.

Like many data breaches, this one involved a stolen laptop, in this case from the employee’s car. However, as NewsTimes.com reported, despite the employer’s encryption policy, the employee downloaded the file to a laptop, without the required encryption, in order to work from home.

Even the best firewalls and other technology-based information system protections cannot save us from ourselves. It was possible here that not only did the employee violate the company’s encryption policy, but he or she also may have exercised poor judgment in leaving the laptop in a car. The ease with which employees acquire, handle and transport massive amounts of sensitive personal information make it critical that businesses ensure their employees have greater awareness of the sensitivity of this information and receive regular training about how to be more cautious handling it. This should be a part of any written information security plan.