When you work in healthcare, you live and breathe sensitive patient data. Every patient’s medical record contains private information and keeping that information private is a key component of every healthcare professional’s job. (Hint, hint, that’s you!) And in today’s digital age, it can feel like security risks lurk around every corner, with bad actors in ski masks seeking to access your patient’s records without permission.
When fear becomes reality and an unauthorized disclosure occurs, it creates a series of problems for healthcare organizations. To help your organization understand what unauthorized access or disclosure means and how it can impact you, we’re going to take a stab at explaining the nuts and bolts of it.
We’ll discuss the different elements of unauthorized access, ranging from legal consequences and regulatory requirements to the risks posed to patients and healthcare providers like you. We’ll begin by exploring what it means, getting an overview of the issue, and diving into the important legal framework that keeps patient information safe and secure. By the end, you’ll be an expert on unauthorized access. Let’s get started!
Breaking Down Unauthorized Access
What exactly is unauthorized access or an unauthorized disclosure? In short, it’s when someone gains access to medical records without permission. In the world of medical and billing records, this includes what is referred to as a “privacy incident.” A privacy incident is where the wrong records were released, or the wrong recipient received the records. Just to make it more confusing, a privacy incident always involves unauthorized disclosure, however, unauthorized disclosure does not always rise to the level of a privacy incident – or a breach.
What differentiates a privacy incident from a breach?
Under HIPAA, a breach, subject to exclusions, is defined as “the acquisition, access, use, or disclosure of protected health information in a manner not permitted under [HIPAA] which compromises the security or privacy of the protected health information.”
In other words, unauthorized access like a privacy incident can rise to the level of a breach where it “compromises the security or privacy of the protected health information.” Typically, this does not occur where continuing harm is unlikely, for example, where the wrong records are confirmed as destroyed by the wrong recipient.
All healthcare organizations, from hospitals to pharmacies, can be at risk for unauthorized access. It is important to note here that unauthorized access can occur both electronically, through the improper use of electronic health record systems, and physically, by accessing paper records without proper authorization.
The significance of protecting patient information cannot be overstated. As discussed above, medical records contain a wealth of personal data, including diagnoses, medical procedures, medications and possibly social security numbers. This information can be exploited for malicious purposes if it falls into the wrong hands.
Regulatory Requirements for Access to Patient Medical Records
To keep patient medical records safe, specific rules and guidelines have been put in place through several different state and federal laws and regulations. Untangling the complex regulatory landscape is more than we have time to tackle here, but we do want to note that the Health Insurance Portability and Accountability Act (HIPAA) is an important guiding force in this effort. HIPAA authorized the Department of Health and Human Services (HHS) to lay down regulations and standards that apply to various organizations known as covered entities, including health care providers, health plans, healthcare clearinghouses and their business partners.
Regulatory agencies, such as HHS and its Office for Civil Rights (OCR) oversee compliance with HIPAA and other privacy laws. They have the authority to investigate reported incidents of unauthorized access, impose penalties and enforce appropriate corrective actions. By staying compliant with these regulations, healthcare organizations can reduce the risks associated with unauthorized access and protect patient privacy. Additionally, for unauthorized access involving consumers, the Federal Trade Commission (FTC) might get involved pursuant to the FTC Health Breach Notification Rule. For the purposes of this blog, we’re going to focus on HIPAA and its subsequent rules, but the FTC rule is something we’re paying attention to (and you should too!)
The Risks of Unauthorized Access to Patient Medical Records
Now that we’ve defined unauthorized access and a bit of the regulatory framework surrounding it, let’s explore the various implications associated with improper access to medical records.
How Does Unauthorized Access to Records Impact Patients?
- Identity theft or data misuse
- Erosion of patient-provider trust
- A gateway to bigger access
Identity Theft or Data Misuse
When a bad actor gains access to sensitive, private information, it can be used for fraudulent or malicious purposes. A patient’s finances, credit history and general well-being can be impacted negatively. Another consideration here is the possibility of future discrimination, stigmatization or difficulty finding healthcare services for the patient.
Erosion of patient-provider trust
Unauthorized access can also undermine the quality of patient care. When information falls into the wrong hands, patients may lose confidence in a healthcare provider’s ability to hold their information…well, in confidence. And a loss of confidence and trust can impact a patient’s willingness to seek medical care and share crucial information about their health in the future, putting their overall well-being at risk.
A gateway to bigger access
Once a bad actor has achieved access to your organization, you are potentially at risk for future breaches. Almost like a neon “open” sign has been placed over your data. Not only is the accessed data at risk for sale to additional bad actors, but the accessor may also continue to take advantage of your organization.
How Does Unauthorized Access Impact Your Organization?
When someone gains unauthorized access to medical records held by your organization there are several potential impacts to think about, should the privacy incident rise to the level of a breach.
- Fines & penalties
- Bad press & media attention (if the breach is large enough)
- Patients seeking care elsewhere
Fines & penalties
Fines and financial penalties are one of the biggest impacts a breach can have on your organization. Fines for violations vary wildly, and key factors that can impact a fine include the size of the breach, the cause and the determined amount of neglect.
Bad press & media attention
When the breach is large enough, organizations must alert the media according to HIPAA’s Breach Notification Rule. And in today’s 24-hour news-driven environment, once you alert a local media outlet, state or nationwide attention on your organization is possible – unfortunately for all the wrong reasons.
Patients seeking care elsewhere
Once any negative spotlight shines on your organization, the next potential consequence is a loss of reputation and unfortunately, patients may choose to leave your practice.
Now that we understand the risks and potential consequences of unauthorized access to patient medical records, particularly those constituting a HIPAA breach, let’s explore two key preventive measures that can be implemented to help protect the security and integrity of patient information. (And your organization’s reputation!)
How Can You Prevent Unauthorized Access to Patient Data?
1. Cutting-Edge Technical Safeguards Bolster Data Security!
To stop unauthorized access to patient medical records, it’s essential to have strong technical safeguards in place. Luckily you don’t have to be a technology whiz to understand functional technical safeguards – or implement them.
Step one: Hire a third-party guide. For example, you could set up your organization to be SOC I or SOC II certified. SOC stands for system and organization controls, and it focuses on the security, availability, processing integrity, confidentiality, and privacy of data and information systems.
Step two: Ensure your organization is utilizing simple solutions like high quality antivirus software and firewalls that can shield electronic systems from outside threats. And regularly updating software and applying patches helps fix vulnerabilities and boost system security.
Step three: Make sure your data is encrypted. Data encryption is also crucial for keeping patient information confidential. By encrypting data both when it’s stored and when it’s sent, healthcare organizations can prevent unauthorized people from understanding sensitive information, even if they somehow get access to it.
Step four: Another safeguard to consider here is access controls. Examples include using unique user IDs, passwords, and role-based permissions to limit who can access patient records, following the principle of least privilege. Regularly checking system logs and conducting audits helps detect any suspicious activities or possible data breaches.
2. The Power of Employee Training
In the battle against unauthorized access to patient medical records, effective employee training and compliance programs play a crucial role. Healthcare organizations must prioritize comprehensive training that covers privacy and security policies, emphasizing the significance of patient confidentiality and the serious repercussions of unauthorized access.
To keep employees updated on ever-evolving security threats and best practices, regular awareness campaigns and refresher training sessions should be conducted – in fact, most third-party certifications (and federal regulations) require it! Topics such as recognizing phishing attempts, social engineering tactics and other tricks used by malicious individuals to gain unauthorized entry should be covered. When you create a culture of compliance, you can ensure your employees fully grasp their responsibility to protect patient information. A key part of a compliant culture is reporting mechanisms for suspicious activities or potential security breaches and clear protocols for incident response.
Securing Patient Trust and Data in the Age of Digital Healthcare
Ensuring the security of patient medical records is of utmost importance in the modern healthcare industry. Hopefully, after reading this blog, you have a new awareness of how unauthorized access to patient information can lead to severe ramifications for both patients and healthcare organizations like yours, as well as how to help prevent bad actors from gaining access to sensitive information.
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