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5 Ways to Promote HIPAA Security Among Your Workforce Members

By Brand Barney, SecurityAnalyst, HCISPP, CISSP, QSA, at SecurityMetrics

Despite advances in HIPAA security and regardless of increased government cyber security initiatives via the Department of Health and Human Services (HHS), attackers continue to steal unprotected patient data. In 2016, medical and healthcare entities accounted for nearly 37% of reported data breaches (Identify Theft Resource Center). While the cause of these data breaches varies from one organization to the next, most security professionals consider workforce members to be the weakest link in Protech Health Information (PHI) security.

To minimize your organization’s risk for a data breach, I’d like to share five things you can do to foster a culture of security among your workforce members:

  1. Create Role-Based Access Controls

Everyone has their own unique role within a healthcare organization, from receptionists to nurses to surgeons. What would happen if the receptionist decided to switch roles with the surgeon for a day? I’d say you’re heading towards a malpractice lawsuit.

The same concept applies to staff accessing PHI. The term “access control” refers to the level of access to PHI by workforce members. When establishing access control in your organization, start by defining roles (e.g., receptionist, volunteer, third party IT), then establish user privileges accordingly. Workforce members should only have access to the minimum amount of information needed for their job role.

User access isn’t just limited to your normal office staff—it applies to anyone who needs permission to your systems or “behind the desk,” including the IT guy you hired to update your EMR software.

  1. Do not allow employees to share ID credentials

Each workforce member should have their own login IDs and passwords for computer, software, and physical access. For example, when using Startel Secure Messaging Plus (SM+), the IT administrator should make sure employees are given their own unique ID and password.

In some cases, the employees may share ID credentials because of the convenience factor. For example, a doctor’s office where the receptionists, medical assistants, and doctors all share one username and password to log on to their system. Sometimes this password is even written on a Post-it note and taped to the computer screen at the reception desk. Employees need to understand that sharing ID credentials is not a safe practice because this makes it easy for intruders, social engineers, and even disgruntled ex-employees to access sensitive information.

  1. Set up and monitor system logs

If you currently haven’t set up system logs, now is a great time to start. Event, audit, and access logging is a requirement for HIPAA compliance. System event logs contain information about actions taken on devices. For example, if I logged into my computer at 10:45AM, this event, date, and time should be recorded.

Make sure to assign someone to review your logs daily to search for errors, anomalies, or suspicious activity that deviate from normal security practices. Reviewing logs regularly can help you identify malicious attacks on your system and prevent data breaches from happening. They are also useful in determining the cause of breach in the event of a forensic investigation.

  1. Ensure your devices have automatic logouts

More often than not, data breaches are a result of small, easy-to-correct things that go unnoticed. For example, computers and devices need to have an automated logout (e.g., a password-protected screensaver that pops up on a computer after a set amount of time). This helps discourage thieves from trying to steal data when employees aren’t present.

Establish no longer than a five-minute time period before the device logs off and makes information inaccessible. High-traffic areas like reception desks should probably be limited to two minutes or less.

Some solutions already have automatic logouts enabled (like Startel’s Secure Messaging Plus Solution), while other programs may require manual configuration.

  1. Conduct regular HIPAA trainings and tests

Last but certainly not least, conduct regular HIPAA trainings with your workforce members. Training will help remind your staff about security practices, showing them how to stop bad security behaviors.

It’s important that your workforce members actually absorb the information in the trainings. Make sure to establish some form of accompanying test to verify that your HIPAA trainings are being retained and that the money you spent on training is not going to waste. Some organizations may be tempted to just “check the box” when it comes to HIPAA compliance, but true data security requires that your employees be knowledgeable about HIPAA best practices.


By following these 5 tips, your workforce members will be better prepared to defend your organization against cyber criminals. Remember, it only takes one weak link to break a chain, so make sure employees know security best practices and take HIPAA compliance seriously.

Brand Barney (CISSP, HCISPP, QSA) is a Security Analyst at SecurityMetrics, and has over 10 years of data security experience. For more information about HIPAA compliance and data security, visit www.securitymetrics.com.

Startel Secure Messaging: Achieving Privacy & HIPAA/HITECH Compliance

Text messaging (sending and receiving alphanumeric messages) is ubiquitous. Since 1982, mobile phones have had texting capability. Mobile phones utilize the mobile cell phone network and have access to the Public Switched Telephone Network (PSTN). Each message utilizing SMS (Short Message Service) is limited to 160 characters, and uses telephone protocols, such as GSM, CDMA, etc.

The advent of the smartphones in 1994 (basically any phone with an operating system that can manage an application) brought the opportunity for phones to access the Internet (opened for public use in the 1990’s), which was a completely different channel of communication from the mobile cell phone network controlled by an oligopoly of carriers. This is why when most smartphone users begin service they have both a voice plan (for mobile cell phone network access) and a data plan (for Internet access). Now with the convergence of smartphones and the Internet, text messages can be sent via the public Internet, and use Internet protocols, e.g., TCP/IP, thus bypassing the carrier cabal. 

Why am I bringing you down this road?
Because to understand today’s world of secure messaging it is important to know which highway text messages flow through and how those messages might be made HIPAA/HITECH compliant. Sending a text message via telephone protocols built by the carriers offers no guarantee that access of the messages will be protected from anyone with despicable intentions and means. In contrast, sending a text message via the Internet makes the use of “direct” encryption options possible. Using the Internet as the platform for sending and receiving text messages places control of whether to encrypt, or not encrypt, in the hands of the application developers and users. Using the mobile cell phone network to send and receive text messages, users are at the mercy of carriers with little incentive to encrypt messages, e.g., it adds cost and complexity to their model. In addition, carriers are designated “conduits” by HIPAA/HITECH and therefore do not share any potential liability in the case of breaches of ePHI (electronic protected health information). It should be noted that no carrier guarantees that SMS messages are encrypted during the time the message is running through their network. Since communication (including texts) most often traverse multiple carriers in the standard process of going from point A to point B, the issue of ensuring security is even less possible.

So what is the answer to protecting ePHI while texting?

What is the best way to guarantee that a text message containing ePHI is encrypted?
The solution lies in an application that utilizes both the Internet and encryption algorithm technology. 

A few years ago, while discussing the concerns of Startel customers and their clients, we anticipated the need for a solution that would help prevent breaches of protected health information (PHI), or more specifically ePHI, and other private information. Soon after that discussion Startel launched a “cloud-based, device access only” secure messaging solution that is fully integrated with Startel’s Contact Center solution, the Startel Contact Management Center (CMC). Startel Secure Messaging is an application that can be downloaded onto any smartphone utilizing the following smartphone operating systems, such as iOS®, BlackBerry® OS and Android® OS. Once downloaded, the user is required to have a registration ID, which they can purchase from one of Startel’s telephone answering service customers or contact centers. Once the registration ID is entered, the application becomes fully operable for use either between the host (TAS or Contact Center) and the smartphone user, or two smartphone users in a peer-to-peer situation.

The Startel Secure Messaging application employs password protection, registration Id’s and Secure Socket Layer (SSL) technology to ensure that secure messages get where they are suppose to go, and only to their intended recipients. At a minimum, 128-bit encryption is utilized throughout the transport layer. Only the Startel Secure Messaging application has the ability to unencrypt a message encrypted by Startel’s Secure Messaging application. If someone intercepted a Startel Secure Message during transport and they used the fastest super computer on the planet – it would take them using brute force over 1.3 quadrillion years to break the message (source: http://www.kotfu.net/2011/08/what-does-it-take-to-hack-aes). Needless to say, the security of the ePHI is assured using the Startel Secure Messaging application. 

Though the user of a smartphone would see no difference between a regular text message and a Startel Secure Message, the differences as noted above are tremendous. In today’s tech world, the power is to the people. No longer do a few carriers control whether the messages you and I send to one another can be read by a third-party. Currently, we are free to move about as we wish and encrypt at will.

A final note on HIPAA/HITECH compliance: Technology itself is not enough to be HIPAA/HITECH compliant. Technology can only assist in creating the environment where a user of ePHI can comply with HIPAA/HITECH. 

At a future date, I will provide details of an active Startel project whose result will be a cloud-based version of Startel Secure Messaging with Web Access, versus just device access only. Please stay tuned. 

HIPAA in the Contact Center: PHI and Encryption

To ensure that your organization and your clients are acting in accordance with the HIPAA Security Rule as it relates to ENCRYPTION of ePHI, I did some extensive research and found a resource written by the American Medical Association titled “HIPAA Security Rule: Frequently asked questions regarding encryption of personal health information.” The document addresses a number of questions among physicians and other health care professionals as well as other HIPAA-covered entities and business associates. Consider the below points as it relates to your usage of ePHI: 

To Begin with, What Information Should You Encrypt?

Any systems and individual files containing PHI/ePHI should be encrypted. Examples include electronic medical records, claims payment appeals, scanned images, emails containing ePHI, etc.

Emails containing ePHI. If you or your clients (physicians) correspond with health insurers or other health care professionals via email and those emails contain ePHI, then you could be accused of failing to protect ePHI for which you are responsible.

Encrypt all devices containing ePHI. Passwords are not enough, especially in the event that a hard drive was removed from a laptop containing ePHI. All devices that contain ePHI, including laptops, PCs, smartphones and tablets, need encryption technology, preferably “whole disk encryption” technology.

If ePHI is accessed via the Internet, encrypt those sessions. Since data that is published on the Internet is available to the public, you need to check with your Web service provider to ensure that any PHI that travels across the Internet is protected by secure sockets layer (SSL) or similar technology.

Encrypt any other remote access sessions. If you have a situation in which physicians/staff connect to the home office remotely to read email or access other resources containing ePHI, then this access may constitute a vulnerability to unauthorized snooping. It is important that these sessions be conducted using encrypted tunnels, or VPNS.

What Happens If a Security Breach Occurs at an Organization That Uses Encryption Technology?

If the ePHI is stored and transmitted in encrypted form, then you do not need to notify patients. This only applies to HIPAA-covered entities and business associates that use encryption technologies that render ePHI unusable, unreadable, or indecipherable to unauthorized individuals.

How do Startel’s Solutions Help Organizations Protect ePHI?

Businesses that handle sensitive information are not only morally obligated to protect sensitive, private and personal information of their clients; they are legally obligated to do so. Startel’s Encrypted Email Service enables compliance with HIPAA by utilizing Secure/Multipurpose Internet Mail Extensions (S/MIME) encryption protocol. This protocol converts email messages from a readable plaintext format to a scrambled cipher text format. Only the recipient using the private key that matches the public key used to encrypt the email message can decipher the message. If someone intercepts the message without access to the private key the email message would appear only as garbled text.

The private and public keys are the means for both encoding and decoding email messages. Essentially the unique private/public key acts as a distinctive digital signature bound to a particular email address.

In addition, the Startel Encrypted Email Service is encoded utilizing the Advanced Encryption Standard (AES) 128 Bit block size. This level of cryptography ensures security is maintained for all encrypted messages. Any attempt to “break” an encrypted message secured at 128 Bit encoding would take billions of years to try every possible combination.

Users of Startel’s Encrypted Email Service have peace of mind knowing that their messages remain secure and private during transmission and storage.

In my third blog post of this topic, I will address how Startel’s Secure Messaging application handles ePHI and specifically, how it complies with HIPAA.

Source: http://www.ama-assn.org/resources/doc/psa/hipaa-phi-encryption.pdf

HIPAA In the Contact Center

The buzz surrounding HIPAA in contact centers is getting louder, and with good reason: As of September 23, 2013, healthcare providers, health plans, other HIPAA covered entities and their business associates must comply with the new Privacy and Security requirements. Those who fail to comply by the deadline or experience breaches in customer data security may face with substantial fines and penalties.

This blog post will be one of several regarding HIPAA, and what we (software vendors and users) must do to comply with it. To ensure we all have a basic and common understanding of HIPAA, this first blog post will address some general definitions, including how Startel and our customers are designated per HIPPA and how the Privacy and Security Rules apply to us.

HIPAA Overview
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information. To fulfill this requirement, HHS published what are commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. These Rules help to protect the privacy of individual’s health information while allowing covered entities to adopt new technologies to improve the quality and efficiency of patient care.

Before we can discuss the HIPAA Privacy Rule and HIPAA Security Rule, we must mention who these Rules apply to.

Covered Entities and Business Associates
The HIPAA Rules apply to both covered entities and business associates:

Covered Entity (CE)
: CEs are basically any person, business, or government entity that furnishes, bills, or receives payment for health care in the normal course of business. Examples include physicians, hospitals, pharmacies, health care clearinghouses (billing services) and health plans/insurers.

Business Associate (BA)
: A business associate is a person or organization that performs a function on behalf of a covered entity. Examples of a BA include software vendors (such as Startel), third-party billing companies, claims processors, collections agencies, and outsourced contact centers. BAs must also agree to the privacy and data security requirements of HIPAA. A business associate could be a contact center outsourcer that handles calls for a covered entity or a collection agency working on their behalf.

Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules’ requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.

The Standards for Privacy of Individually Identifiable Health Information, also known as the Privacy Rule, establishes a set of national standards that protects individuals’ health information – called “protected health information (PHI)”. PHI is “any health information that is individually identifiable”. Examples include an individual’s name, date of birth, social security number, address, as well as health status and payment/billing information. The Privacy Rule addresses the use and disclosure of PHI whether in written, oral, or electronic format by covered entities. It also sets standards for individuals’ privacy rights to understand and control how their health information is used.

The Security Standards for the Protection of Electronic Protected Health Information, or the Security Rule, is a national set of security standards for protecting certain health information that is held or transferred in electronic form (ePHI). The Security Rule addresses the technical and non-technical safeguards that covered entities must put in place to secure individuals’ ePHI. Technical safeguards include access control, audit controls, integrity controls and transmission security. Each of these technical safeguards can be addressed with software solutions, including encryption technology and secure messaging.  

In March 2013, the long-awaited Omnibus Rule made the most sweeping changes since the HIPAA Privacy and Security Rules were first implemented. The new rule expands the definition of a business associate to include “any downstream subcontractor that creates, receives, maintains, or transmits PHI on behalf of the business associate.” Business associates and their subcontractors who have access to PHI are directly liable for compliance with the HIPAA Privacy and Security Rules. In addition, among the changes is an enhanced opportunity for the Office for Civil Rights to enforce compliance.

Why am I sharing all of this information to you and why is it important? Since both Startel and our customers (telephone answering services and contact centers) are considered business associates we are therefore:
•    Required to comply with the Rules’ requirements, including the Obnibus Rule, to protect the Privacy and Security of PHI. We have until September 2013 to become compliant.
•    Directly liable for compliance with certain provisions of the HIPAA Rules. Penalties can be civil or criminal and may cost thousands of dollars and possibly imprisonment.

In my next blog post, I will address how Startel’s solutions address a pressing topic area: Encryption of PHI/ePHI, and specifically, what information/devices must be encrypted to ensure HIPAA compliance.

Source: http://www.hhs.gov/

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