In the more than 20 years since the landmark passage of the Health Insurance Portability and Accountability Act (HIPAA), healthcare organizations have come a long way in protecting the security and privacy of patient data. Organizations now use sophisticated tools in the form of electronic health records (EHRs), online patient portals and virtual clinics that have elevated modern medicine to a new level of care. As a result, patients have come to expect a seamless interaction – whether digitally or in-person – with their healthcare provider, and trust that their personal information is safeguarded throughout.
But just as these new digital records and online portals make it easier to access and manage patient care and medical history, there still looms a security threat that organizations may not be as well-equipped to prevent. Despite the regulations put in place to guard against privacy violations and data theft, healthcare data breaches now occur at a rate of more than one per day, with nearly 60 percent of these breaches coming from insiders. You read that right. Unfortunately, the greatest threat to a healthcare organization may not always be from outside cybercriminals hacking into an organization’s network and stealing patient medical records. While the vast majority of healthcare workers are good and honest people, it only takes one employee succumbing to curiosity and taking a peek at a patient’s EHR without a valid reason, to violate HIPAA compliance laws and potentially cause a massive data breach.
Why are insider threats on the rise?
The healthcare sector employs tens of millions of people across the country, and organizations go to great lengths to hire quality employees. But the fact remains that access to sensitive information, coupled with large organizations that employ people with varying levels of commitment – whether full-time, part-time or as contractors – can present opportunities for unethical and unlawful actions.
For instance, I recently spoke with Phil Fasano, CEO and co-founder of Bay Advisors, LLC, and former executive at Kaiser Permanente, and he noted that the size of many large healthcare providers is more like a city than a business, and they often employ temporary staff and contractors. When he was executive vice president and chief information officer at Kaiser in the early 2000s, the organization employed more than 300,000 people, with some 60,000 to 80,000 being temporary, such as contact center workers, custodians and administrative staff. In high turnover roles and with temporary staff, not only may there be a lower familiarization with compliance regulations and data security protocols, there may also be a greater willingness to skirt the rules for short-term gain. Thus it becomes even more imperative for businesses to have the right tools, technology and training in place in order to ensure data security and privacy – not only to comply with the law, but to protect patients and the long-term viability of their business.
This issue is not hypothetical. There have been many high-profile examples in the news of healthcare insiders stealing patient data to use for fraudulent purposes, or simply viewing it out of sheer curiosity, which is still a major violation. In a recent case of identity fraud, UMass Memorial Healthcare had to pay $230,000 to settle a lawsuit that resulted from two employees stealing patient information to open credit card and cellular phone accounts. In a truly egregious example from several years ago, an employee of the UCLA Medical Center leaked the late actress Farrah Fawcett’s cancer diagnosis to the National Enquirer before she even had the opportunity to break the news to family and friends herself. These cases are unfortunately not isolated incidents. Shockingly, a recent survey of healthcare workers found that one in five would be willing to sell confidential patient data if given the opportunity.
How to mitigate insider threats
First and foremost, healthcare organizations should institute mandatory background checks on all full-time, part-time and temporary hires – no exceptions. They should also aim to improve employee awareness and understanding of the laws by conducting annual training sessions and refreshers on all relevant data security and privacy regulations, including HIPAA, the General Data Protection Regulation (GDPR) and the Payment Card Industry Data Security Standards (PCI DSS) – this last one being especially important for patient billing and contact centers that handle payment card data. There are also several advanced technologies and strategies that an organization can implement to improve its defenses from insider threats, namely:
Establish staff guidelines for patient record access
The best way to avoid an internal compromise of sensitive information is to establish and enforce the principle of least privilege user access (LUA) on all computer systems, which states that an employee should only have the minimum level of access necessary to do their job. For example, an agent in the health system’s contact center may need access to some patient data such as payment or scheduling information, but they may not need to see information about medical history. Creating LUA controls limits unnecessary access and adds a strong, first level of security.
Monitor and flag staff access to patient data
Systems can include various levels of protection, from asking employees to enter password information twice before accessing confidential patient information, to red-flagging abnormal activity. Red-flagging provides an alert to senior staff of suspicious behaviors in the cases where an employee may be accessing large amounts of patient information or performing irregular activities within the network.
From last few years, there have been significant modifications in the rules in addition to guidelines that medical coding and billing firms must achieve. The medical billing vendor that is fully compliant in all under HIPAA are authoritatively business associates of most ideal healthcare clients. This means they never reveal private information, take substantial deterrents with client data, and shield the uprightness of the client.
But another utmost and instantaneous requirement is to influence the company’s profits as to make certain you file the medical claims as rapidly and swiftly as possible. For this determination, you can farm out the situation to a medical billing vendor as they promise to adhere to a strict round-the-clock turnaround for medical claim filing. Also, they have the real strength and aptitude to make available the flexible times for patient queries from outpatient ambulatory surgery centers to large hospitals.
Nonetheless to share your medical billing success story across healthcare landscape, some essentials should be think through in accordance of what’s being said, demonstrated and delivered at any stage:
Medical Bill Repricing Solutions
It is for this reason, the top medical billing vendor companies are certainly in a successful partnership attitude that lay emphasis on prompt, practical and a patron-centric billing approach. The objective ought to provide excellence attention to injured worker’s compensation claims and effectual charge clarifications. It always starts by real-time bill review besides fake finding for self-insured houses, third-party administrators in addition to insurance companies. Such practices prevent excessive payments and endorse an equitable repricing level for reimbursement.
Non-Network Negotiation
The non-network negotiations possibly will continue to establish the average for fair and reasonable reimbursement aimed at medical billing claims. But getting the substantial discounts on non-network claims and to regulate 100 percent in excess of provider sign-off to ease the risk is always an ideal method used by medical billing vendors. The supplementary healthcare cost suppression approach can be used for any other reporting type in delivering fair and equitable money to the paymaster and reasonable payment to the provider as well.
Fragmentation into coordination
An outsourced medical billing claim service means that you have a complete squad of professionals who make sure that your entitlements get treated swiftly and precisely, sendoff your practice minus at risk to interruptions in cash-flow. When a physician confidence the chosen billing service company and works self-possessed with billing prerogative team, they develop long-lasting benefits like.
More focus on patient care
Improved cash flow
Reduced billing errors
Elimination of training costs
Ensured billing compliance
Decreased call volume
Regular reports about income
Reduction in storage space
Exclusion of costs linked with hiring additional workers
Reduction in patient satisfaction risks
Savings on software, billing equipment and more
Claim denials reduction
Monitoring and Analytics
Your days in A/R, or revenue cycle period has a noteworthy impression on your bottom line. A medical billing service mete out their overheads transversely the all-inclusive client based on providing an economy of scale, monitoring and analytics. Thought, such medical billing vendors can have the funds to chartering with the best staff potential, so that you pay a smaller amount for the comparable and frequently complex collection percentages. In addition to the uninterrupted fiscal advantage of greater returns as well as decreased costs.
Intiva Health is the first truly integrated career platform for healthcare professionals. It redefines the medical credentialing process by making it faster, more efficient and more secure.
Elevator pitch
Intiva Health provides healthcare professionals with a single place to manage their credentials,continuing education, new job opportunities, secure messaging needs and more. It is built on the Hashgraph digital ledger platform, which means it is faster, more secure, and more error proof than blockchain.
Founders’ story
Intiva Health was founded in 2006 as a staffing agency for surgical services and emergency rooms. Today the Austin, Texas, company it has reinvented itself as a digital health startup featuring a next generation blockchain technology that cuts the time it takes for the medical credentialing process from months to seconds, improves HIPPA compliance,and makes document tampering or theft almost impossible.
Marketing/promotion strategy
Intiva Health focuses its marketing and PR efforts on licensed medical professionals (LMPs), practice managers, and the facilities where they work including medical groups, hospitals and professional associations.The company launched a new brand awareness campaign in March 2018 that includedthe introduction of the Intiva Token, a new cryptocurrency that LMPs can use to purchase continuing education classes, cyber insurance and other services.
Intiva is also partnering with the National Osteoporosis Foundation to test the advantages of using the Intiva Token for charitable donations.
Market opportunity
The Intiva Health Platform automates the burdensome tasks of credential and licensure management, continuing education, and discovering job opportunities for healthcare professionals. Intiva Health’s new ReadyDoc™credential verification solution, built on top of the Hashgraph distributed ledger technology, disrupts the existing broken, slow, and error-prone healthcare credentialing system, which today can take weeks or months to verify credentials, and is subject to tampering.
Intiva believes that ReadyDoc can replace the current processes of credentialing and primary source verification by storing documents and credentials in a Hashgraph-based distributed ledger. Providers and facilities can obtain information that is pre-verified, securely stored, and readily available, creating an ongoing, self-auditing verification of provider work history and clinical reputation.
ReadyDoc will act fluidly between health systems and facilities across the U.S., allowing organizations to instantly verify work history and clinical reputations. In the event of an emergency like the Houston hurricane, facilities will be able staff up by vetting the credentials of qualified providers instantly. ReadyDoc eliminates redundancy and the need for third party verification organizations, letting medical professionals get to work sooner.
Who are your competitors?
We believe that Intiva Health is the first integrative platform to manage healthcare career information from one seamless dashboard. It is certainly the first to use the Hashgraph digital ledger technology and offer a cryptocurrency utility token. However, Doximity also offers a career management application for medical professionals.
How your company differentiates itself from the competition and what differentiates Intiva Health?
Intiva Health can replace the current processes of credentialing and primary source verification by storing documents and credentials in a Hashgraph-based distributed ledger. Providers and facilities can obtain information that is pre-verified, securely stored, and readily available, creating an ongoing,self-auditing verification of provider work history and clinical reputation.
The Health Insurance Portability and Accountability Act, known as HIPAA, was enacted in the United States in 1996. The legislation creates data security and privacy requirements for safeguarding medical information. In recent years, HIPAA compliance has become a hot button issue for software developers in the healthcare space, as a number of high profile data breaches compromised millions of patient records across the country.
If you’re developing an eHealth or mobile health app, it is vital that you determine whether your software could be subject to the requirements of HIPAA for medical software applications. Failure to do so could subject you to thousands or even millions of dollars of liability if the use of your application results in an unauthorized disclosure of health information that is protected under HIPAA. Here’s how to tell whether HIPAA applies to you, and how to know if your software is HIPAA compliant.
Does HIPAA apply to me?
Before you start worrying about compliance with the security and privacy requirements of HIPAA, you should determine whether they can be applied to you and your organization. Both the HIPAA privacy rule and the HIPAA security rule apply to all covered entities under HIPAA, such as health plans, healthcare clearinghouses and healthcare providers. The website for Centers Medicade & Medicaid Service offers a Covered Entity Guidance Tool that can help you determine whether your organization is a covered entity.
HIPAA was expanded in 2009 with the introduction of the HITECH Act and again in 2013 with the HIPAA omnibus rule which clarified the responsibilities of business associates of covered entities when it comes to managing privacy and security of patient records. Further guidance was issued in 2016 indicating that cloud service providers would also be covered by the HIPAA privacy, security and breach notification rules.
Software developers in the healthcare space need to tread carefully here – the original regulations of HIPAA that deal with covered entities probably won’t apply to most organizations creating eHealth or mobile health products, but if your app will manage protected health information and share it with any covered entities, such as health plans or doctors, then HIPAA applies to you and you must comply.
If your software collects protected health information from patients but does not share it with a doctor or another covered entity at any point, the HIPAA rules won’t apply to you and you don’t need to worry about compliance.
Required safeguards for software HIPAA compliance
The available data indicates that while theft of computing hardware was the primary cause of healthcare data breaches in 2017, the greatest vulnerability that was exploited was health IT networks. For software developers, the HIPAA security rule is the most likely potential source of compliance issues. The rule mandates three types of safeguards that protect patient data – administrative, physical, and technical. In creating these safeguards, software developers must establish a secure application where authorized personnel have access to the required patient information while unauthorized persons do not. Patient information must also be protected from alteration or destruction.
Administrative safeguards ensure that software administrators who make have access to the data are acting responsibly. If your software stores medical data, anyone with access to that data must be authorized and trained on the ethical and legal requirements of that access. Administrative safeguards include:
Security management process
Security personnel
Information access management
Workforce training and management
Evaluation
Physical safeguards help to mitigate data breaches by ensuring that only authorized users can access the facilities and machines where protected health information is stored. Physical safeguards include managed policies for:
Facility access and control
Workstation and device security
Technical safeguards present the greatest challenge for software developers building HIPAA-compliant products, as software bugs represent the best opportunity for data attacks against your organization. HIPAA does not detail exactly what firewalls, anti-malware devices or encryption tools should be used to secure your software against a data breach, but it does indicate the need for several types of controls:
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions in need of solving, obstacles and the most important hurdles that must be overcome. And how solving these problems might alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes: For everyone you ask, you’re likely to receive a different answer. What must first be addressed? In this series (see part 2 and part 3), we ask. We also examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
So, without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities — healthcare’s most pressing questions, problems, hurdles, obstacles, things to overcome? How can they be best addressed?
Nick Knowlton, VP of strategic initiatives, Brightree
Throughout the healthcare ecosystem, patient-centric interoperability has historically been a huge challenge, specifically throughout post-acute care. This problem results in poor outcomes, unnecessary hospital re-admits, patients not getting the treatment they deserve, excessive cost burden and poor clinician satisfaction. This challenge can be solved through creating better standards, adapting existing interoperability approaches to meet the needs of post-acute care, implementing more scalable interoperable technologies, and involvement with national organizations, such as CommonWell Health Alliance and DirectTrust, amongst others.
Cybersecurity is one of the most pressing hurdles in the healthcare industry. The life and death nature of healthcare and the shift to electronic health records (EHR) creates an environment where hackers that successfully deploy ransomware and other cyberattacks can extort large sums of money from healthcare entities and steal highly sensitive data. To address this challenge, healthcare entities need to continue to increase their investment in cybersecurity and focus on improving their overall security posture by implementing tools and processes that will monitor all devices and assess their compliance with security policies; stop phishing attacks; keep all servers patched and current; ensure third party vendors comply with policies; and train employees on proper security hygiene.
Cyberattacks continue to expose the security vulnerabilities of healthcare institutions, keeping many industry stakeholders awake at night. This is why every organization handling protected health information (PHI) needs to build security frameworks and risk sharing into their infrastructure by implementing risk-mitigation strategies, preparedness planning, as well as meet industry standards for adhering to HIPAA requirements. Hospitals and healthcare systems must keep their focus on strategies and tactics that ensure business continuity in the event of an attack as it’s clearly not a matter of if a breach can happen but when.
The core problem for healthcare isn’t science, technology or caregiving intervention. It’s making sure that the systems of delivery and communications are thought through and actually respond to the way patients need and expect healthcare to be delivered. This means it doesn’t matter how advanced and perfected your health system may be — unless it conforms to culture — the way people think and behave — it will do nothing but confuse and frustrate patient needs, which are psychological and social, as well as physical and mental.
The Datica platform manages all ongoing compliance and security burdens not covered by AWS and Microsoft Azure. Through the platform, customers deploy cloud-native applications and integrate with EHRs. The HITRUST CSF Certified Datica platform services all who handle PHI in the cloud, from startups to the Fortune 100.
Elevator Pitch
Datica removes the risks for digital health in the cloud.
Founders’ story
Travis Good, MD
When CEO Travis Good, MD, and co-founder Mohan Balachandran, began solving healthcare’s universal hurdle in building applications in the cloud — HIPAA — the two entrepreneurs solved the problem. Along the way, they realized that other development companies had also been trying to solve the same problem. They thought: Why should any of us reinvent the wheel? With the compelling market need in front of them, they built their HIPAA-compliant platform and made it available to other development teams, and eventually enterprises. Knowing that trust, security, and compliance would remain the pillars to their platform, the founders sought certifications and audits through HITRUST, SOC 2, and GDPR to make the Datica Platform the most trusted foundation on which to build applications in the cloud.
Marketing/promotion strategy
Datica helps healthcare enterprises and digital health vendors accelerate innovation to improve healthcare through the use of its HIPAA compliant platform. We promote Datica to both market segments through outbound and inbound channels, direct outreach through webinars and local/national presentations around the company’s framework for digital health success, as well as through its podcast, quarterly reports, and executive speaking.
Market opportunity
The market opportunity for the Datica platform is extensive, touching all B2B healthcare stakeholders who store, manage and transmit personal health information in the cloud. Our target audience is 60/40 enterprise (healthcare providers, pharma, and payors), as well as digital health vendors. World-class companies like Johnson & Johnson, Zipnosis, Healthloop, Propeller Health, Methodist Le Bonheur, Stony Brook Medical, Optum and more, trust Datica to remove the risks of digital health in the cloud.
Who are your competitors?
Our largest competitors in the compliant cloud space aren’t other PaaS vendors but rather managed service solutions on one of the major IaaS vendors like Amazon’s AWS or Microsoft’s Azure. With Datica, developers can deploy application workloads to their Datica environment instead of directly to another IaaS to eliminate the burden of compliance. With the Datica Platform, a customer gets the benefits of AWS, Azure, or other infrastructures as the foundation of our platform, plus Datica automates all DevOps and DevSecOps requirements in the cloud. Developers can deploy services & workloads in minutes that are fully in compliance with HIPAA and HITRUST.
How your company differentiates itself from the competition and how Datica differs.
Datica differentiates itself in two ways. The first is through open source resources. Datica has a strong belief in open source resources as the fastest and best way to promote healthcare innovation. Datica open sourced its company policies and resources early in the company life. During HIMSS18, we also announced that the Datica platform now uses Kubernetes (an open source system for automating deployment) as its underlying container orchestration, granting customers greater technical flexibility.
Second, Datica stands apart from other PaaS competitors through its firm commitment to third-party audit and verification of the Platform’s trusted security. Datica is HIPAA compliant, HITRUST CSF Certified and has certifications for SOC 2, GDPR, and GxP.
A relentless parade of fronts from communication to banking, shopping seems to be unfolded, all thanks to the emerging technology. But somehow healthcare used to stay behind because many of you believed it was too complicated to be fixed. Well, that’s just not true! Now, more than ever, technology has not just succeeded in improving the consumer experience but also has removed the unnecessary cost from the entire healthcare system.
In order to maintain standards of care and improved outcomes for patients, hospitals and medical centers, technology is providing ever-smarter ways like never before. Enacted by the U.S. Congress in 1996, HIPAA was introduced because of the increasing need to address growing technological changes and problems. According to the HIPAA Privacy rule, saving, accessing and sharing of medical and personal information is prohibited. Moreover, it specifically outlines national security standards to protect health data created, received, maintained or transmitted electronically (ePHI — electronic protected health information).
Apart from this, there are a few primary components one needs to be concerned with:
Privacy rules emphasize on what qualifies as PHI (protected health information) and who is mainly responsible for ensuring that nothing would get disclosed improperly. It includes covered entities ranging from health plans to health care clearinghouse, health care providers who have the right to transmit any health information electronically regarding the Department of Health and Human Services (HHS). Other than covered entities, privacy rules even encompass of business associates (anyone who stores, collects, maintains, or transmits protected information on behalf of a covered entity).
On the other hand, security rules relate specifically to electronic information and set guidelines for how to secure PHI. Administrative, physical and technical are the three main categories in which it is broken down. As the name implies, administrative revolves around access control and training, physical safeguards are for actual devices, and technical relates to the data itself.
HIPAA Breach Notification Rule is basically a set of standards that covered entities and business associates must follow in the event of a data breach containing PHI and ePHI. This rule, in particular, emphasizes on two kinds of breaches; minor breaches and meaningful breaches. As a result, organizations are required to report all type of breaches, regardless of size to HHS OCR, but the specific protocols for reporting change depending on the type of breach.
Omnibus Rule: This rule was enacted in order to apply HIPAA to business associates, in addition to covered entities. According to the rule, business associates must be HIPAA compliant.
By Brooke Faulkner, a writer in the Pacific Northwest; @faulknercreek.
Healthcare is in a constant state of updating. From new technologies to the latest scientific research, nothing stays the same for long. If it does, there’s almost certainly someone, somewhere, attempting to find a better way.
Right now, though, more than just the medicine is changing. The way we interact with our doctors and the way our doctors interact with each other is redefining what patient care looks like. Slowly but surely, the communication and management of healthcare data is joining the rest of us in the 21st century and going digital. Doctors are available on demand, medical records can be accessed without waiting for a courier, and the amount of information available to the public is growing by the second.
It’s not all so optimistic, though. Concerns about privacy exist in tandem with the benefits of increased access, and medical facilities can be vulnerable to a variety of cyber attacks. Whether you’re considering public health on a global scale or just going to the doctor for a yearly wellness check, digital health data is changing the way we see medical care.
Public Health Opportunities
Increased connectivity in the medical world makes more data available to more people. It’s easier than ever to track disease outbreaks, compare national statistics, and identify trends in global health. In the United States, the field of public health research is expected to spend more than $3.7 trillion in 2018 alone.
We have fewer communicable disease epidemics now than at any time in recorded history. Diagnosis and treatment protocols are more sophisticated, but more often than not, we don’t have to worry about smallpox, measles, or rubella thanks to vaccinations. Instead, many of the health concerns facing Americans are preventable, non-communicable diseases borne of unhealthy lifestyles. In 2017, more than 36 percent of the adult population was obese and 9.4 percent had type II diabetes.
With the data recorded by fitness trackers, electronic food diaries, and other health-focused devices, public health researchers can paint a clearer picture of the lifestyle choices that lead to illness. Public health campaigns can become more targeted and an emphasis placed on follow up and plan adherence through personal technology. By crunching the numbers generated from various populations, researchers can compare and contrast differences among nationalities, noting genetic trends and trying to tease out nature from nurture.
In the more than 20 years since the landmark passage of the Health Insurance Portability and Accountability Act (HIPAA), healthcare organizations have come a long way in protecting the security and privacy of patient data. Organizations now use sophisticated tools in the form of electronic health records (EHRs), online patient portals and virtual clinics that have elevated modern medicine to a new level of care. As a result, patients have come to expect a seamless interaction – whether digitally or in-person – with their healthcare provider, and trust that their personal information is safeguarded throughout.
The 
Healthcare is in a constant state of updating. From new technologies to the latest scientific research, nothing stays the same for long. If it does, there’s almost certainly someone, somewhere, attempting to find a better way.