Friday, 6 May 2016

Human Error Is A Key Driver Of Health Information Leaks and Breaches It Seems.

Human Error Is A Key Driver Of Health Information Leaks and Breaches It Seems.

This appeared last week:

Human element the weakest link in healthcare security, says Verizon report

The majority of threats to security are from external sources that prey on the bad habits of personnel.
April 26, 2016 09:47 AM
"Hackers are beginning to impersonate executives to get the data they want," said Suzanne Widup, senior analyst on the Verizon RISK team.
Stolen credentials, privilege misuse and miscellaneous errors were the three biggest causes for health data breaches in 2015, according to the 9th annual Verizon Data Breach Investigations Report released Tuesday.
The majority of threats come from outside of organizations rather than with internal actors.
Furthermore, there's an increasing trend of external culprits taking advantage of employees' missteps online.
"There's a pronounced trend of a combination of social engineering, like phishing that is followed by hacking actions," said Suzanne Widup, senior analyst on the Verizon RISK team. "Hackers are beginning to impersonate executives to get the data they want, for financial fraud and other kinds of information."
"We find the human element is really the weakest link," she added. "You can train people, but there are still employees that will click on the suspicious link. It's concerning to see that it's now become so mainstream."
According to the report, 30 percent of phishing messages were opened by the target and 12 percent of those targets actually clicked on the malicious link.
And while encryption can help protect against these types of attacks, Widup said. There's a strong hesitation to do so, as it slows down workflow.
Verizon studied more than 100,000 security incidents that occurred in 2015 across all industries to confirm data had been breached. However, lost data is prevalent in healthcare, which means it can't be verified as breached. Those incidents were not included on the report, said Widup, but it remains a serious problem in healthcare.
More here:
Nice to see what we all knew confirmed. What is not clear is just what exactly can be done to reduce / eliminate the risk.
Here is the link to the report:
Enjoy.
David.
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Senate Estimates Was On This Afternoon. E-Health Ignored Again!

Senate Estimates Was On This Afternoon. E-Health Ignored Again!

E-Health is such a hot topic - not a single question.

Outcome 7: Health System Capacity and Quality
Program 7.1: e-Health Implementation
Program 7.2: Health Information
Program 7.3: International Policy Engagement
Program 7.4: Research Capacity and Quality
Program 7.5: Health Infrastructure
Program 7.6: Blood and Organ Donation
Program 7.7: Regulatory Policy

No one seems to be interested in any of this...

David.

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Thursday, 5 May 2016

Does A Move To Real Time Narcotic Prescription Monitoring Say Something About The Value Of The myHR in Medication Management?

Does A Move To Real Time Narcotic Prescription Monitoring Say Something About The Value Of The myHR in Medication Management?

This release appeared last week:

Real Time Prescription Monitoring Will Save Lives

25 April 2016
The Andrews Labor Government is taking action to reduce the number of Victorians dying from prescription drug overdoses, with the introduction of a real-time prescription monitoring system.
With more people losing their lives each year in Victoria from overdoses of prescription drugs than those dying in road accidents, a real-time prescription monitoring system has the potential to prevent the deaths of up to 90 Victorians over the next five years.
Many prescription overdoses result from people “prescription shopping” from multiple doctors and pharmacies. Without a centralised monitoring system, this often goes undetected with tragic results.
A real-time monitoring system will help our medical clinics, pharmacies and hospitals better identify prescription drug seekers earlier, before their addiction escalates into serious harm.
Since 2012, there have been 21 coronial findings calling for the implementation of a Victorian real-time prescription monitoring system, however the former Liberal Government failed to act.
To implement this life-saving initiative, we will provide close to $30 million in the 2016-17 Victorian Budget to roll out the monitoring software, provide additional counselling and addiction treatment services, as well as providing training and support for doctors and pharmacists to identify and help prescription drug misusers early.
Once implemented, the system will allow clinicians at 1900 GP clinics, 1300 pharmacies and 200 hospitals to do an on-the-spot check before prescribing or dispensing medicines that are at high risk of misuse.
This is expected to reduce the number of people taken to emergency departments with overdoses by more than 500 per year, and see a further 700 people a year referred to counselling to try and beat their addiction.
The scheme will include Schedule 8 medicines such as morphine and oxycodone at a minimum, and the Government will consult with professional medical and pharmacy groups to determine the best way to include other high-risk medicines such as diazepam.
In 2015, 330 Victorians lost their lives due to prescription drug overdoses – 5 per cent more than the previous year. This is higher than the 217 overdose deaths from illicit drugs and the 252 people killed in road accidents.
Quotes attributable to Minister for Health Jill Hennessy
“With more Victorians dying every year from prescription drug overdoses than road accidents, we can’t afford to wait any longer to take action.”
“We have listened to the families who have experienced first-hand the tragedies of prescription medicine overdoses, and we’re getting on with delivering this life-saving initiative.”
Quotes attributable to Minister for Mental Health Martin Foley
This will help us identify people misusing prescription drugs earlier, so they can get the support and treatment they need to beat their addiction.”
The release is found here:
Typical of the press commentary was this:

Doctors welcome Vic prescription drugs plan

26 April 2016
The Victorian government has committed $30 million to a real-time prescription monitoring system in an attempt to crack down on doctor and prescription shopping.
The centralised system will allow doctors and pharmacists to do on-the-spot checks before prescribing or dispensing medicines that have a high risk of misuse, such as morphine and oxycodone.
Health Minister Jill Hennessy says it is a “life-saving initiative” that will help identify drug seekers before their addiction escalates.
AMA Victoria president Dr Tony Bartone says the development has been a long time coming.
“The thing that stands out most is that more people die from prescription medicine overdoses than in road accidents in Victoria,” says Dr Bartone, who is a practising GP.
“In most practices there is a blanket ban on these kinds of drugs. However, this prevents access for people who really need them. At the same time, there’s nothing worse than to find out that one of your patients has been seeing other practitioners for prescriptions,” says Dr Bartone.
Part of the funding will go towards counselling and addiction treatment services, as well as training and support for doctors and pharmacists to help identify drug misusers early.
Pharmacy Guild of Australia Victorian branch president Anthony Tassone says the government is showing “great vision”.
While a new monitoring system will go a long way towards identifying patients with a drug misuse concern, addiction and counselling services are also vital, he says.
“This is a complex issue that needs a broad solution, and the Victorian government has shown great vision in recognising that a software system alone is not the complete answer.”
According to the government, 330 Victorians died from prescription overdoses in 2015. That’s 100 more than those who died from illicit drugs in the same year.
Since 2012, there have been 21 coronial findings calling for the implementation of a Victorian real-time prescription monitoring system.
More here:
What struck me with this was that to have it work there would need to be both a database of all narcotic and benzodiazepine prescriptions, some form of pretty robust patient identification and access to the database available for all dispensers and prescribers.
There also seem to be a range of privacy, consent and confidentiality issues which I imagine need to be addressed legislatively.
That said - how does all this differ from providing access to the myHR using the medication records collected via eTP and the PES services.
It is by no means clear to me how these apparently parallel systems interact or overlap and why we need both? I look forward to having this all explained to me and the readers.
David.
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Wednesday, 4 May 2016

The Health Budget Seems To Be Not Very Well Received. GPs Especially Seem To Be Hit.

The Health Budget Seems To Be Not Very Well Received. GPs Especially Seem To Be Hit.

This appeared today in the Medical Observer:

Five things GPs need to know about the budget

4 May 2016

1. The Medicare rebate freeze has been extended until 2020

The move effectively cuts nearly $1 billion from Medicare.
Health Minister Sussan Ley is defending the freeze, saying it is “in recognition” of the fiscal situation and the recently announced Healthier Medicare reforms, which include changes to payments and models of care for chronically ill patients.
RACGP President Dr Frank Jones calls it a “calamitous” move that may leave general practices unviable. He calls the budget illogical and says the government has taken no heed of the college’s advice.
AMA President Dr Brian Owler says the most vulnerable will be hardest hit, while Dr Ewen McPhee, President of the Rural Doctors Association of Australia, says extending the freeze will “send more rural and remote patients to the healthcare equivalent of deepest, darkest Siberia”.
"This is bigger than the co-payment. This is a war on general practice," he said on Wednesday.

2. $21.3 million cut from the PIP and moved into the Health Care Homes program

…..

3. Pause of indexation on Medicare Levy Surcharge and Private Health Insurance rebates extended

…..

4. Crackdown on Medicare compliance

…..

5. Millions to be funnelled into the My Aged Care website and digital health

$136.6 million in funding is expected to help the My Aged Care website and contact centre meet rapidly growing demand.
A further $156.5 million will be provided to the new Australian Digital Health Agency for its first year of operation. The nascent agency is set to assume management and governance responsibilities for many aspects of the digital health scheme, including strategy, design, development, delivery and operations.
More here:
Australian Doctor is equally unhappy.

Budget: Gov hacks $1 billion from Medicare

| 4 May, 2016 |  
Another billion dollars will be effectively cut from Medicare after the Federal Government pledges to extend the rebate freeze until 2020.
The first budget from Treasurer Scott Morrison (pictured) described the move as a “broad-based measure”, which will have a “minimal” impact on individual services.
Record bulk-billing rates for GP attendances — now at 83% — are cited as a justification for the cuts.
MBS rebates for GP care were originally frozen until mid-2018, with Health Minister Sussan Ley saying last year they would be in place no longer than necessary.
However, the 2016 Budget noted the policy will run until mid-2020, saving an estimated $925 million over two years.
The continued freeze covers all MBS services – including GP, allied health and other specialist services. The savings will be redirected to fund health policy priorities, according to the government.
Ms Ley defended the freeze last night. Referring to the looming Health Care Homes trial where practices will get bundled quarterly payments for managing enrolled patients' chronic conditions, she said: "The [freeze] is in recognition of the current fiscal environment and the Healthier Medicare reforms...including a new, fairer bundled payment and incentive model for GPs treating chronically ill patients that will no longer rely solely on the fee-for-service Medicare rebate model. 
One big question is whether the continued freeze will force GPs and clinics to ditch bulk-billing. 
Doctors — particularly in low socio-economic areas — have previously warned that their patients could not afford to pay gap fees.
According to figures provided to Australian Doctor, the average full-time urban GP already lost the equivalent of $9600 in reduced Medicare funding during this financial year.
However, this will increase with inflation to $29,500 in 2017/18.
Lots more here:
It seems to me the Government is pushing rather hard on General Practice and that if it keeps happening we are going to see a very different system with Bulk Billing becoming a rarity as the economic viability of GP deteriorates.
It is also interesting to see just how much the Digital Health Agency  and  the My Aged Care are costing.
More reaction will be covered a bit later.
A useful overview for the health sector is also found here:
David.
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Tuesday, 3 May 2016

Privacy Of Health Information Hits The Headlines Again. Some GPs May Not Be As Careful As They Should Be But Most Are.

Privacy Of Health Information Hits The Headlines Again. Some GPs May Not Be As Careful As They Should Be But Most Are.

This appeared a few days ago:

Some Australian GPs found to be putting your privacy at risk

April 28, 20166:44pm
Sue Dunlevy News Corp Australia Network
YOUR health information could be at risk with the nation’s privacy watchdog finding major holes in the way GP practices manage patient privacy.
One in ten GP clinics have no privacy policy a review by the Acting Information Commissioner Timothy Pilgrim has found.
And many GPs who did have a privacy policy were found to have major holes in their systems.
“A recent assessment of GP practices by the Office of the Australian Information Commissioner (OAIC) suggests that many practices could use more practical support to improve or establish privacy policies,” Mr Pilgrim said.
The commission last year conducted an assessment of the privacy policies of 40 GP practices from across Australia.
Four practices had no privacy policy.
While 36 GP clinics had a privacy policy only two appropriately advised patients how to make a complaint about breaches of their privacy, the review found.
Only two clinics advised patients how they could request a correction to their personal information and only one advised patients how they could request access to their personal information.
The holes in the privacy system take on greater importance as the government pushes ahead with plans to automatically issue every Australian with an electronic health record managed by their GP.
Privacy Foundation spokesman Bernard Robertson-Dunn says the Information Commissioner’s report is very concerning.
 “GPs are the people who have access to and control the most private of information that applies to Australians,” he said.
“Doctors should be at the forefront of privacy concerns,” he said.
He says the tougher penalties the government applied to its new electronic MyHealth record should also apply to a GPs own patient records.
More here:
The release from the Privacy Commissioner that stimulated the article said the following:

Improving privacy in Australia’s general practices a joint effort

Thursday, 28 April 2016
Acting Australian Information Commissioner, Timothy Pilgrim, has today welcomed a series of actions by Australia’s peak medical groups to improve privacy practices at Australia’s GP clinics.
“A recent assessment of GP practices by the Office of the Australian Information Commissioner (OAIC) suggests that many practices could use more practical support to improve or establish privacy policies,” said the Commissioner.
“The OAIC appreciates that many GP practices are small to medium sized businesses and so practical, industry-relevant support is an effective way to improve privacy outcomes for practices and patients.”
“So I welcome the fact that the Australian Medical Association (AMA), the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM) and the Australian Association of Practice Management (AAPM) have come together with the OAIC to provide practical support to their members to deliver open and transparent privacy policies within their practices.”
The OAIC regulates Australia’s Privacy Act1988 and last year conducted an assessment of the privacy policies of 40 GP practices from across Australia. When the assessments revealed room for improvement, medical peak bodies were approached to help deliver training and practical solutions to assist GP practices.
Chair of the AMA Council of General Practice, Dr Brian Morton, said that “privacy is fundamental to the trusted relationship between a doctor and a patient and practices go to great lengths to protect this. The assessment report shows that some may need more guidance on how to develop transparent and robust privacy policies. The AMA is actively helping them with this.”
The Royal Australian College of General Practitioners President, Dr Frank R Jones, said the report was a timely reminder for general practices to review their privacy policies. “The RACGP provides useful resources to general practices to make adherence to the rules straightforward and our goal is to improve the practical help and support we already provide.”
Danny Haydon, President of AAPM, confirmed that Practice Managers have a key role in ensuring their practice has an easily accessible privacy policy in place and that AAPM assists practice managers to implement this through a range of resources.
ACRRM President Professor Lucie Walters said, “rural and remote doctors are keenly aware of the importance of privacy issues, especially given the circumstances of rural medical practice. ACRRM will be doing as much as possible to support its members to ensure that both the documentation and implementation of practice privacy policies are consistent with the requirements of the Privacy Act”.
Commissioner Pilgrim emphasised that a collaborative approach to create strong privacy governance in Australian businesses was always the OAIC’s preferred approach.
“The OAIC works constructively with businesses and the wider community to build an integrated approach to privacy compliance,” said the Commissioner.
“Thanks to the efforts of these peak bodies and the OAIC’s team, that preferred approach will lead to improved privacy management for Australian GPs and their patients.” 

About the report

The report focused on assessing the privacy policies of 40 General Practice Clinics against Australian Privacy Principle (APP) 1 under the Privacy Act 1988. APP1 has a focus on open and transparent management of personal information.
The purpose of the assessment was to assist GP clinics to improve or enhance their existing privacy policy, taking into account the requirements under the Privacy Act 1988 (Privacy Act).The assessment aimed to enhance the GP clinics’ understanding of privacy and their obligations under the Privacy Act.
It examined the content, layout and availability of the privacy policy but did not consider how the information handling procedures set out in the privacy policy were implemented in practice. This report does not make conclusions about broader privacy practices of GP clinics beyond the scope described above.
The General Practice Clinics APP 1 Privacy Policy assessment report was conducted under Section 33C of the Privacy Act 1988.
Here is the link:
Most useful in the full report was the following:

APP 1.4 — Content: eHealth

Background

3.1           The assessment also aimed to enhance the GP clinics’ understanding of privacy in the context of their obligations under the My Health Records Act and the HI Act.
3.2           Therefore, as part of the assessment the OAIC reviewed the privacy policies to ensure GP clinics adequately covered the use of the My Health Record system and their collection and use of IHIs. The assessment also looked at the use of electronic transfer of prescriptions (eTP) services.

Commentary and recommendations

3.3           31 of 36 GP clinics had signed a PCEHR Participation Agreement. Only one of these GP clinics specifically referred to the collection, use or disclosure of personal information by GPs through the use of the My Health Record system.
3.4           33 of 36 GP clinics stated that they held IHIs. 12 privacy policies specifically referred to the collection, holding, use or disclosure of IHIs.
3.5           No privacy policy specifically referred to the collection, use or disclosure of personal information as a result of using an eTP service.
3.6           The OAIC recommended GP clinics amend their privacy policy so that:
·         if the My Health Record system is used, it informs patients that the GP clinic may collect, use and disclose their health information for the purposes of using the My Health Record system
·         if IHIs are collected, it informs patients that the GP clinic collects, holds, uses or discloses IHIs
·         if an eTP service is used, it informs patients that the GP clinic may collect, use, hold or disclose their health information for the purposes of using that eTP service.
----- End Extract.
The take-away for me in all this is if you plan to get involved in the myHR environment or e-Prescribing then it is important to have the relevant privacy policy in place for the patients of the practice. It’s a one off compliance issue but it is probably needed if the GP decides they want to go with the myHR to obtain the e-PIP incentives.
Overall I thought it was pretty impressive how compliant most practices seemed to be - recognising that these areas are almost certainly properly handled even if not formally documented.
Given there are lots of resources available for those who are not presently compliant it seems sensible to take advantage of these and get it all sorted.
More important, of course, is to have proper procedures and training in place to minimise risk of leaks and breaches.
David.
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