It’s time for HHS’ Office for Civil Rights to release “strong guidance” on cloud computing in healthcare, according to a letter sent by advocacy group Patient Privacy Rights. The letter, sent by PPR president Deborah Peel, argues that the transition to EMRs will be hampered if patients aren’t confident that their medical information is protected wherever it goes, including the cloud.
“More specific guidance in the health care ecosystem would help ensure that cloud providers, health care professionals and patients alike are aware of how the privacy and security rules apply to clouds,” Peel writes.
Peel suggests that HHS rely on lessons learned from the recently-settled Phoenix Cardiac Surgery case, in which a medical group was fined $100,000 for HIPAA violations including exposing clinical and surgical appointments on a publicly-available Internet calendar.
Specifically, Peel recommends the following standards be established:
Security Standards: Security standards must be implemented that are consistent and
compatible with standards required of federal agencies including the HIPAA Security
Rule and the HITECH breach notification requirements.
Privacy of Protected Health Information: Standards must be included that establish the
appropriate use, disclosure, and safeguarding of individually identifiable information,
which take into account stronger state and federal requirements, Constitutional rights to
health information privacy, and the fact that HIPAA is the “floor” for privacy protections
and was never intended to replace stronger ethical, or professional standards or “best
BAA Requirement and Standardization: Consistent with prior OCR guidance, any
software company given access to protected health information by a HIPAA-covered
entity to perform a service for the covered entity is a business associate. Thus, as OCR
representatives have publicly stated on several occasions, a Business Associate
Agreement (BAA) is required between a cloud computing provider and any customer
entity that uses or discloses protected health information or de-identified health
information. It is imperative that these BAA standards promote the protection of privacy
and security of health information to ensure public trust in health IT systems and promote
quality health care, health care innovation and health provider collaboration.
I was particularly interested to note her suggestion that software companies given access to ePHI sign Business Associate Agreements. My guess is that some cloud providers would fail miserably if asked to uphold HIPAA standards, simply because they aren’t prepared. If Peel’s recommendations were enacted, in other words, it could shake up the cloud services industry. Maybe that’s a good thing, but it won’t be a pleasant one for some.