Patient Data Security: Facility Overview and FAQ

What is data security? In healthcare, data security is mostly concerned with the safety of sensitive patient data or protected health information (PHI). The public trusts healthcare institutions to ensure all confidential information is kept private and secure. It’s vital that facilities take an active role in safeguarding this information from cyber-attacks and security breaches.

We’ll discuss the importance of patient data security and some of the regulations that have been established to protect PHI. We’ll give an overview of data security from the facility perspective and answer some of the most frequently asked questions about the protections used to ensure privacy.

Why Is Patient Data Security Important?

Electronic health record (EHR) systems have brought many advances to the delivery of healthcare services. Patient portals make accessing information more convenient than ever, transforming patients into active players in managing their care. EHRs integrate health services, making true interdisciplinary care possible in ways that weren’t imaginable with paper documentation.

However, our reliance on EHRs has also put patient data at risk on a larger scale than before. Here are a few statistics about the prevalence of security lapses:

• From 2005 to 2019, 249.09 million people were affected by healthcare data breaches.
• In 2019 alone, over 41 million records were exposed to information breaches.
• During the COVID-19 pandemic, the U.S. healthcare industry reported a 25% increase in successful cyber-security attacks.

In addition, the financial impacts of these breaches are significant, with an average cost of $10 million per attack. But the costs don’t stop there. The effect on the public’s trust in the healthcare system is even more important. Patients expect that their most personal and confidential information will be kept safe from privacy invasions.

What Is HIPAA?

In 1996, the U.S. Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to create national standards for data security in healthcare. At the time, computers had already been used in healthcare for decades but were primarily only used for billing purposes. With the rise of large electronic health record (EHR) systems, Congress anticipated the need for increased security measures and standardization to protect sensitive PHI.

HIPAA defined guidelines for health information transactions, medical codes, unique health identifiers, and security measures. As technologies continued to advance and expand, so did HIPAA, and today it continues to play a vital role in protecting patient data. HIPAA guidelines for healthcare professionals are outlined in a series of rules, which include the following:

• Privacy Rule
• Security Rule
• Breach Notification Rule
• Enforcement Rule
• Omnibus Final Rule

The Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR) are responsible for enforcing the HIPAA Privacy, Security, and Breach Notification Rules. Violations of some HIPAA regulations are punishable with penalties including fines and imprisonment (for criminal offenses enforced by the U.S. Department of Justice).

How Does HIPAA Protect Patient Data?

HIPAA primarily protects patient data through the Privacy Rule and Security Rule. The HIPAA Privacy Rule establishes national standards for protecting medical records and individually identifiable health information. The rule applies to PHI in any medium, including paper documentation.

The HIPAA Security Rule sets standards for protecting the confidentiality, integrity, and availability of electronic PHI created and used by covered entities. But, unlike the Privacy Rule, HIPAA specifically covers electronic PHI (e-PHI) in the Security Rule. It also requires facilities to identify reasonably anticipated threats to e-PHI security, protect against prohibited uses or disclosures, and confirm compliance by their workforce.

How Is Patient Data Protected in My Facility?

There are many physical and technology-based safeguards that facilities typically use to protect patient data. Examples of these types of safeguards include:

• Facility access
• Workstation controls
• Device security

For example, using simple protections like locks on doors, alarms, and cable locks on computers provides physical security. Technical safeguards include data control, auditing tools to monitor access, data encryption, tap-and-go systems, and secure transmission networks.

Your facility may also implement administrative safeguards like workforce training programs, ensuring a process for regular updates of security policies and procedures, and establishing a security management process.

What are Some Ways to Maintain Security of Health Information?

Protecting patient data security is an ongoing process that requires constant vigilance and maintenance. Continuing risk analysis and management are required by HIPAA. Programs must include strategies for tracking access to PHI and ways to evaluate and update security measures. A system must be in place to perform regular audits, evaluate potential risks, and review actual security incidents. Ongoing risk analysis processes typically evaluate:

• EHR software and hardware
• Efficacy of practice protocols
• Physical environment
• Workforce education and training
• EHR access controls
• Contracts with external businesses
• Patient relations and communications

Workforce training on HIPAA requirements should be conducted regularly to refresh staff on best practices and promote compliance.

What Happens If a Security Breach Occurs?

The HIPAA Breach Notification Rule requires covered entities and their business associates to provide notification following a breach of unsecured protected health information. A patient data security breach can include loss, theft, or impermissible use or disclosure of unsecured PHI. In the event of a breach of unsecured protected PHI, the facility must notify the affected individuals and the Secretary of Health and Human Services. If the breach affects more than 500 people from a state or jurisdiction, the organization must also notify the media.

Looking for More Ways to Protect Patient Data?

We’ve covered an overview of patient data security and answered some of your most frequently asked questions. If you’re looking for more information about patient privacy protections and compliance, IntelyCare is your trusted source for information. Our newsletter is full of free nursing management insights to support healthcare leaders.