What Measures Can Be Taken to Guarantee the Security of EHRs?

Safeguarding Patient Health Information: A Multi-Faceted Approach to Securing EHRs

Electronic health records (EHRs) have become the backbone of healthcare delivery, providing convenient digital access to vital patient information for authorized providers. However, this reliance on technology also introduces cybersecurity risks that could lead to breaches of sensitive health data.

In fact, healthcare data breaches are on the rise, with over 700 major incidents reported in 2022 alone. Protecting the privacy of patient information stored in EHR systems requires a collaborative effort between patients, healthcare personnel, technologies, and regulatory oversight.

The Critical Need for Securing EHRs

EHRs contain extensive personal and medical information on patients, including details on diagnoses, medications, medical history, insurance data, and more. Unauthorized exposure of this sensitive data can lead to fraud, identity theft, and irreparable damage to a patient's privacy.

For healthcare organizations, a breach of EHR systems can also have far-reaching implications beyond the substantial financial penalties and legal liabilities.

Patient trust in the healthcare system can be severely eroded. Medical services can be disrupted if EHR systems are rendered unavailable. Ultimately, the delivery of safe and effective care to patients is jeopardized when EHR security is compromised.

Robust measures to safeguard EHRs are imperative for ethical, operational, and regulatory reasons. A multi-layered approach is needed, involving coordinated efforts across patients, healthcare personnel, technologies, and regulatory mandates.

Patient Responsibilities in Securing EHR Data

While healthcare organizations bear the brunt of responsibility for EHR security, patients can also take steps to protect their own medical information.

Using Strong Passwords

Patients granted access to provider portals should create complex passwords. These should have a mix of letters, numbers, and symbols that would be difficult for unauthorized parties to guess.

Practicing Caution Online

Patients should avoid accessing medical portals over public Wi-Fi networks which can expose login credentials and data to hackers. Software and apps should be kept updated and antivirus solutions used.

Understanding Patient Rights

Patients have certain rights under HIPAA regarding their medical records. Being aware of these rights, like the ability to request copies of records or restrict some sharing of information, helps patients be informed stakeholders in data security.

Safeguards by Healthcare Personnel

Doctors, nurses, and other personnel accessing EHR systems play a pivotal role in maintaining security across the following domains:

Access Limitations

Configuring role-based access ensures personnel can only access parts of the EHR system needed for their role. For instance, a doctor may have full access while billing staff have restricted access.

Ongoing Training

Conducting regular cybersecurity and HIPAA training keeps personnel alert to threats like phishing scams and teaches best practices for handling sensitive data.

Physical Controls

EHR workstations should be positioned to limit unauthorized viewing. Access to infrastructure hosting EHR systems should be physically restricted. Protocols must secure devices like laptops taken off-site.

Technical Safeguards in EHR Systems

Well-designed EHR systems incorporate robust technical measures to control access, monitor activity, recover from outages, and protect data:

Access Authentication

Multifactor authentication adds an extra layer of verification, requiring personnel to provide an additional credential like a unique code from their mobile device when logging in.

End-to-End Encryption

Encrypting data in transit and at rest prevents unauthorized parties from being able to read EHRs even if they manage to gain access. Encryption provides an important last line of defense for patient privacy.

Detailed Audit Trails

Logs allow any EHR access or changes to be traced back to the responsible personnel. This is crucial for detecting suspicious insider activity or breaches.

Backup and Recovery

EHR systems must have procedures for automated backups and disaster recovery to mitigate outages from ransomware, technical failures, or other disruptions.

Laws Regulating EHR Security

Healthcare entities must comply with laws like HIPAA and HITECH that mandate technical, physical, and administrative safeguards for EHR systems and impose penalties for non-compliance.

Law/Act	Key Provisions	Regulatory Body	Compliance Requirements	Penalties for Non-Compliance
HIPAA Security Rule	The HIPAA Security Rule mandates safeguards for electronically protected health information (ePHI), including administrative, physical, and technical measures. It requires entities to assess security risks, manage those risks, and maintain comprehensive documentation of compliance efforts.	HHS Office for Civil Rights (OCR)	Entities must conduct regular security risk assessments, implement required safeguards to protect ePHI, and keep detailed records of all compliance-related actions and protocols.	Penalties are tiered based on the severity of the violation, ranging from minimal fines for unintentional breaches to significant penalties for willful neglect.
HITECH Act	The HITECH Act extends the provisions of the HIPAA rules to business associates and their subcontractors, imposing stricter enforcement and reporting requirements. It holds these associates directly accountable for compliance with the Privacy and Security Rules and mandates the reporting of breaches.	HHS Office for Civil Rights (OCR)	Entities are required to comply with the extended HIPAA provisions, ensuring that business associates and subcontractors are also in compliance. Mandatory breach reporting is a critical component of compliance.	Violations lead to increased fines and penalties, which are determined by the nature and severity of the breach.
ONC HIT Certification Program	This program establishes standards and certification criteria for Electronic Health Record (EHR) technology, supporting incentive programs for EHR adoption. It ensures that EHR systems meet specific standards for functionality, interoperability, and security.	Office of the National Coordinator for Health IT (ONC)	Entities must use EHR technology that meets ONC's certification criteria. They are also required to attest to certain standards of interoperability and information sharing as part of participating in incentive programs.	Non-compliance may not directly lead to penalties but can affect eligibility for federal incentive programs and potentially result in lost incentives.
CMS Regulations	CMS regulations govern the Medicare Promoting Interoperability Programs, setting forth requirements for the use of certified EHR technology. They focus on enhancing care quality and patient safety through the effective use of EHRs, emphasizing interoperability and patient access to health information.	Centers for Medicare & Medicaid Services (CMS)	Providers must attest to using certified EHR technology and comply with specific criteria related to interoperability and patient information access to participate in the Medicare Promoting Interoperability Programs.	Failure to meet these requirements can result in the loss of incentive payments and adjustments to Medicare reimbursements, impacting the financial bottom line of healthcare providers.

Looking Towards the Future

As technology evolves, healthcare entities must remain proactive in their security measures, continually adapting to meet new threats.

Innovative solutions like artificial intelligence for real-time threat detection and blockchain for tamper-proof records hold promise for the future.

However, a focus on fostering a culture of security—with patients, personnel, technology, and regulators working together—remains important.

In the modern healthcare landscape, safeguarding electronic health information isn't just a practical necessity; it's an ethical duty.

By prioritizing education, robust technology, access controls, ongoing training, and strict compliance, the healthcare ecosystem can protect the privacy, integrity, and availability of vital EHR data.