Tips for protecting computer information
Tips for protecting computer information
To minimize the chance that deleted information can fall into the wrong hands, consider these options:
• Either prohibit the use of file recovery software in your facility or severely restrict it. Consider that type of software very powerful. Since there can be legitimate uses, it might be a good idea to keep the software in your office or the computer manager’s office and then control its use carefully.
• Encrypt confidential files. Encryption is a way to scramble the file in such a way that it cannot be read without a software "key." If the file is encrypted, it cannot be read even if recovered after deletion.
• If you delete confidential information from diskettes, initialize or reformat them. That will effectively erase the deleted files. When discarding diskettes, destroy them by bending or cutting them to make the disk inoperable.
Do not allow used tapes or diskettes to be passed around the facility or placed in a common supply area. Reuse is okay within reason, but allowing them to circulate all over the facility increases the risk that confidential information will be spread far and wide.
• Consider storing confidential files on removable drives and tapes. They can be removed and locked up when not in use by authorized staff.
High-tech tools threaten patients’ confidentiality
Convenience can have a high price
It usually is nice to be complimented on your work, but not if you’re a psychiatrist and a hospital technician praises you for the way you talked a patient out of suicide yesterday. How did the technician know about the patient’s crisis? And how did he know exactly what you said to the patient?
The reason is the psychiatrist’s cell phone. The technician was sitting in the hospital using commonly available equipment to eavesdrop on cell phone calls in the area and heard every word of the confidential conversation.
That situation really happened to a psychiatrist, says Jill Callahan Dennis, JD, RRA, a principal with Health Risk Advantage, a consulting firm in Winfield, IL. Cell phones are just one way high-tech tools can pose unusual threats to patient confidentiality, she says.
"People do listen in to your cell phone calls," she stresses. "It used to be that people just eavesdropped on police radio calls, but now every cell phone in the area is up for grabs."
The risk posed by cell phones can be demonstrated with an inexpensive radio frequency scanner. Paul English Smith, JD, uses one to make the point when he makes presentations on the threats to confidentiality from high-tech devices. Smith is vice president for legal services and risk management at Cabell Huntington (WV) Hospital.
"I pull out the scanner and let people listen to what’s going on around us. I tell them this is how easy it is," Smith says. "We’ve even listened in on an FBI agent using a cell phone to check his confidential voice mail."
Smith points out that the same problem is posed by wireless telephones in the home or office. Smith and the hospital’s medical staff leaders remind physicians that most telephone communications are not secure and discourage them from phoning in dictation.
Dennis acknowledges that cell phones are tremendous aids to busy physicians and other health professionals, but she says risk managers should make them aware of the risks and how best to minimize them. One option is to inform the patient that the call is being placed on a cell phone and offer to call later if the patient wants a higher degree of confidentiality.
"That way the patient has some choice in the matter," Dennis says.
There may be limits to what sort of work should be done on the cell phone, Dennis suggests. Many doctors dictate patient notes, operative reports, and discharge summaries while driving away from the hospital, but she says that may be taking efficiency too far. Complete patient identification and personal information are being broadcast on the airwaves when doctors use cell phones that way.
Dennis discussed the confidentiality hazards of high-tech tools at the recent meeting of the American Society for Healthcare Risk Management in San Francisco.
Many tools useful but threatening to privacy
Cell phones may be the most obvious risk from sophisticated technology, but Dennis explains that there are many more. Some are not so obvious, such as the problem of data remanence. In simple terms, data remanence is the availability of computerized data that you have already deleted.
Computer professionals understand the concept well, but typical computer users usually believe that "deleted" files are gone forever and thus pose no confidentiality risk. In fact, deleted files are still present on the computer disk or tape for some time, usually until the computer needs to overwrite the data because of space needs. Until that time, the data can be retrieved by anyone who knows how.
"There are horror stories out there about people who thought they erased the hard drive, sometimes in anticipation of litigation, and then an investigator comes in and says, No, those files are still there,’" Smith says. "That can be a real shock."
Large mainframe computer systems usually have safeguards against unauthorized access to data remanence, but personal computer systems usually do not. To the contrary, software is easily obtained to find data remnants on personal computer systems. Such software is intended for legitimate use, such as when a needed file is accidentally deleted, but Dennis warns that it easily can be misused.
On the other hand, you also can purchase software that specifically overwrites files that have been deleted. In general however, Smith points out that there are more confidentiality risks than solutions with high-tech resources.
"There is some technology out that can protect computer systems from unauthorized access, but security systems are usually two or three steps behind the people who have learned how to beat the systems," Smith says.
In many ways, computers make unauthorized access to confidential information easier than ever before, he says. When the information existed only on a paper record, a person had to physically get access to the office, get into the file cabinet where it was stored, and then get it out of the office. With computers, access to information can be much more direct and easy. Access can be achieved at one’s leisure, and chances are good that the rightful owner will never know it was accessed.
Smith also points out that skullduggery is not always necessary to breach confidentiality. In many cases, authorized computer users can inadvertently access confidential patient information with a misplaced cursor or accidental keystroke.
Beware of shared hardware
Another problem that can be overlooked is the shared use of computer hardware by several people. A confidentiality breach is simple if data are not protected in some way from the next person who sits down at the keyboard. But because the data can remain even after seemingly being deleted, shared computer hardware poses special problems, Smith notes.
If a computer, or even just the hard drive, is moved from one office to another within your facility because of repairs, upgrades, or expansions, confidential data may go with it.
"Laptops are a great example of how that happens," Smith says. "People share them and there’s no telling what sort of confidential information is still on the computer when someone else takes it."
Many of the same confidentiality breaches can occur with audio and videotapes, Dennis says.
Use caution when sending hardware out for repair, or when it is sold or traded. Remember that simply deleting files does not mean the new owner will not be able to pull up a wealth of confidential information. Take the proper steps to wipe the system clean of confidential files before letting it go.
The proliferation of voice mail also poses a threat to confidentiality. Dennis warns against relying too much on voice mail and answering machines because, as she points out, everyone has gotten a stranger’s message at some point. When using voice mail and answering machines, first double-check the phone number before calling, she suggests.
When leaving a message, Dennis suggests being circumspect and never leaving confidential information on the system. An example might be "This is Dr. Smith’s office with a message for Mr. Jones. Your test results are in. Please call us."
Dennis also warns against careless use of e-mail. Though convenient, e-mail usually does not offer complete privacy. And be sure to practice safe fax. Most health care facilities now employ cover sheets warning that the information is confidential, and many require that the destination fax number be confirmed before they send the document.
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