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The term “cloud computing,”  — a process by which remote computers are used to store, manage and process data — is no longer an unfamiliar term. According to at least one estimate, “approximately 90 percent of businesses using the cloud in some fashion.” American Airlines is assessing major providers of cloud services for an eventual relocation of certain portions of its customer website and other applications to the cloud.

What some may not realize is that there are actually three main types of clouds: public, private and hybrid.  Public clouds are those run by a service provider, over a public network.  For example, Amazon Web Services offers public cloud services, among others.  A private cloud is operated for a single entity, and may be hosted internally or by a third-party service provider.  A hybrid cloud is a composition of two or more clouds, such as a private cloud and a public cloud, such that the benefits of both can be realized where appropriate.  Each of these cloud infrastructure types has different advantages and disadvantages.

For a given company looking to migrate to the cloud, the appropriate option will be motivated in part by business considerations; however, data privacy and security laws, compliance best practices, and contractual obligations will provide mandatory baselines that companies cannot ignore. As such, relevant laws, best practices, and contractual obligations serve as a useful starting point when evaluating the appropriate cloud option.

Most every organization has data flow systems that receive data, and then process and use the data to deliver a service. Below are three initial steps a decision maker should take when evaluating a potential cloud infrastructure choice.


First, consider the statutory implications of the types of data being processed

For example, is the system collecting social security numbers and driver’s license numbers? Pursuant to California Civil Code Section 1798.81.5, businesses that “own or license” personal information concerning a California resident are required to “implement and maintain reasonable security procedures and practices . . . to protect the personal information from unauthorized access, destruction, use modification, or disclosure.”  Of course, many other state and federal laws may also provide additional obligations, such as the HIPAA Security Rule, which applies to certain health information under certain circumstances.

Deciding which relevant laws apply, and then interpreting language such as “reasonable security procedures and practices” is a complicated process. Companies should consult experienced legal counsel regarding these risks, especially in light of potential liability.

Second, consider any relevant contractual obligations

For example, many companies may have contracts that provide for certain service level availability (SLA) obligations for services they provide. It is also possible that these contracts could have their own security requirements in place that must be met.

Third, decide which cloud architecture option makes sense in light of the first two steps as well as business considerations

After senior decision makers, with the benefit of experienced legal counsel, have decided what elements of applicable laws, best practices, and contractual obligations apply, further business considerations may need to be addressed from an operational standpoint.  For example, interoperability with other services may be an issue, or scalability may be an issue.


Through these requirements, in conjunction with appropriate information technology stakeholders, the appropriate cloud architecture can be chosen. Private clouds can offer the strongest security controls, as they are operated by a single entity and can offer security options not present in public clouds.  As such, a private cloud may be appropriate where a very strong security stance is deemed necessary.  Public clouds are often less expensive, but offer a more limited range of security options.  A hybrid cloud may be appropriate where an entity hosts certain high security data flow systems, as well as other systems with less sever security requirements.  For example an entity that has an HR system that contains social security numbers, as well as an employee shift scheduling system might choose to host the HR system on a private cloud, while hosting the customer feedback system on a public cloud system, with limited cross over and interoperability between the two systems.

Once you have chosen which cloud suits your business and data flow, the real work of getting appropriate contract documents in place begins.   We’ll discuss those issues in a future blog post.



Two recent data breach incidents in the healthcare industry prove what readers of this blog have heard all too often:  KNOW THY VENDORS.

Last week, Phoenix-based Banner Health reported one of the year’s largest data breaches.  Banner reported that it had suffered a massive cyberattack potentially affecting the information of 3.7 million patients, health plan members and beneficiaries, providers.   This attack is notable for all companies and not just healthcare providers covered by HIPAA.   Reportedly, the attack occurred through the computer systems that process food and beverage purchases in the Banner system.  In the incident, according to reports, the hackers gained access to the larger systems through the point-of-sale computer system that processes food and beverage purchases.  The attack was discovered on July 13, and Banner believes hackers originally gained access on June 17. Continue Reading To Protect Data: Keep Your Network Access Close, and Your Vendors Closer

The U.S. Department of Health and Human Services Office for Civil Rights (OCR)  recently issued a warning regarding vulnerabilities in third-party applications used by entities covered by HIPAA.  The OCR warning applies generally to HIPAA Covered Entities and Business Associates.  While Covered Entities and Business Associates are more cognizant of vulnerabilities in operating systems (like Windows) and install updates and patches as needed (we hope), OCR reported that companies are less likely to do the same for third-party applications (like Adobe’s Acrobat or others). Continue Reading OCR Warns of HIPAA Risks in Third-Party Apps

The number one threat to a company’s information (personal or confidential) is still its own employees. Data security and privacy training are the first lines of defense against negligent employee behavior.

Join us tomorrow (6.22) at 1 PM ET for a webinar in which we will explore why traditional training programs are falling short and what you can do to boost your efforts and counter top concerns regarding malicious and negligent employee handling of personal and confidential data.

Register here.

CLE credit available in NY and CA

Last week, the Federal Trade Commission (FTC) announced (press release) that Practice Fusion, the largest cloud-based electronic health company in the United States, has agreed to settle FTC charges over deceptive practices involving the public disclosure of healthcare provider review information collected from consumers that included sensitive personal and medical information. Below is our review of the circumstances of the basis of the FTC complaint, a summary of the terms of the settlement, and a few pointers on how to avoid a similar situation.    There are many lessons to be learned from this FTC complaint for all online providers, not only EHR providers.   Read on ….. Continue Reading Practice Fusion and FTC Settle Complaint Over Deceptive Statements About the Privacy of Consumer-Generated Online Content

At long last, the Department of Health and Human Services Office for Civil Rights (OCR) has released a revamped audit protocol that now addresses the requirements of the 2013 Omnibus Final Rule. OCR will be using the audit protocol for its impending Phase 2 audits of covered entities and business associates, which are set to begin next month.

The protocol covers the following subject areas:

  • Privacy Rule requirements for (1) notice of privacy practices for PHI, (2) rights to request privacy protection for PHI, (3) access of individuals to PHI, (4) administrative requirements, (5) uses and disclosures of PHI, (6) amendment of PHI, and (7) accounting of disclosures.
  • Security Rule requirements for administrative, physical, and technical safeguards.
  • Breach Notification Rule requirements.

OCR has also released other materials that shed light on the logistics of the audit process, including a copy of the Audit Pre-Screening Questionnaire that it will use to collect demographic information about covered entities and business associates. OCR will use this information to create a pool of potential auditees.

Entities selected for audit will be required by OCR to identify and provide detailed information regarding their business associates.  The information collected by OCR will be used to help identify business associates for the Phase 2 audits. OCR has released a template with the information that covered entities will have to provide, including the business associate’s name, contact information, type of services, and website.

Covered entities and business associates should be working to ensure that they have the required compliance documents and materials ready, especially given OCR’s aggressive timetable: if selected for an audit, an auditee will have only 10 days to respond to OCR.

As we have discussed previously on this blog, the audit protocol is an excellent HIPAA compliance tool, especially for audit readiness assessment.  Unfortunately, the version of the tool on the OCR website can be unwieldy to use in practice.   In order to assist covered entities and business associates with their HIPAA compliance efforts, we have repackaged the audit protocol into a more user-friendly format that can be downloaded here.


Originally posted to Mintz Levin’s Health Law & Policy Matters Blog on 4/20/16

The HHS Office for Civil Rights (“OCR”) officially launched  the long-awaited (and dreaded) Phase 2 of the HIPAA Audits Program on March 21st. Covered Entities and Business Associates need to be prepared for these audits and be on the lookout for emails (check your spam filter!) from OCR that will begin the audit process.

Why Audits? Why Now?

The Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH Act”) requires OCR to periodically audit both Covered Entities and Business Associates for compliance with the HIPAA Privacy, Security, and Breach Notification Rules. OCR conducted Phase 1 audits in 2011 and 2012. The Phase 1 audits only examined Covered Entities and the results were generally disappointing. Only 11% of the entities audited had no findings or observations and many findings related to Security Rule compliance. After many delays, OCR is now proceeding with Phase 2. Continue Reading Phase 2 HIPAA Audits Coming to You: Check Your Spam Filter!

21st Century Oncology Holdings, a company that operates a chain of 181 cancer treatment centers in the US and Latin America, announced on Friday March 4 that it was latest victim of a cyber-attack affecting 2.2 million individuals. When did the attack occur? Months ago.   Read on for the gory details….. Continue Reading Not again …. yet another health care data breach

In a chain of events that should be a wake-up call to any entity using and storing critical health information (and indeed, ANY kind of critical information), Hollywood Presbyterian Medical Center (“HPMC”) has announced that it paid hackers $17,000 to end a ransomware attack on the hospital’s computer systems. On February 5, HPMC fell victim to an attack that locked access to the medical center’s electronic medical record (“EMR”) system and blocked the electronic exchange of patient information. Earlier reports indicated that the hackers had originally demanded $3,400,000.Such “ransomware” attacks are caused by computer viruses that wall off or encrypt data to prevent user access. Hackers hold the data ransom, demanding payment for the decryption key necessary to unlock the data. The attacks are often caused by email phishing scams. The scams may be random or target particular businesses or entities. In the case of HPMC, the medical center’s president and CEO indicated to media outlets that the attack was random, though Brian Barrett, writing for Wiredquestioned that assertion.The medical center’s announcement of the resolution of the incident indicates that there is no evidence that patient or employee information was accessed by the hackers as part of the attack. Even if the data was not compromised, the attack led to enormous hassles at the hospital, returning it to a pre-electronic record-keeping system.

We have seen many variations of the ransomware attacks on the increase lately.   Cryptolocker and Cryptowall are the two most prevalent threats, but a Forbes article about the HPMC attack revealed that HPMC was victimized by a variant called “Locky,” which, according to the Forbes article, is infecting about 90,000 machines a day.

Details of the HPMC Incident

On February 2, 2016, three days before the HPMC attack, the Department of Health & Human Services Office for Civil Rights (“OCR”) announced the launch of its new Cyber-Awareness Initiative. That announcement included information on ransomware attacks and prevention strategies. Suggested prevention strategies from OCR included:

  1. Backing up data onto segmented networks or external devices and making sure backups are current.  That protects you from data loss of any kind, whether caused by ransomware, flood, fire, loss, etc.  If your system is adequately backed up, you may not need to pay ransom to get your data unlocked.
  2. Don’t be the low-hanging fruit:  Ensuring software patches and anti-virus are current and updated will certainly help.   Many attacks rely on exploiting security bugs that already have available fixes.
  3. Installing pop-up blockers and ad-blocking software.
  4. Implementing browser filters and smart email practices.

Most of these prevention strategies are HIPAA security and overall general business security measures that ought to be in place for companies across the board. As OCR and the FBI (see below) both indicate, smart email practices and training the workforce on them are key elements to preventing phishing scams.  If you are a HIPAA-covered entity, you should be checking in with Mintz’s Health Law & Policy Matters blog on a regular basis.

FBI on Ransomwaredigitallife03-111715

One of the big questions arising out of the HPMC and other ransomware cases is:  do we pay?   If your business is about to grind to a halt, you likely have no choice.    However, the incident should first be reported to the FBI and discussed with forensics and legal experts who have experience with ransomware in particular.    The FBI’s Ransomware information page provides some tips.  Ransomware attacks should be part of your incident response plan and the “what do we do” should be discussed at the highest levels of the company.

When in Doubt, Don’t Be a Click Monkey!

Before clicking on a link in an email or opening an attachment, consider contextual clues in the email. The following types of messages should be considered suspicious:

  • A shipping confirmation that does not appear to be related to a package you have actually sent or expect to receive.
  • A message about a sensitive topic (e.g., taxes, bank accounts, other websites with log-in information) that has multiple parties in the To: or cc: line.
  • A bank with whom you do not do business asking you to reset your password.CodeMonkey-68762_960x3601
  • A message with an attachment but no text in the body.

All businesses in any sector need to take notice of the HPMC attack and take steps to ensure that they are not the next hostages in a ransomware scheme.