Security is a growing issue as more medical practices offer patients online access to their own health records.
The push to move the health care sector toward electronic records includes a requirement that patients be able to access, download and share their health information on an ongoing basis to help coordinate and manage care. This is a condition of stage two of the "meaningful use" regime that delineates the access providers have to federal funding to underwrite the transition to electronic health records, and ultimately will factor into reimbursement by Medicare, Medicaid and other programs.
For providers, a big issue is how to give their patients secure access to records. Health records are arguably far more sensitive than financial information, because a financial breach can be repaired with new credit card numbers or bank information, and because consumers are ultimately made whole for lost funds. But once you've lost your health record, that's it: your information is in the hands of a third party, and there's no way to undo it. This becomes increasingly important as genomic information, mental health records, and other highly sensitive data becomes a regular part of an integrated online electronic health record.
This raises the issue of how patient access to health records should be governed. Issuing physical credentials can be expensive and unwieldy. But relying on conventional username-password access gives rise to problems as well.
"Passwords are a disaster," said Jeremy Grant, senior executive advisor for identity management at the National Institute of Standards and Technology and the head of the National Strategy for Trusted Identities in Cyberspace (NSTIC). "With health care especially, we want to make sure you are who you say you are," he said.
The solution for feds -- embedded personal identity verification chips in identification badges -- is not likely to work with the general population because of the considerable expense and inconvenience. "PIV is not the solution in the consumer space. If it was, we'd see everyone carrying one," Grant said.
NSTIC funds pilot projects with an eye to seeding the market with solutions to the password problem. One such pilot program, funded with $2.6 million in NSTIC grants since 2012, is set to launch to users of the Inova health care system in Northern Virginia. By the end of July 2014, a group of Inova patients will have the option of reconfiguring their access to electronic health records using a combination of verified credentials.
The Cross Sector Digital Identity Initiative (CSDII) brings together data from name brand online services like Microsoft, Google, LinkedIn, Facebook and others, information from state motor vehicle departments, and commercial databases, and validates user identity using voice matching. For example, an Inova user can sign up with a Gmail account and driver's license information. The Gmail account is confirmed with a ping to Google, and the driver's license information is validated against patient information, and other third-party data. Once that is done, a patient is contacted by phone to confirm the account. Subsequent access to the health record is maintained on a two-factor authentication basis – a user signs in and then has to respond to a phone call to guarantee they have custody of the phone number on their account.
"Once somebody comes through with one combination of credentials that bind them to their EHR, then it's going to be really difficult if not impossible for another individual to recreate that exact chain," said Michael Farnsworth, an identity management specialist who is leading the pilot.
The American Association of Motor Vehicle Administrators is the grantee on the project, and it is being launched in collaboration with the Virginia DMV, along with Microsoft, CA Technologies and Biometric Signature ID. Farnsworth, a 15-year veteran of the Virginia DMV, left the state workforce to manage the project through Binary Structures Corporation.
"Folks look at DMVs as a very valid identity-vetting source," Farnsworth said.
The pilot had to deal with a slew of privacy and regulatory issues. The system's encryption makes sure that the companies that supply the third-party credentials – the email providers and social networks – don't track patient activity inside their health record. There are knotty compliance issues with Health Insurance Portability and Accountability Act and Fair Credit Reporting Act restrictions, as well.
After patient access, the next use case for the CSDII pilot will involve outside providers who need access to patient records. If the project goes well, the CSDII will be poised for wider implementation. Farnsworth said that so far about two dozen companies across different sectors are interested in implementing the identity management system.
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