Unprotected data

One warm night in mid-July, more than 4 million patient records breezed out the door of the Advocate Medical Group administrative office in the arms of an unidentified thief who stole four computers from the largest medical group in Illinois. The 1,100-physician medical group based in Park Ridge is part of the 10-hospital Advocate Health Care system.

Those records were kept on four stolen computers that were not protected by encryption. If a summary of that event gets posted to the “wall of shame” website kept by the Office for Civil Rights at HHS, which most likely it will, it will rank as the largest breach of federally protected records by a healthcare provider on that list.

Penalties in the form of settlement agreements for breaches of this magnitude in recent years have run to $1 million or more.

“It's a huge breach,” said Tom Walsh, principal of Tom Walsh Consulting, Overland Park, Kan.

This is likely to be the second trip to the OCR wall for Advocate. The theft of a laptop in November 2009 also made the list because it, too, was unencrypted. The stolen laptop carried the medical records of 812 individuals.

In an Aug. 23 statement, Advocate announced the breach, adding that it had sent letters to the affected patients and had offered them one year of credit monitoring. Advocate also said it had “reinforced our security protocols and encryption program with associates.” An Advocate spokeswoman said an encryption program launched by the organization in 2009 had not reached the four computers in the Park Ridge office.

Susan McAndrew, deputy director for health information privacy at the Office for Civil Rights, confirmed the agency had received a breach report from Advocate and has referred it to its regional office in Chicago for investigation.

Maura Possley, spokeswoman for Illinois Attorney General Lisa Madigan, said her office is also investigating the Advocate breach incident for potential violations under the Health Insurance Portability and Accountability Act and the Illinois Consumer Fraud and Deceptive Business Practices Act.

The costs to Advocate of this latest breach are likely to be substantial.

“You can imagine the extent of the forensic analysis to uncover what was on those hard drives,” said Kelly Jo Golson, senior vice president and chief marketing officer for Advocate Health Care, based in Downers Grove, Ill. “To the best of our knowledge, this data goes back to the early 1990s.”

“We established the call center, we set up the website,” Golson said. Advocate also sent out more than 4 million letters to affected patients and even hired 24/7 security guard coverage at its Park Ridge administrative office and is reviewing the need for physical security throughout the organization.

Golson said Advocate hasn't tallied up the costs of the breach. “At some point, we'll look at the financial implications, but we're not there yet.”

So far, there has been no recovery of the computers or an arrest.

Golson said Advocate embarked on a program of encrypting its computers in 2009, the year the laptop went missing. The initial target was to encrypt “all new laptops and all old ones that were able to be encrypted.”

Golson said she didn't know the number of computers Advocate uses at its more than 250 care sites.

Golson said the data types in the stolen records varied. Some included Social Security numbers or medical record numbers, while others did not. The data were used for primarily operational and administrative purposes such as appointment scheduling, benefits verification, coordination of care and patient registration.

Those data elements, while limited, still would be sufficient for medical identity theft, said Pam Dixon, founder and executive director of the World Privacy Forum.

In two online public statements, Advocate said the breach involved “no patient medical records” and it “has no impact on patient care.”

“We are certainly not trying to state that this information couldn't be used inappropriately,” Golson said.

“We just wanted to assure folks it wasn't the level of information that's included in a full medical record. We understand why our patients are concerned. We deeply regret this,” she said.

According to Walsh, given the risk of storing data without encryption and the relatively low cost to encrypt—about $55 per computer—it's hard to accept the lack of encryption.

Since 2005, data handlers have been required to be in compliance with HIPAA's security standards, he said.

Only 64% of healthcare organizations—both hospitals and office-based physician practices—use encryption when they transmit healthcare information, according to a survey conducted in 2012 by the Healthcare Information and Management Systems Society, said Lisa Gallagher, vice president of technology solutions for HIMSS.

For a big group such as Advocate, “I just can't understand how an organization could have allowed that to occur,” Walsh said. “They should have identified this through their risk analysis years ago, and it should have been remediated.”

Follow Joseph Conn on Twitter: @MHJConn