Corporate custodians of confidential medical data should be closely monitoring events connected to a nightmarish computer security breach in the St. Louis region.

Express Scripts is one of the nation’s largest pharmacy benefits managers. The company, with headquarters in St. Louis County, handles approximately 500 million prescriptions per year for 50 million workers at 1,600 American companies. Early in October, it received an extortion letter, the details of which it released on Nov. 6.

The letter included personal information on about 75 Express Scripts clients — Social Security numbers, dates of birth and, in some cases, information about prescription medications. Whoever sent the letter demanded money from the company — the amount has not been disclosed — and threatened to use the Internet to reveal personal and medical information about millions of people if the demands were not met.

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Beyond the scale of the problem for Express Scripts — and the potential impact on the company is enormous — the issue extends well beyond the mounting concerns about identity theft, a phenomenon with which most people have become at least somewhat familiar.

The greater problem is the unique nature of personal medical records, the importance of moving to computerization of such records to improve health safety and reduce costs and the irreversibility of the damage people can suffer if confidential medical information becomes public. The stakes are so high that a federal law establishes strict standards for maintaining the privacy of medical information and stiff fines for failing to do so.

Medical records of all kinds — paper and, especially, electronic — must be protected with the most sophisticated kinds of security systems available, including backup protections and automatic alerts of security violations. Yet Express Scripts learned of this breach in the “worst way,” as InformationWeek.com security correspondent George Hulme put it in an online report: “via an extortion letter.”

The Express Scripts breach raises many questions for all elements of the health industry: hospitals, clinics and doctors’ practices, benefits management firms, insurance companies, pharmacies, employers and government agencies:
Are they using the most advanced information security technology possible? Do they minimize the amount of data they collect and keep it only as long as necessary? Do they have strict protocols governing access to personal and medical data — and systems to enforce those protocols? If criminals were to hack into their systems, how would the companies know? How soon? And are the systems capable of instantly cutting off illegal access as soon as a breach is discovered?

Confronted with a grave breach of electronic security, Express Scripts has responded by contacting law enforcement, establishing an informational website, offering a substantial reward and hiring a private consulting firm to help clients who have privacy concerns and investigate situations that “appear to be tied to identity theft” and provide “identity restoration services.” There is no question that the company is taking the situation extremely seriously.
Given the ongoing criminal situation, information about how Express Scripts’ data systems were compromised — and whether it could have been avoided — has yet to be disclosed. But the American people have the right to expect that their sensitive personal and medical information is zealously protected and kept secure — not only by Express Scripts but also by every person or company entrusted with it.

"Customers and customer relationships...have tangible measurable value to businesses, and their value is much easier to communicate to those who fund projects. So in an enterprise risk management scenartio, their vlaue informs the risk management process...[For example, consider] a farmer deciding which crop to grow. A farmer interested in short term profits may grow the same high yield crop every year, but over time this would burn the fields out. The long term focused farmer would rotate the crops and invest in things that build the value of the farm and soil over time. Investing in security on behalf of your customers is like this. The investment made in securing your customer's data build current and future value for them. Measuring the value of the customer and relationships helps to target where to allocate security resources."

He makes the argument that the Digital Theft Deterrence and Copyright Damages Improvement Act of 1999 is very much unconstitutional, in that its hefty fines for copyright infringement (misleadingly called "theft" in the title of the bill) show that the bill is effectively a criminal statute, yet for a civil crime. That's because it really focuses on punitive damages, rather than making private parties whole again. Even worse, it puts the act of enforcing the criminal statute in the hands of a private body (the RIAA) who uses it for profit motive in being able to get hefty fines.

Imagine a statute which, in the name of deterrence, provides for a $750 fine for each mile-per-hour that a driver exceeds the speed limit, with the fine escalating to $150,000 per mile over the limit if the driver knew he or she was speeding. Imagine that the fines are not publicized, and most drivers do not know they exist. Imagine that enforcement of the fines is put in the hands of a private, self-interested police force, that has no political accountability, that can pursue any defendant it chooses at its own whim, that can accept or reject payoffs in exchange for not prosecuting the tickets, and that pockets for itself all payoffs and fines. Imagine that a significant percentage of these fines were never contested, regardless of whether they had merit, because the individuals being fined have limited financial resources and little idea of whether they can prevail in front of an objective judicial body.

Another news story.

"The rigorous studies clearly show red-light cameras don't work," said lead author Barbara Langland-Orban, professor and chair of health policy and management at the USF College of Public Health. "Instead, they increase crashes and injuries as drivers attempt to abruptly stop at camera intersections."

Comprehensive studies from North Carolina, Virginia, and Ontario have all reported cameras are associated with increases in crashes. The study by the Virginia Transportation Research Council also found that cameras were linked to increased crash costs. The only studies that conclude cameras reduced crashes or injuries contained "major research design flaws," such as incomplete data or inadequate analyses, and were always conducted by researchers with links to the Insurance Institute for Highway Safety. The IIHS, funded by automobile insurance companies, is the leading advocate for red-light cameras since insurance companies can profit from red-light cameras by way of higher premiums due to increased crashes and citations.

And, of course, the agenda of the government is to increase revenue due to fines:

A 2001 paper by the Office of the Majority Leader of the U.S. House of Representatives reported that red-light cameras are "a hidden tax levied on motorists." The report came to the same conclusions that all of the other valid studies have, that red-light cameras are associated with increased crashes and that the timings at yellow lights are often set too short to increase tickets for red-light running. That's right, the state actually tampers with the yellow light settings to make them shorter, and more likely to turn red as you're driving through them.

In fact, six U.S. cities have been found guilty of shortening the yellow light cycles below what is allowed by law on intersections equipped with cameras meant to catch red-light runners. Those local governments have completely ignored the safety benefit of increasing the yellow light time and decided to install red-light cameras, shorten the yellow light duration, and collect the profits instead.

The cities in question include Union City, CA, Dallas and Lubbock, TX, Nashville and Chattanooga, TN, and Springfield, MO, according to Motorists.org, which collected information from reports from around the country.

One of the things that I have always not understood about HIPAA is what teeth do these regulations have and who is going to enforce them.  There are plenty of firms willing to take your money and rubber stamp you HIPAA compliant, but who is going to say your not HIPAA compliant and why should you care. Finally reading this article in Security Bytes it looks like the federal government has stepped up to enforce HIPAA and have put some bite behind the bark. Providence Health in Seattle was fined 100k by US Department of Heath and Human Services for losing data containing patients information. 

I say good for the HHS!  A few well publicized fines where people had to pay real money will go further in getting people to take HIPAA seriously than all of the other dog barking and warnings that have taken place to date.  The same goes for other regulations and statues on compliance as well.  Lets hear about some financial sanctions or penalties around PCI and you will see a drastic rise in compliance there as well.  Rules and regulations without enforcement serve no purpose at all and hurt more than they help.

One of the things that I have always not understood about HIPAA is what teeth do these regulations have and who is going to enforce them.  There are plenty of firms willing to take your money and rubber stamp you HIPAA compliant, but who is going to say your not HIPAA compliant and why should you care. Finally reading this article in Security Bytes it looks like the federal government has stepped up to enforce HIPAA and have put some bite behind the bark. Providence Health in Seattle was fined 100k by US Department of Heath and Human Services for losing data containing patients information. 

I say good for the HHS!  A few well publicized fines where people had to pay real money will go further in getting people to take HIPAA seriously than all of the other dog barking and warnings that have taken place to date.  The same goes for other regulations and statues on compliance as well.  Lets hear about some financial sanctions or penalties around PCI and you will see a drastic rise in compliance there as well.  Rules and regulations without enforcement serve no purpose at all and hurt more than they help.