Telecommuting under scrutiny

To comply with government regulations, health care organizations aren't just overhauling their operations. They're also reviewing their telecommuting policies.

The privacy rules of the Health Insurance Portability and Accountability Act, with which health care organizations must comply by April 2003, states that unauthorized persons can't have access to private medical data. That has prompted several health organizations to review their telecommuting policies to prevent off-site privacy breaches.

"At work, you can make sure people don't enter a facility unless they're authorized, but at home, it's different," said Jim Hudack, CEO of UnitedHealth Group Inc.'s technologies division in Minnetonka, Minn.

Although Hudack doesn't think HIPAA will force UnitedHealth to ban telecommuting altogether, he said the company has to "be careful about what we let people work on at home."

For instance, if an employee was telecommuting and his son walked into the room and saw confidential patient information, that would violate the privacy rule.

Health care organizations also need to consider whether telecommuters are downloading patient information from the network and storing it on their home computer hard drives, said James Harvey, an attorney at Alston & Bird LLP in Atlanta who specializes in privacy issues. If so, organizations need to extend security rules to home computers, he said.

"It's much easier to address security issues in a centralized mainframe environment than on a distributed basis," he said.

HIPAA includes measures for both the security and privacy of patient information. Penalties for breaches include severe fines and possible jail time. To avoid these consequences, many health care organizations said they will ramp up security measures to protect applications on home devices, such as using virtual private networks, encryption or public-key infrastructure.

To comply with the final HIPAA security rules, health care managers will have to authenticate who is accessing the data, said Patrick Grotton, CIO at Mercy Hospital in Portland, Maine.

Grotton said he's considering using a biometric device, such as an eye or fingerprint scanner, combined with various layers of password protection to ensure that unauthorized individuals can't access patient information.

But to a large extent, privacy measures will involve educating and training telecommuters and enforcing policies. Some health care IT managers said telecommuters who work in a home office rather than at a computer set up in the living room or bedroom are less likely to invite prying eyes.

Employees at Cook County Hospital in Chicago, including systems employees who access information from home, must sign a patient confidentiality agreement prior to employment, said Soloman Appavu, director of systems planning. But in order to comply with HIPAA, the hospital will also implement strict disciplinary procedures for any confidentiality breaches, he said.

To a certain extent, however, hospitals may have difficulty ensuring that telecommuters are keeping data private, said Appavu.

"If the person is not honest, then you're taking a risk," he said. It may be "beyond that person's control to secure a device."

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