Preventing Email-Based Data Leakage in Healthcare

Brien Posey, Freelance Writer and Former CIO | 9/26/2013 | 29 comments

Brien Posey
Because email is one of the most common ways data is transmitted, it is also one of the easiest ways for sensitive data, like patient data and other confidential records, to be leaked. These leaks put you in danger of major fines from HIPAA violations.

HIPAA regulation 164.312 (e) (1) states:

Standard Transmission Security. Implement technical security measures to guard against unauthorized access to electronic-protected health information that is being transmitted over an electronic communications network.

Although this particular requirement seems really simple, there are many different ways in which it could be (and has been) interpreted. On the surface the requirement seems to point to the need to use mechanisms such as encryption and authorization any time that patient health data is being transmitted from one person to another.

Another way of looking at this requirement however, is that the regulation requires you to take measures to prevent patient health data from being transmitted in an unsecure manner or to an unauthorized recipient. In other words, it is prudent for a covered entity to take steps to make sure that patient health data is not sent by email (unless a long list of very specific requirements are met).

One way of helping to make sure that patient health data is not sent by email is to take advantage of the Microsoft Exchange Server 2013 Data Loss Prevention feature. This feature is designed to look at outbound email to see if it contains any sensitive data that should not be emailed.

The Data Loss Prevention feature is based around the use of Data Loss Prevention policies (which can be created through the Exchange Administrative Center). These policies are really nothing more than just a collection of transport rules. Although transport rules have existed since the days of Exchange Server 2007, Microsoft has enhanced the available transport rules so that they are better equipped to handle the task of data loss prevention.

First generation transport rules were designed primarily to perform light weight compliance tasks, such as appending a disclaimer to the end of outbound email messages. Exchange Server 2013 is still able to perform these types of tasks, but the transport rules engine is far more dynamic than previous editions. For example, it is now possible to count the number of times that a particular item occurs within an email message and then take action only if a certain threshold is crossed.

Exchange Server 2013's new detection capabilities are nice, but by themselves they do very little to help an organization to protect itself against the leakage of electronic-protected health data. You must actually create and enforce rules that are designed to trap unauthorized email messages. This is where the Data Loss Prevention feature really shines.

The thing that makes the Data Loss Prevention feature different from a basic transport rule repository is that Microsoft makes it possible to build a Data Loss Prevention policy from a template. There are a number of different templates that are baked into Exchange Server 2013, including a HIPAA template (it's the US Health Insurance Act template).

When you create a DLP policy based on the HIPAA template, the policy will include about half a dozen predefined rules (you are also free to create your own). Some of these rules refer to the message content. For example, there is a rule that takes action if the message contains a social security number or a Drug Enforcement Agency number.

Other rules are geared toward deep scanning email attachments. In essence if a message contains an attachment that cannot be fully processed (such as might be the case for an unknown attachment type) then the policy can take action on the message.

The Exchange Data Loss Prevention feature can go a long way toward preventing the leakage of electronic-protected health data. However, most organizations will need to customize the rules used by a DLP policy based on the HIPAA template.

And, of course, none of this supplants the value of good security training for your staff, common sense policies, and physical security of workstations and mobile devices. But when one of these policies fail (and we know they do, especially those involving the human element) you might be able to stop (or contain) a breach through use of Data Loss Prevention.

View Comments: Newest First | Oldest First | Threaded View
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Marif   Preventing Email-Based Data Leakage in Healthcare   10/1/2013 5:27:58 AM
Re: Preventing Email based Data leakage in healthcare
@sara: having too much expectations in terms of security from a clinic or an underfunded hospitals is not fair. Such security will not only require a major implementation of security controls but also a team would be needed to monitor controls, manage the frequent upgrades and make themselves secure with all new vulnerabilities that are adding up everyday. That is a too much to ask from a modest self employed person or a small scale hospital.
mejiac   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 12:32:24 PM
Re: Liability and Compensation

Well...I'm personally using two with a physical eToken, and another using the same token, but via a smartphone app.

The smarphone version is definitly more cost effective, but the user is tied to always having the phone available (so if you lose your phone, you lose your access).

I think this really depends on what type of infrastructure set up the company has. If it's something that can easilly be implemented with minimal investement, than it's worth pursuing. But if it entails significant investment, I think that's where IT departments will need to think on ways to better monitor and have better security layers established.
kicheko   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 11:30:04 AM
Re: Liability and Compensation
Sara, - Indeed strictly speaking, "security by obscurity" is not a highly regarded security strategy. At least like in cryptography for example, the rule is that you don't make a cipher secure by hiding the cryptosystem. Only the key is kept secret. However in this case of mass client data i'll use the phrase loosely. To mean that by default i am obscure if i am standing inside a crowd of 1000 people. Until i do something outstanding, or until someone calls me out.
SunitaT   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 11:07:39 AM
Re : Preventing Email-Based Data Leakage in Healthcare
Healthcare security is tough to achieve, even by DLP standards. Most healthcare management systems have easily accessible servers (or none at all) from which data can be downloaded. Anybody with a brain can use the date for a particular patient and cause harm to him/her. DLP, following the policies, (try as it may) cannot fully be incorporated into the hospital management systems, plainly for the reasons that the information transfer architechture (i.e. how information is sent) of the hospitals need a makeover.
Sara Peters   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 9:49:37 AM
Re: Liability and Compensation
@kicheko  There's always been a debate in the security community about the effectiveness of security through obscurity. It often comes up when discussing the relative benefits of open source.
Sara Peters   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 9:40:11 AM
Re: Preventing Email based Data leakage in healthcare
@Marif  That's a great point. I hadn't even thought about the possibility that this could be cheaper (at least in the long run) for the small, underfunded hospitals.
Marif   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 9:29:48 AM
Re: Preventing Email based Data leakage in healthcare
@sara: if the health care can be considered as another industry where information security matters than such controls should also be implemented similar to the one in a financial organization. But it doesn't seem that small clinics or hospitals can invest so much in their security. So as you suggested, it would be better for them to have their data at a central repository where the only thing the individuals will have to care about is secure communication and multi-factor authentication and data encryption would serve the purpose.
kicheko   Preventing Email-Based Data Leakage in Healthcare   9/30/2013 5:35:22 AM
Re: Liability and Compensation
Sara, - Seems real privacy here will only come from the obscurity of our data existing within a larger flood of data. But indeed preventing email-based leakage is important because then if a small section of data leaks, that obscurity of being part of the flood is lost.
Sara Peters   Preventing Email-Based Data Leakage in Healthcare   9/29/2013 5:05:43 PM
Re: Preventing Email based Data leakage in healthcare
@tekedge  Well as you say, "Email is a powerful tool and it is the easiest way to get the information across to people," but that's one of the reasons that I really wish that health information exchange systems would catch on. If I and all my different doctors were able to share data in some central place -- and if that place were highly, highly secured with great multi-factor authentication -- then it would largely eliminate the need/temptation to use email for exchanging health info.

Sara Peters   Preventing Email-Based Data Leakage in Healthcare   9/29/2013 5:00:24 PM
Re: Liability and Compensation
@kicheko  I go back and forth and up and down with it, but generally speaking I now feel the same way you do:  "In a recent visit to hospital, i had to hand my prescription over to several people as part of the normal procedure. In the end its like , why fight for email privacy of stuff that a thousand people read as part of their i just loosen up and let it be." When it comes to healthcare I just want the medical professionals to know what they need to know to help me.

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