Two months after Congress mandated notification for the breach of unsecured protected health information (PHI), the Secretary of Health and Human Services (HHS) defined what it means to be “unsecured.” As required by Section 13402 of the HITECH Act, H.R. 1, 111th Cong. (1st Sess. 2009) (which was part of the American Recovery and Reinvestment Act of 2009), the Secretary issued guidance and a request for comments on the technologies and methodologies rendering information unusable, unreadable or indecipherable. 74 Fed. Reg. 19006 (Apr. 27, 2009) (to be codified at 45 C.F.R. pts. 160, 164).
As we previously reported, the HITECH Act’s notification requirements for breaches of unsecured PHI apply to entities subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), their business associates, and non-HIPAA covered vendors of personal health records (PHR). To constitute a breach, the acquisition, use, access or disclosure of the PHI must “compromise the security or privacy of such information.” HITECH Act at §13400(1)(A). The newly issued HHS guidance lists technologies and methodologies that secure information, rendering the data unusable, unreadable, or indecipherable. If PHI is secured according to the HHS guidance, unauthorized access to such information will not trigger the HITECH breach notification requirements, although these breaches may still be subject to state law notification requirements.
This HHS guidance also is to be used to render identifiable health information unusable, unreadable, or indecipherable for purposes of the temporary breach notification requirements that apply to vendors of PHRs, the requirements for which are to be administered by the Federal Trade Commission (which in turn issued proposed regulations, on April 16, 2009, addressing consumer notice for breaches of electronic health information by PHRs).
The HHS guidance provides two methods of securing information for the purposes of the HITECH Act: destruction and encryption. Destruction may secure information that was found in either paper format or in electronic media. In order to satisfy the destruction method, the paper or other hard copy media must be shredded or destroyed such that the PHI cannot be read or otherwise reconstructed. Electronic media must be cleared, purged, or destroyed in accordance with the specifications set forth in National Institute of Standards and Technology (NIST) Special Publication 800-88. 74 Fed. Reg. at 19010.
According to the guidance, the effectiveness of encryption depends on the strength of the algorithm and the security of the decryption key or process. PHI is not secure if the decryption key or process has been breached. Encryption only secures PHI if, in accordance with the HIPAA Security Rule, an algorithm “transform[s] data into a form in which there is a low probability of assigning meaning without the use of a confidential process or key.” 45 C.F.R. § 164.304. Accordingly, the HHS guidance only specifies encryption processes that have been tested and approved by NIST. Data at rest, which is filed or stored in a database, should be encrypted according to the processes outlined in NIST Special Publication 800-111, Guide to Storage Encryption Technologies for End User Devices. Encryption processes for data in motion, including that being transmitted or moving through a network, should comply with Federal Information Processing Standards (FIPS) 140-2. Some examples of conforming processes for data in motion are outlined in NIST Special Publications 800-52 (relating to Transport Layer Security (TLS) Implementations); 800-77 (addressing IPsec VPNs); and 800-113 (SSL VPNs), and may include others which are FIPS 140-2 validated.
Since the technologies and methodologies in the guidance are intended to be exhaustive, the Secretary of HHS sought comments regarding additional technologies or methodologies for inclusion in future guidance. HHS also requested comments on various other related issues, including instances when specified technologies and methodologies would fail to secure information, how the federal notice requirements affect existing state law requirements, and whether and how limited data sets (created in accordance with the HIPAA Privacy Rule) could be included in this guidance. This HHS guidance will be closely watched not only as it relates to federal law, but also as to how it informs state law interpretations. Encryption remains undefined under state law, and the HHS guidance provides a potentially important source of interpretation.
This guidance will apply to breaches that occur at least thirty days after publication by HHS of the interim final regulations on breach notification (which have not yet been issued). Any modifications to this guidance based on comments received are expected to be made prior to or concurrent with those regulations.
Proskauer summer associate Katrina McCann contributed to this post.