Common standards urged for public, private data exchanges

Secure and private exchange of patient medical data between federal government agencies and the private sector would be easier if there were common expectations about the security standards to be involved, a federal health information technology security official said today.

The Veterans Affairs Department’s private and secure exchange of medical data with the private sector is being accomplished through a set of agreements and standards, Gail Belles, health care security director for the Veterans Health Administration, said today in an online seminar sponsored by Federal Computer Week.

In a demonstration project in San Diego, veterans’ health information is being shared with Kaiser Permanente for the purpose of improving patient care. The data exchange is occurring on the federal Nationwide Health Information Network (NHIN), which is a set of agreements and standards governing the exchanges.

The Defense Department is set to join the project next.

If such exchanges are to flourish, it would be advantageous for federal agencies to agree on common security standards, according to Belles said.

“Federal agencies currently have different expectations for ‘appropriate security’ of non-federal interfaces,” Belles said . “This creates complexity and burden for non-federal entities that with to exchange information with multiple federal agencies.

“Longer-term, there is a need for a consistent nationwide information security posture for electronic health information exchange between federal and non-federal entities,” Belles said.

In the VA’s project, Kaiser and the VA must adhere to the Health and Human Services Department's Data Use and Reciprocal Support Agreement for connection to the NHIN and must follow applicable security and privacy laws. For the VA, that would include compliance with the Federal Information Security Management Act while, for Kaiser, it would include compliance with the Health Insurance Portability and Accountability Act, among other laws, Belles said.

Overall, federal-private health information exchange must operate within a framework of at least four major federal laws, two presidential directives, dozens of federal technical standards, hundreds of security standards, state laws and evolving privacy demands from patients, Belles said.

Standards are applied in access controls, identity management, management of patient preferences and consent, audits and security assurance and interoperability.

The standards may vary depending on the purpose of the exchange, whether for treatment or marketing, for example, and also depending on the providers involved, by the type of information, and by the sensitivity of the information., Belles said. This adds complexity to the security picture.

Steve Lubniewski, vice president of Lockheed Martin Health Solutions, said in the seminar that there are gaps in managing patient consents and in the hand-offs of data between federal and commercial entities.

“Third-party security will be the key for health exchange,” agreed Khalid Kark, security analyst for Forrester Research.