In the United States, sensitive health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). This act limits the disclosure of Protected Health Information (PHI) without the patient’s consent or knowledge. However, as medical care becomes web-integrated, many providers have chosen to use third-party web trackers for measurement and marketing purposes. This presents a security concern: third-party JavaScript requested by an online healthcare system can read the website’s contents, and ensuring PHI is not unintentionally or maliciously leaked becomes difficult. In this paper, we investigate health information breaches in online medical records, focusing on 459 online patient portals and 4 telehealth websites.
We find 14% of patient portals include Google Analytics, which reveals (at a minimum) the fact that the user visited the health provider website, while 5 portals and 4 telehealth websites con- tained JavaScript-based services disclosing PHI, including medications and lab results, to third parties. The most significant PHI breaches were on behalf of Google and Facebook trackers. In the latter case, an estimated 4.5 million site visitors per month were potentially exposed to leaks of personal information (names, phone numbers) and medical information (test results, medications). We notified healthcare providers of the PHI breaches and found only 15.7% took action to correct leaks. Healthcare operators lacked the technical expertise to identify PHI breaches caused by third-party trackers. After notifying Epic, a healthcare portal vendor, of the PHI leaks, we received a prompt response and observed extensive mitigation across providers, suggesting vendor notification is an effective intervention against PHI disclosures.
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An Activity Theory Approach to Leak Detection and Mitigation in Patient Health Information (PHI)
The migration to electronic health records (EHR) in the healthcare industry has raised issues with respect to security and privacy. One issue that has become a concern for healthcare providers, insurance companies, and pharmacies is patient health information (PHI) leaks because PHI leaks can lead to violation of privacy laws, which protect the privacy of individuals’ identifiable health information, potentially resulting in a healthcare crisis. This study explores the issue of PHI leaks from an access control viewpoint. We utilize access control policies and PHI leak scenarios derived from semi structured interviews with four healthcare practitioners and use the lens of activity theory to articulate the design of an access control model for detecting and mitigating PHI leaks. Subsequently, we follow up with a prototype as a proof of concept.
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- Award ID(s):
- 2126504
- PAR ID:
- 10356072
- Date Published:
- Journal Name:
- Journal of the Association for Information Systems
- Volume:
- 22
- Issue:
- 4
- ISSN:
- 1536-9323
- Page Range / eLocation ID:
- 1007 to 1036
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.17705/1jais.00687
