admin , 7 months ago to psychology

TITLE: Polite Example Letter to a Health-Related Website Endangering Your Privacy

THIS is the letter I wish more people would send to health-related websites and merchants when they observe a privacy problem!

fullscript.com is a service that dispenses non-pharma products to patients (like medical grade supplements) based upon doctor's orders. You have to be referred by a physician to get a patient account. They even have a way of integrating with EHR systems.

They need to get security right.

To: Fullscript Support <[email protected]>

Dear Fullscript Team:

I have always appreciated being able to order from your excellent website.

Your service strives to supply patients with supplements and medicines ordered by doctors. As such, what is ordered can give insight into medical conditions that patients may have.

You may or may not be covered by HIPAA regulations, but I'm sure you will agree that ethically and as a matter of good business practice, Fullscript would want to maintain medical privacy of patients given that medical practices trust you.

This is why I'm concerned with the HIGH level of 3rd party tracking going on throughout your product catalogue. On your login page, the Firefox web browser displays a "gate" icon to let me know that information (I believe my email address) is being shared with Facebook. This is also the case with your order checkout page (see attached screenshot showing Facebook "gate" icon, as well as Privacy Badger and Ghostery plug-in icons in upper right-hand corner blocking multiple outbound data connections).

Privacy Badger is a web browser plugin that detects and warns of or stops (depending upon severity) outbound information from my web browser to 3rd party URLs. Directly below is Privacy Badger's report from your checkout page:

~~~~  
Privacy Badger (privacybadger.org) is a browser extension that automatically learns to block invisible trackers. Privacy Badger is made by the Electronic Frontier Foundation, a nonprofit that fights for your rights online.

Privacy Badger blocked 23 potential trackers on us.fullscript.com:

insight.adsrvr.org  
js.adsrvr.org  
bat.bing.com  
static.cloudflareinsights.com  
script.crazyegg.com  
12179857.fls.doubleclick.net  
12322157.fls.doubleclick.net  
googleads.g.doubleclick.net  
connect.facebook.net  
www.google-analytics.com  
analytics.google.com  
www.google.com  
www.googletagmanager.com  
fonts.gstatic.com  
ad.ipredictive.com  
trc.lhmos.com  
snap.licdn.com  
o927579.ingest.sentry.io  
js.stripe.com  
m.stripe.network  
m.stripe.com  
q.stripe.com  
r.stripe.com  
~~~

Please note that I was able to successfully checkout WITH Privacy Badger blocking protections on, so most of this outbound information was NOT necessary to the operation of your website.

There are several advertising networks and 3rd party data brokers receiving some kind of information.

I am aware that a limited amount of data sharing can be necessary to the operation of a website (sometimes). I am also aware that this all is not malicious -- web development and marketing does not usually talk to the legal department before deploying tools useful to gathering site usage statistics (Crazy Egg and Google Analytics). However, these conversations need to happen.

As for "de-identified" or "anonymized" data -- data brokers collect information across several websites, and so are able to reconstruct patient identities even if you don't transmit what would obviously be PHI (protected health information). As an example, if Google sees the same cookie or pixel tracking across multiple websites and just one of them sends a name, then Google knows my name. If Facebook is sent my email address (as looks to be the case), and I happen to have a Facebook account under that same email address, then Facebook knows who I am -- and can potentially link my purchases with my profile.

The sorts of computing device data that you are collecting and forwarding here may well qualify as PHI. Please see:

Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates  
<https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-online-tracking/index.html>

This HHS and OCR guidance includes many 3rd party tracking technologies.

What I would really like to see happen is:

a) A thorough look at what information your website is sending out to what 3rd parties, along with an understanding of how data brokers can combine information tidbits from multiple websites to build profiles.

b) Use of alternative marketing analysis tools that help your business. For example, there are alternatives to Google Analytics that do not share all that data with Google and still give your marketing team the data they need.

c) An examination if you are sharing information about what products patients are clicking on and/or purchasing with 3rd parties. This would be especially problematic. (Crazy Egg tracks client progress through a website, but I'm unclear if they keep the information or just leave it with you.)

d) Use of alternative code libraries that are in-house. For example, web developers frequently utilize fonts.gstatic.com, but you could likely get fonts and other code sets elsewhere or store them in-house.

I appreciate you taking time to read this and working on the privacy concerns of your patients and affiliated medical practices.

Thanks.

~~~~~~  
#AI #CollaborativeHumanAISystems #HumanAwareAI #artificialintelligence #psychology #counseling #socialwork #psychotherapy #EHR #medicalnotes #progressnotes @[email protected] @[email protected] @[email protected] @[email protected] @socialwork @[email protected] #mentalhealth #technology #psychiatry #healthcare #patientportal #HIPAA #dataprotection #infosec @[email protected] #doctors #hospitals #BAA #businessassociateagreement #coveredentities #privacy #HHS #OCR #fullscript

admin , 7 months ago to psychology

TITLE: Further Adventures in the HIPAA Silliness Zone

This short essay was inspired by a video I watched going over Microsoft legal agreements, the upshot of which is that they can harvest and use ALL of your data and creations (See *1 below in References). This inspires interesting HIPAA questions to say the least:

1. IF you have a HIPAA agreement with Microsoft, do they actually NOT harvest or use your data? How do they track that across all their applications and operating systems to tell?

2. Do their HIPAA and regular legal departments even talk to each other?

3. If you have a HIPAA agreement for your work computers, but then access your data through home computers, are all bets off? (And what sole proprietors don't mix use of computers for both?)

Now I don't really believe that Microsoft is doing all of this. What I THINK is that their lawyers just wrote overly broad legalese to protect them from all situations. Still -- legally it leaves us hanging. I certainly don't know that they are NOT doing it.

Then, I start thinking on some of the other crazy security situations I've encountered the past few years:

-- The multi-billion dollar medical data sales vendor that bought a calendar scheduling system, then wrote a HIPAA BAA agreement in which the PROVIDER has to pay any financial damages and penalties if THEY slip-up and lose data. (*2). Gee, what could go wrong?

-- The new AI progress notes generator service that sends data to 3rd parties including Google Tag Manager, LinkedIn Analytics, Facebook Connect, and Gravatar (*3)

-- The countless data breaches currently hitting hospitals across the USA. (*4)

It's all really quite mind numbing if you are a small healthcare provider or sole practitioner. I suspect 99% of us have just tuned this all out as noise at this point. After all, do we have the time or money to take on the legal departments of multi-billion dollar corporations?

The net results of this will be helpless nonchalance, boredom, and a gradual shifting of liability to US when upon occasion data is actually leaked by our vendors. And, of course, ever more fear and uncertainty in professions already full of it. Oh, and client data flowing through data brokers everywhere.

So what can we do? At first glance, not much. We need to be pressuring our professional associations to take on (or further take on) data security concerns including liability of giant "subcontractors" and insurance companies versus small healthcare providers. We also need to be supporting HHS and Federal government efforts to stop 3rd party trackers, including cookies, web beacons, pixel tracking, etc. from being allowable on systems related to healthcare. (*5) Bonus points if the penalties can apply mainly to larger corporations rather than hitting small provider offices hard.

Thanks,
Michael Reeder LCPC
Baltimore, MD

REFERENCES:

(*1)  
The following video walks through the Microsoft Services Agreement and Microsoft Privacy Agreement to explain how Microsoft reserves the rights to use all data that you transmit through their services, or create or store in their apps (including data stored on OneDrive). It also collects information from all the programs used on your Windows machine. (This would seem to mean they can harvest data from your local hard drive, but I'm not sure.)

Microsoft Now Controls All Your Data  
[https://m.youtube.com/watch?v=1bxz2KpbNn4&pp=ygUkTWljcm9zb2Z0IG5vdyBjb250cm9scyBhbGwgeW91ciBkYXRh](https://m.youtube.com/watch?v=1bxz2KpbNn4&pp=ygUkTWljcm9zb2Z0IG5vdyBjb250cm9scyBhbGwgeW91ciBkYXRh)  
"("Data"), how we use your information, and the legal basis we use to process your Personal Information. The Privacy Statement also describes how Microsoft uses your content, i.e. Your communications with other people; the submissions you send to Microsoft through the Services; and the files, photographs, documents, audio, digital works, live streams, and videos that you upload, store, transmit, create, generate, or share through the Services, or any input you submit to generate content ("Your Content")."

(*2)  
Full Slate: Last I checked their HIPAA, privacy, and BAA agreements. Although they reserve the right to change these agreements without notification and just post them to their website, so who knows at this point. <https://www.fullslate.com>

(*3)  
Autonotes.ai: In fairness, they claim that no HIPAA data should be input into their system, even though you are writing progress notes. As of 7/30/23 they sent some sort of data to Google Tag Manager, LinkedIn Analytics, Facebook Connect, Gravatar which was severe enough that the Ghostery browser plug-in felt compelled to block or flag the transmissions. I hope they have changed this.

It should be pointed out that services similar to Full Slate and Autonotes claim that data sent to 3rd parties is not PHI and/or necessary to the operation of the service. This all could be true. I find that when Privacy Badger, or Ghostery, or my Pihole DNS server block these 3rd party transmissions that the vast majority of the time services work just fine.

Please also see Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates  
<https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-online-tracking/index.html>

This HHS and OCR guidance includes the sorts of 3rd party tracking technologies often referred to as non-PHI, or de-identified. My non-lawyer mind is suspicious that violations could be found at several services.

(*4)  
Just take a look at any of the daily headlines on Becker's Hospital Review:  
<https://www.beckershospitalreview.com/cybersecurity.html>

(*5)  
Hospital associations sue HHS over pixel tracking ban  
<https://www.beckershospitalreview.com/healthcare-information-technology/hospital-associations-sue-hhs-over-pixel-tracking-ban.html>

--

#AI #CollaborativeHumanAISystems #HumanAwareAI #artificialintelligence #psychology #counseling #socialwork #psychotherapy #EHR #medicalnotes #progressnotes @[email protected] @[email protected] @[email protected] @[email protected] @[email protected] @[email protected] #mentalhealth #technology #psychiatry #healthcare #patientportal #HIPAA #dataprotection #infosec @[email protected] #doctors #hospitals #BAA #businessassociateagreement #Microsoft #coveredentities #privacy #HHS #OCR

edintone , 7 months ago to histodons

If you are a Windows 11 user you might not know that the Snipping Tool now includes an OCR function. Clip your image as normal then click the button circled in yellow. You can then either "Copy all text" or select part of the text and copy and paste it elsewhere. #Windows #OCR #SnippingTool #genealogy @geneadons @genealogy @histodons