Disadvantages of Spreadsheets – Obstacles to Compliance in the Healthcare Industry

Most of the regulatory compliance issues we talked about concerning spreadsheets have been related to financial data. But there are other kinds of data that are stored in spreadsheets which may also cause regulatory problems in the future.

In the US, a legislation known as HIPAA or Health Insurance Portability and Accountability Act is changing the way health care establishments and practitioners handle patient records. The HIPAA Privacy Rule is aimed at protecting the privacy of individually identifiable health information a.k.a. protected health information (PHI).

Examples of PHI include common identifiers like a patient’s name, address, Social Security Number, and so on, which can be used to identify the patient. HIPAA covers a wide range of health care organisations and service providers, including: health plan payers, health care clearing houses, hospitals, doctors, dentists, etc.

To protect the confidentiality, integrity, and availability of PHI, covered entities are required to implement technical policies such as access controls, authentication, and audit controls. These can easily be implemented on server-based systems.

Sad to say, many health care organisations who have started storing data electronically still rely on spreadsheet-based systems. Those policies are hard to implement in spreadsheet-based systems, where files are handled by end-users who are overloaded with their main line of work (i.e. health care) and have very little concern for data security.

In some of these systems, spreadsheet files containing PHI may have multiple versions in different workstations. Chances are, none of these files have any access control or user authentication mechanism whatsoever. Thus, changes can easily be made without proper documentation as to who carried out the changes.

And because the files are normally easily accessible, unauthorised disclosures – whether done intentionally or accidentally – will always be a lingering threat. Remember that HIPAA covered entities who are caught disclosing PHI can be fined from $50,000 up to $500,000 plus jail time.

But that’s not all. Through the HITECH Act of 2009, business associates of covered entities will now have to comply with HIPAA standards as well. Business associates are those companies who are performing functions and services for covered entities.

Examples of business associates are accounting firms, law firms, consultants, and so on. They automatically need to comply with the standards the moment they too deal with PHI.

More Spreadsheet Blogs

Spreadsheet Risks in Banks

Top 10 Disadvantages of Spreadsheets

Disadvantages of Spreadsheets – obstacles to compliance in the Healthcare Industry

How Internal Auditors can win the War against Spreadsheet Fraud

Spreadsheet Reporting – No Room in your company in an age of Business Intelligence

Still looking for a Way to Consolidate Excel Spreadsheets?

Disadvantages of Spreadsheets

Spreadsheet woes – ill equipped for an Agile Business Environment

Spreadsheet Fraud

Spreadsheet Woes – Limited features for easy adoption of a control framework

Spreadsheet woes – Burden in SOX Compliance and other Regulations

Spreadsheet Risk Issues

Server Application Solutions – Don’t let Spreadsheets hold your Business back

Why Spreadsheets can send the pillars of Solvency II crashing down

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How DevOps oils the Value Chain

DevOps ? a clipped compound of development and operations – is a way of working whereby software developers are in a team with project beneficiaries. A client centred approach extends the project plan to include the life cycle of the product or service, for which the software is developed.

We can then no longer speak of a software project for say Joe?s Accounting App. The software has no intrinsic value of its own. It follows that the software engineers are building an accounting app product. This is a small, crucially important distinction, because they are no longer in a silo with different business interests.

To take the analogy further, the developers are no longer contractors possibly trying to stretch out the process. They are members of Joe?s accounting company, and they are just as keen to get to market fast as Joe is to start earning income. DevOps uses this synergy to achieve the overarching business goal.

A Brief Introduction to OpsDev

You can skip this section if you already read this article. If not then you need to know that DevOps is a culture, not a working method. The three ?members? are the software developers, the beneficiaries, and a quality control mechanism. The developers break their task into smaller chunks instead of releasing the code to quality control as a single batch. As a result, the review process happens contiguously along these simplified lines.

Code	QC	Test	?	?	?
?	Code	QC	Test	?	?
?	?	Code	QC	Test	?
?	?	?	Code	QC	Test

Colour Key

Developers

Quality Control

Beneficiary

This is a marked improvement over the previously cumbersome method below.

Write the Code	?	Test the Code	?	Use the Code
?	Evaluate, Schedule for Next Review			?

Working quickly and releasing smaller amounts of code means the OpsDev team learns quickly from mistakes, and should come to product release ahead of any competitor using the older, more linear method. The shared method of working releases huge resources in terms of user experience and in-line QC practices. Instead of being in a silo working on its own, development finds it has a richer brief and more support from being ?on the same side of the organisation?.

The Key Role that Application Program Interfaces Play

Application Program Interfaces, or API?s for short, are building blocks for software applications. Using proprietary software-bridges speeds this process up. A good example would be the PayPal applications that we find on so many websites today. API?s are not just for commercial sites, and they can reduce costs and improve efficiency considerably.

The following diagram courtesy of TIBCO illustrates how second-party applications integrate with PayPal architecture via an API fa?ade.

The DevOps Revolution Continues ?

We close with some important insights from an interview with Jim Stoneham. He was general manager of the Yahoo Communities business unit, at the time Flickr became a part. ?Flickr was a codebase,? Jim recalls, ?that evolved to operate at high scale over 7 years – and continuing to scale while adding and refining features was no small challenge. During this transition, it was a huge advantage that there was such an integrated dev and ops team?

The ?maturity model? as engineers refer to DevOps status currently, enables developers to learn faster, and deploy upgrades ahead of their competitors. This means the client reaches and exceeds break-even sooner. DevOps lubricates the value chain so companies add value to a product faster. One reason it worked so well with Flickr, was the immense trust between Dev and Ops, and that is a lesson we should learn.

?We transformed from a team of employees to a team of owners. When you move at that speed, and are looking at the numbers and the results daily, your investment level radically changes. This just can’t happen in teams that release quarterly, and it’s difficult even with monthly cycles.? (Jim Stoneham)

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Risk Assessment

Risk assessment is a vital component in BC (Business Continuity) planning. Through risk assessment, your company may determine what vulnerabilities your assets possess. Not only that, you’ll also be able to quantify the loss of value of each asset against a specific threat. That way, you can rank them so that assets that are most likely to cripple your business when say a specific disaster strikes can be given top priority.

However, a poorly implemented risk assessment may also cost you unnecessary expenditures. Many risk assessors are too enthusiastic in pointing out risks that, at the end of the assessment, they tend to over-appraise even those having practically zero probability of ever occurring.

We can assure you of a realistic assessment of your assets’ risks and propose cost-effective countermeasures. These are the things we can do:

Identify your unsafe practices and propose the best alternatives.
Perform qualitative risk assessment if you want fast results and lesser interruptions on your operations.
Perform quantitative risk assessment if you want the most accurate depiction of your risks and the corresponding justifiable costs of each.
Conduct frequency and consequence analysis to identify unforeseen harmful events and determine their effects to various components of your organisation and its surroundings.

We can also assist you with the following:

Authentication and Access Control

Threats to your data can come from external or internal sources.

There are individuals who don’t have the authorisation but are driven by malicious intentions to gain access to certain information. This may refer to individuals who already belong to your organisation (but don’t have the necessary access rights) as well as those who don’t.
There are individuals who have both the authorisation and, unfortunately, the malicious intentions over certain information.
Finally, there are individuals who have the authorisation, no malicious intentions, but have accidentally exposed the information in question to those without the proper authority.

While curbing threats 2 and 3 would require other methods, threat #1 can be countered if the right authentication and access control systems are in place.

Here’s what we can do for you:

Work with your key personnel to determine who gets access to what.
Help you decide whether a single factor or a two-factor authentication (2FA) is appropriate for your organisation and recommend which factors are most suitable. Login methods may include but are not limited to the following:
- biometric devices
- Kerberos tickets
- mobile phones
- passwords
- PKI certificates
- proximity cards
- smart cards
- tokens
Install the necessary infrastructure needed for the factors chosen. For instance, if you opt to use biometrics, then biometric scanners will be installed. We’ll make sure that the authentication terminals are situated in places where achieving optimal traffic and work flow has been taken into consideration.

Other defences we’re capable of putting up include: