Healthcare Technology Vendor News

Alarming Number of Medical Devices Vulnerable to Exploits Such as BlueKeep

The healthcare industry is digitizing business management and data management processes and is adopting new technology to improve efficiency and cut costs, but that technology, in many cases, has been added to infrastructure, processes, and software from a different era and as a result, many vulnerabilities are introduced.

The healthcare industry is being targeted by cybercriminals who are looking for any chink in the armor to conduct their attacks, and many of those attacks are succeeding. The healthcare industry is the most targeted industry sector and one third of data breaches in the United States happen in hospitals.

According to the recently published 2020 Healthcare Security Vision Report from CyberMDX almost 30% of healthcare delivery organizations (HDOs) have experienced a data breach in the past 12 months, clearly demonstrating that the healthcare industry is struggling to address vulnerabilities and block cyberattacks.

Part of the reason is the number of difficult-to-secure devices that connect to healthcare network. The attack surface is huge. It has been estimated that globally there are around 450 million medical devices connected to healthcare networks and 30% of those devices are in the United States. That equates to around 19,300 connected medical devices and clinical assets per hospital in the United States. It is not uncommon for large hospitals to have more than 100,000 connected devices. On average, one in 10 devices on hospital networks are medical devices.

The report reveals 80% of device makers and HDOs say medical devices are difficult to secure due to a lack of knowledge on how to secure them, a lack of training on secure coding practices, and pressure to meet product deadlines.

71% of HDOs say they do not have a comprehensive cybersecurity program that includes medical devices, and 56% believe there will be a cyberattack on their medical devices in the next 12 months. That figure jumps to 58% when you ask medical device manufacturers. Even if an attack occurred, only 18% of HDOs say they are confident that they would be able to detect such an attack.

45% of Medical Devices Vulnerable to Flaws Such as BlueKeep

CyberMDX’s analysis revealed 61% of medical devices are exposed to some degree of cyber risk. 15% are exposed to BlueKeep flaws, 25% are exposed to DejaBlue flaws, and 55% of imaging devices run on outdated software that is vulnerable to exploits such as BlueKeep and DejaBlue. Overall, around 22% of Windows devices on hospital networks are vulnerable to BlueKeep.

BlueKeep and DejaBlue are vulnerabilities that can be exploited via Remote Desktop Protocol (RDP). The flaws can be exploited remotely and allow an attacker to take full control of vulnerable devices. BlueKeep is also wormable, so malware could be created that could spread to other vulnerable devices on a network with no user interaction required.

BlueKeep affects older Windows versions – Windows XP to Windows 7 and Windows Server 2003 to 2008 R2 – but many medical devices run on those older operating systems and have not been updated to protect against exploitation. DejaBlue affects Windows 7 and later versions.

Even Linux-based operating systems are vulnerable. Approximately 15% of connected hospital assets and 30% of medical devices are vulnerable to a flaw known as SACK Panic. It has been estimated that around 45% of medical devices are vulnerable to at least one flaw.

Prompt Patching is Critical, But That’s Not Straightforward

CyberMDX’s research found that 11% of HDOs don’t patch their medical devices at all and when patches are applied, the process is slow. 4 months after a vulnerability as serious as BlueKeep is discovered, an average hospital will only have patched around 40% of vulnerable devices.

The situation could actually be far worse, as the report reveals 25% of HDOs do not have a full inventory of their connected devices and an additional 13% say their inventory is unreliable. 36% do not have a formal BYOD policy and CyberMDX says a typical hospital has lost track of around 30% of its connected devices.

Patching medical devices is no easy task. “Where vulnerabilities concern unmanaged devices, there is no easy way to identify the relevant patch level for each device and no way to centrally push patches (through the active directory and SCCM) to devices distributed throughout the organization,” explained CyberMDX. “For these devices, technicians must individually investigate and manually attend the affected devices.”

Alarmingly, even though medical devices are vulnerable to attack, a majority of HDOs neglect granular network segmentation or segment their networks for reasons other than security, so when network segmentation is used, segments contain a variety of different devices with some connections open to the internet.

If flaws are exploited, many HDOs would struggle to detect an attack. More than a third of HDOs do not continuously monitor their connected devices and a further 21% identify, profile, and monitor their devices manually.

So, What is the Solution?

Improving the security of medical devices is no easy task, as CyberMDX explains. It requires “continuous review of configuration practices, segmentation, network restrictions, appropriate use, credential management, vulnerability monitoring, patching & updating, lifecycle management, recall tracking, access and role controls, compliance assurance, pen testing, live context-aware traffic monitoring & analysis, oversight of partner and third-party security practices, and more.” Further, “If you don’t know what devices you have networked, you won’t be able to understand their individual attack vectors.”

Improving security is certainly a daunting task, but the goal is not to make your organization 100% secure, as that would be an impossible goal. The aim should be to address the most important issues and to significantly reduce the attack surface.

“By more clearly defining lifecycle-wide security responsibilities and expectations with your vendors, by restricting functionally unnecessary in-VLAN communications, by investing in staff-wide cyber training, by normalizing basic network hygiene practices (like password and access management, patching & updating, etc.), and by tweaking security policies (at the NAC or firewall level) specifically for monitors, infusion pumps, and patient tracking devices, you can dramatically shrink your attack surface in short order,” suggest CyberMDX.

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Medtronic Issues Patches for CareLink Programmers and Implanted Cardiac Devices

The medical device manufacturer Medtronic has issued patches to correct flaws in its CareLink 2090 and CareLink Encore 29901 programmers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy defibrillators (CRT-Ds).

The vulnerabilities were first identified by security researchers in 2018 and 2019. When Medtronic was informed about the vulnerabilities, mitigations were quickly published to reduce the risk of exploitation of the vulnerabilities and allow customers to continue to use the affected products safely. The development and release of patches for these complex and safety-critical devices has taken a long time due to the required regulatory approval process.

“Development and validation can take a significant amount of time and also includes a required regulatory review process before we can distribute updates to products. Medtronic worked to develop security remediations quickly while also ensuring the patches continue to maintain comprehensive safety and functionality,” explained Medtronic.

In 2018, Security researchers Billy Rios and Jonathan Butts identified three vulnerabilities in Medtronic’s CareLink 2090 and CareLink Encore 29901 devices, prompting an advisory to be issued in February 2018. The devices are used to program and manage implanted cardiac devices. The vulnerabilities would allow an attacker to alter the firmware via a man-in-the-middle attack, access files contained in the system, obtain device usernames and passwords, and remotely control implanted Medtronic devices.

Several researchers were credited with the discovered two further vulnerabilities in 2019 in the Medtronic Conexus telemetry protocol, prompting a second Medtronic advisory in March 2019. The vulnerabilities concern the lack of encryption, authentication, and authorization. If exploited, an attacker could intercept, replay, and modify data, and change the configuration of implanted devices, programmers, and home monitors. One of the vulnerabilities, CVE-2019-6538, was rated critical and was assigned a CVSS v3 base score of 9.3 out of 10.

The latest patches correct the flaws in CareLink monitors and programmers and MyCareLink monitors. Patches have also been released for approximately half of the affected Medtronic implantable devices impacted by the Conexus vulnerabilities:

  • Brava™ CRT-D, all models
  • Evera MRI™ ICD, all models
  • Evera™ ICD, all models
  • Mirro MRI™ ICD, all models
  • Primo MRI™ ICD, all models
  • Viva™ CRT-D, all models

Patches for all the remaining vulnerable devices will be released later this year.

To prevent exploitation of the flaws, Medtronic disabled the software development network (SDN) that was used to deliver device updates, so software needed to be updated manually via a secured USB. Now that patches have been released, the SDN has been reactivated and it can be used by customers to update their devices.

Medtronic has been monitoring for exploitation of the vulnerabilities and says there have been no cyberattacks or privacy breaches as a result of the vulnerabilities and no patients have been harmed.

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How One Company is Helping to Drive Down the Cost of U.S. Healthcare and Improve Patient Outcomes

2019 Health Statistics published by the Organisation for Economic Co-operation and Development’s (OECD) show healthcare expenditures in the United States are significantly higher than those in other developed countries. A 2018 Harvard study of 11 developed countries showed the United States had the highest healthcare costs relative to its GDP out of all 11 countries studied. Per capita healthcare spending was found to be almost twice that of other wealthy, developed countries.

Higher costs are not necessarily bad if they translate into better patient outcomes, but the OECD figures show that is not the case. The United States performed poorly for patient outcomes, even though the costs of healthcare are so high. Reducing the cost of healthcare is a major challenge and there is no silver bullet, but there are ways for costs to be reduced and for patient outcomes to be improved.

The Trump Administration is committed to reducing the cost of healthcare through executive orders and HHS rulings. In November 2018 an executive order – Improving Price and Quality Transparency in American Healthcare – was issued which is intended to improve healthcare price transparency to increase competition among hospitals and insurers and drive down healthcare spending.

Another key area where costs can be cut is by eliminating wastage in healthcare. A great deal of money being wasted due to inefficiency, such as the continued use of outdated communications technology.

The healthcare industry is still heavily reliant on communications technology from the 1970s. Advances are being made and new communications tools are being introduced, but oftentimes when new communications technology is purchased, it tends to be introduced in silos and healthcare organizations fail to achieve the full benefits. As a result, communications problems persist.

Communication inefficiencies are costing the healthcare industry dearly and that cost is being passed onto patients. Research shows communication inefficiencies cost a single 500-bed hospital around $4 million a year. The breakdown in communication is estimated to be a major factor in 70% of medical error deaths, according to a study published in the Journal of Medical Internet Research.

One company helping to cut the cost of healthcare is TigerConnect. TigerConnect has developed an advanced communications and collaboration solution that allows all members of care teams to communicate and collaborate quickly, efficiently, and effectively. The platform helps accelerate productivity and eliminates wastage, which allows healthcare providers to reduce the cost of healthcare. The solution has also been shown to improve patient outcomes.

The platform has been shown to reduce wait times in emergency departments, reduce the potential for medical errors, reduce the length of hospitals stays, and the platform helps improve staff morale, especially among physicians. The platform eliminates phone tag, allows all members of the care team to access the data they need to make decisions, and ensures proper patient handoffs, which is where the majority of medical errors occur.  

The TigerConnect team is committed to solving pervasive problems in healthcare communication and continues to innovate and develop its solution to meet the need of healthcare organizations of all sizes. The platform has proven popular with healthcare organizations and the company has been enjoying a period of tremendous growth, according to 2019 figures released today.

The TigerConnect solution is the most widely adopted healthcare communications and collaboration platform in the United States and 2019 has seen the company expand its industry footprint further. More than 600 new clients have been added in 2019, including 100 new enterprise clients such as Geisinger, NCH Healthcare System, Penn State Health, University of Maryland Medical System, Einstein Medical Center, Cooper University Health Care, and St. Luke’s University Health Network. More than 6,000 healthcare organizations are now using the platform.

TigerConnect has also expanded its workforce to cope with the increased demand. Over 50 new members of staff joined the company in 2019. TigerConnect also created new leadership roles, with the appointment of former Vacasa CTO, Tim Goodwin, as its first Chief Technology Officer, former McKesson consultant Sarah Shillington as the SVP of client success, and former Expedia executive, Allie Hanegan as VP of People.

TigerConnect is now looking to make greater gains in 2020 and has launched several initiatives to accelerate growth. Ahead of HIMSS20, TigerConnect will be launching several major product and partner initiatives, the company will be aggressively marketing its solution toward new clients and will also be looking to expand its footprint with its existing customer base. TigerConnect has also confirmed it will be forming a client advisory group and will be leveraging additional forums to get feedback from users to identify areas where the platform can be further improved.

“As we look ahead to the next decade, we see nothing but greenfield opportunity to redefine the way healthcare teams, payers, and patients connect and collaborate. We remain steadfast in our mission to partner with care organizations of every size and type, providing them with the world’s most advanced collaboration technology to produce a vision of the future we can all be proud of,” said Brad Brooks, co-founder, and CEO of TigerConnect.

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2020 Emergency Preparedness and Security Trends in Healthcare Survey

Every year, Rave Mobile Safety conducts a nationwide survey to identify healthcare security trends and assess the state of emergency preparedness and security trends in the healthcare industry.

For the 2020 Emergency Preparedness and Security Trends in Healthcare report, Rave Mobile Security is seeking insights from leaders in the healthcare industry on the efforts they have made to prepare for emergency situations.

Many HIPAA Journal readers participated in last year’s survey and have provided information on the steps they have taken to improve safety in the workplace in emergency situations. That information has been used to get an overview of emergency preparedness in the United States.

The 2020 survey is now being conducted and HIPAA Journal readers have been requested to take part in the study. If you so wish, you can participate completely anonymously.

You can participate in the survey by clicking the following link:

Click here for the Emergency Preparedness and Security Trends in Healthcare Survey.

If you provide your email address, you’ll receive the anonymized survey results before they are published and will be entered into a prize draw for a $200 gift card from the survey sponsor.

HIPAA Journal will eventually publish the results of the survey.

Note: HIPAA Journal is not conducting this survey and does not receive any payment for promoting this survey. HIPAA Journal has no commercial relationship with the survey sponsor. If your organization is running a survey that is of interest to healthcare professionals, you can contact us with the details.

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TitanHQ and Pax8 Partnership Announced

Pax8 partners can now benefit from two new cybersecurity solutions thanks to a new partnership with TitanHQ.

Pax8 is a born in the cloud distributor that connects the channel ecosystem to its award-winning transactional cloud marketplace. Pax8 helps its partners achieve more in the cloud through productivity, infrastructure, continuity, and security solutions. The company is one of the fastest growing in the world and has been placed at number 60 in the 2019 Inc. 5000 list and is a true leader in the cloud.

Pax8 greatly simplifies the cloud for managed service providers and allows them to easily find, purchase, and implement cloud-based solutions from leading vendors. Two areas where Pax8 partners required greater choice were email and web security. Options have now been increased in both areas thanks to the new partnership with TitanHQ.

TitanHQ is the leading provider of cloud-based email and web security solutions for MSPs serving the SMB market. Under the new partnership agreement, Pax8 partners can now protect their and their client’s networks with TitanHQ’s multi-award-winning email security solution, SpamTitan, and its DNS filtering solution, WebTitan Cloud.

“TitanHQ’s cloud-based AI-driven threat intelligence technology protects email and web security solutions for MSPs and their customers,” said Ryan Walsh, chief channel officer at Pax8. “Our partners are excited about the addition of TitanHQ and the ability to protect their clients’ businesses by blocking malware, phishing, ransomware, and links to malicious websites from emails.”

SpamTitan provides protection from phishing, spear phishing, and email impersonation attacks and blocks known and zero-day malware threats. WebTitan provides protection against the web-based element of cyberattacks such as exploit kits, phishing kits, and drive-by malware downloads.

The solutions incorporate many MSP-friendly features and Pax8 partners benefit from a fully transparent pricing policy, centralized billing, and industry-leading technical support.

“I am delighted to partner with the Pax8 team,” said Ronan Kavanagh, CEO TitanHQ. “Their focus and dedication to the MSP community is completely aligned with ours at TitanHQ, and we look forward to delivering our integrated solutions to their partners and customers.”

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Amazon Lex is Now HIPAA Compliant

Amazon has announced that the Amazon Lex chatbot service now supports HIPAA compliance and can be used by healthcare organizations without violating Health Insurance Portability and Accountability Act Rules.

Amazon Lex is a service that allows customers to build conversational interfaces into applications using text and voice. It allows the creation of chatbots that use lifelike, natural language to engage with customers, ask questions, collect and give out information, and complete a range of different tasks such as scheduling appointments. The conversational engine that powers Amazon Lex is also used by Amazon Alexa.

Until recently, there was limited potential for use of Amazon Lex in healthcare as the solution was not HIPAA-compliant and could therefore not be used in connection with electronic protected health information (ePHI). The service was also not covered by Amazon’s business associate agreement (BAA).

On December 11, 2019, Amazon confirmed that Amazon Lex is now included in its AWS business associate agreement (BAA) addendum and that the service is eligible for use with workloads involving ePHI, provided that a BAA is in place. Amazon Lex has been subjected to third-party security assessments under multiple AWS compliance programs, and in addition to being HIPAA eligible is also compliant with PCI and SOC.

As with any software solution, a BAA does not guarantee compliance. Amazon has ensured appropriate safeguards have been implemented to ensure the confidentiality, integrity, and availability of ePHI, but it is the responsibility of users to ensure that the solution is implemented correctly and used in a manner that complies with HIPAA Rules.

Amazon has released a whitepaper on Architecting for HIPAA Security and Compliance on AWS, which details best practices for configuring AWS services that store, process, and transmit ePHI. Guidelines on the administration of Amazon Lex have also been published.

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New Alexa Healthcare Skill Helps Patients Manage Their Medications

Amazon has announced that Alexa has a new healthcare skill that patients can use to manage their medications and order prescription refills.

Earlier this year, Amazon announced that it has developed a HIPAA-eligible environment for skill developers that incorporates the necessary safeguards to comply with the requirements of the HIPAA Privacy and Security Rules. Amazon set up an invite-only program for a select group of skill developers to create new skills that could benefit patients.

The new skill is the result of a collaboration between Amazon and the medication management firm Omnicell. Amazon contacted Omnicell and offered the company the chance to create the new skill after it was noticed that many Alexa users were using their devices to set medication reminders. Amazon had received feedback from several users who requested improvements be made to the reminders feature to allow them to set multiple reminders a day to take their medications.

Initially, the new Alexa capabilities will be available to customers of the Giant Eagle pharmacy chain, which operates over 200 pharmacies throughout the Midwest and Mid-Atlantic. The new skill allows patients to set reminders to take their medications, check their current prescriptions, and order prescription refills at Giant Eagle by issuing voice commands to their Alexa devices.

The new skill incorporates a range of privacy and security protections to prevent unauthorized access and misuse. After enabling the Giant Eagle Pharmacy skill and linking their account, users are required to set up a voice profile and set a PIN. Alexa will recognize a user by their voice profile, but they will be required to provide their PIN before any information will be relayed. Healthcare related information is also redacted in the app to maintain privacy and voice recordings can be reviewed and deleted at any time through the Alexa app, Privacy Settings page, or by issuing voice commands after authentication.

“This new technology is just the beginning, as we continue to identify straightforward and easy-to-use pharmacy tasks that voice–powered devices can perform in the real world to keep the patient at the center of care and streamline pharmacy workflow,” said Danny Sanchez, vice president and general manager, Population Health Solutions, Omnicell.

The initial launch will provide Amazon with valuable data that will be used to improve the customer experience. Amazon will be adding further pharmacy chains in the New Year.

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Smartwatch Data Act Introduced to Improve Privacy Protections for Consumer Health Data

The Stop Marketing And Revealing The Wearables And Trackers Consumer Health (Smartwatch) Data Act, has been introduced by Sens. Bill Cassidy, M.D., (R-Louisiana) and Jacky Rosen, (D-Nevada). The new legislation will ensure that health data collected through fitness trackers, smartwatches, and health apps cannot be sold or shared without consumer consent.

The Health Insurance Portability and Accountability Act (HIPAA) applies to health data collected, received, stored, maintained, or transmitted by HIPAA-covered entities and their business associates. Some of the same information is collected, stored, and transmitted by fitness trackers, wearable devices, and health apps. That information can be used, shared, or sold, without consent. Consumers have no control over who can access their health data. The new legislation aims to address that privacy gap.

The bill prohibits the transfer, sale, sharing, or access to any non-anonymized consumer health information or other individually identifiable health information that is collected, recorded, or derived from personal consumer devices to domestic information brokers, other domestic entities, or entities based outside the United States unless consent has been obtained from the consumer.

Consumer devices are defined as “equipment, application software, or mechanism that has the primary function or capability to collect, store, or transmit consumer health information.”

The Smartwatch Data Act applies to information about the health status of an individual, personal biometric information, and kinesthetic information collected directly through sensors or inputted manually into apps by consumers. The Smartwatch Data Act would treat all health data collected through apps, wearable devices, and trackers as protected health information.

There have been calls for HIPAA to be extended to cover app developers and wearable device manufacturers that collect, store, maintain, process, or transmit consumer health information. The Smartwatch Data Act does not extend HIPAA to cover these companies, instead the legislation applies to the data itself. The bill proposes the HHS’ Office for Civil Rights, the main enforcer of compliance with HIPAA, would also be responsible for enforcing compliance with the Smartwatch Data Act. The penalties for noncompliance with the Smartwatch Data Act would be the same as the penalties for HIPAA violations.

“The introduction of technology to our healthcare system in the form of apps and wearable health devices has brought up a number of important questions regarding data collection and privacy,” said Sen. Rosen “This commonsense, bipartisan legislation will extend existing health care privacy protections to personal health data collected by apps and wearables, preventing this data from being sold or used commercially without the consumer’s consent.”

The legislation was introduced following the news that Google has partnered with Ascension, the second largest healthcare provider in the United States, and has been given access to the health information of 50 million Americans. That partnership has raised a number of questions about the privacy of health information.

The Ascension data passed to Google is covered by HIPAA, but currently fitness tracker data is not. Google intends to acquire fitness tracker manufacturer Fitbit in 2020 and concern has been raised about how Google will use personal health data collected through Fitbit devices. The Smartwatch Data Act would help to ensure that consumers are given a say in how their health data is used.

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House Committee Leaders Demand Answers from Google and Ascension on Project Nightingale Partnership

Leaders of the House Committee on Energy and Commerce are seeking answers from Google and Ascension on Project Nightingale. The Department of Health and Human Services’ Office for Civil Rights has also confirmed that an investigation has been launched to determine if HIPAA Rules have been followed.

The collaboration between Google and Ascension was revealed to the public last week. The Wall Street Journal reported that Ascension was transferring millions of patient health records to Google as part of an initiative called Project Nightingale.

A whistleblower at Google had contacted the WSJ to raise concerns about patient privacy. A variety of internal documents were shared with reporters on the extent of the partnership and the number of Google employees who had access to Ascension patients’ data. Under the partnership, the records of approximately 50 million patients will be provided to Google, 10 million of which have already been transferred.

According to the WSJ report, 150 Google employees are involved with the project and have access to patient data. The whistleblower stated that those individuals are able to access and download sensitive patient information and that patients had not been informed about the transfer of their data in advance. Understandably, the partnership has raised concerns about patient privacy.

Both Google and Ascension released statements about the partnership after the WSJ story was published, confirming that Google was acting as a business associate of Ascension, had signed a business associate agreement, and that it was in full compliance with HIPAA regulations. Under the terms of the BAA, which has not been made public, Google is permitted access to patient data in order to perform services on behalf of Ascension for the purpose of treatment, payment, and healthcare operations.

Google will be analyzing patient data and using its artificial intelligence and machine learning systems to develop tools to assist with the development of patient treatment plans. Google will also be helping Ascension modernize its infrastructure, electronic health record system, and improve collaboration and communication. Google has confirmed in a blog post that it is only permitted to use patient data for purposes outlined in the BAA and has stated that it will not be combining patient data with any consumer data it holds and that patient data will not be used for advertising purposes.

Democratic leaders of the House Committee on Energy and Commerce wrote to Google and Ascension on November 18, 2019 requesting further information on the partnership. The inquiry is being led by House Energy Committee Chairman, Frank Pallone Jr. (D-New Jersey). The letters have also been signed by Chairwoman of the Subcommittee on Health, Anna Eshoo (D-California), Subcommittee on Consumer Protection and Commerce Chair, Jan Schakowsky (D-Illinois), and Subcommittee on Oversight and Investigations Chair, Diana DeGette (D-Colorado).

In the letters, the Committee leaders have requested information on the “disturbing initiative” known as Project Nightingale.

“While we appreciate your efforts to provide the public with further information about Project Nightingale, this initiative raises serious privacy concerns. For example, longstanding questions related to Google’s commitment to protecting the privacy of its own users’ data raise serious concerns about whether Google can be a good steward of patients’ protected health information.”

Ascension’s decision not to inform patients prior to the transfer of protected health information has also raised privacy concerns, as has the number of Google employees given access to the data. Further, employees of Google’s parent company Alphabet also have access to Ascension data.

The Committee leaders have requested a briefing by no later than December 6, 2019 about the types of data being used, including the data being fed into its artificial intelligence tools, and the extent to which Google and Alphabet employees have access to the data. The Committee leaders also want to know what steps have been taken to protect patient information and the extent to which patients have been informed.

The Department of Health and Human Services’ Office for Civil Rights has also confirmed that it has launched an investigation into the partnership. Its investigation is primarily focused on how data is being transferred, the protections put in place to safeguard the confidentiality, integrity, and availability of protected health information, and whether HIPAA Rules are being followed. Google has stated it will be cooperating fully with the OCR investigation.

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