[Beowulf] $1, 279-per-hour, 30, 000-core cluster built on Amazon EC2 cloud

[Robert G. Brown]

On Tue, 4 Oct 2011, Lux, Jim (337C) wrote:

> 
> The reason it wasn't encrypted is almost certainly not because it
> was difficult to do so for technology reasons. When you see a story
> about "data being lost or stolen from a car" it's because it was an ad
> hoc situation. Someone got a copy of the data to do some sort of
> analysis or to take it somewhere on a onetime basis, and "things went
> wrong".
>
> Any sort of regular process would normally deal with encryption or
> security as a matter of course: it's too easy to do it right.

The problem being that HIPAA is not amused by incompetence.  The
standard is pretty much show due diligence or be prepared to pay massive
bucks out in lawsuits should the data you protect be compromised.  It is
really a most annoying standard -- I mean it is good that it is so
flexible and makes the responsibility clear, but for most of HIPAA's
existence it has provided no F***ing guidelines on how to make protected
data secure.

Consequently (and I say this as a modest consultant-level expert) your
data and mine in the Electronic Medical Record of your choice is
typically:

   a) Stored in flat, unencrypted plaintext or binary image in the base
DB.

   b) Transmitted in flat, unencrypted plaintext between the server and
any LAN-connected clients.  In other words, it assumes that your local
LAN is secure.

   c) Relies on third party e.g. VPN solutions to provide encryption for
use across a WAN.

Needless to say, the passwords and authentication schemes used in EMRs
are typically a joke -- after all, the users are borderline incompetent
users and cannot be expected to remember or quickly type in a user id or
password much more complicated than their own initials.  Many sites have
one completely trivial password in use by all the physicians and nurses
who use the system -- just enough to MAYBE keep patients out of the
system while waiting in an examining room.

I have had to convince the staff of at least one major EMR company that
I will refrain from naming that no, I wasn't going to ship them a copy
of an entire dataset exported from an old practice management system --
think of it as the names, addresses, SSNs and a few dozen other
"protected" pieces of personal information -- to them as an unencrypted
zip file over the internet, and had to finally grit my teeth and accept
the use of zip's (not terribly good) built in encryption and cross my
fingers and pray.

Do not underestimate the sheer power of incompetence, in other words,
especially incompetence in an environment almost completely lacking
meaningful IT-level standards or oversight.  It's really shameful,
actually -- it would be so very easy to build in nearly bulletproof
security schema that would make the need for third party VPNs passe.

I don't know that ALL of the EMRs out there are STILL this bad, but I'd
bet that 90% of them are.  They certainly were 3-4 years ago, last time
I looked in detail.

So this is just par for the course.  Doctors don't understand IT
security.  EMR creators should, but security is "expensive" and they
don't bother because it isn't mandated.  The end result is that
everything from the DB to the physician's working screen is so horribly
insecure that if any greed-driven cracker out there ever decided to
exclusively target the weaknesses, they could compromise HIPAA and SSNs
by the millions.

Sigh.

    rgb

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Robert G. Brown	                       http://www.phy.duke.edu/~rgb/
Duke University Dept. of Physics, Box 90305
Durham, N.C. 27708-0305
Phone: 1-919-660-2567  Fax: 919-660-2525     email:rgb at phy.duke.edu