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Failed IT causes major Georgia Blue Cross health privacy breach

By | August 4, 2008, 7:43am PDT

Summary: Poor system testing caused a medical records privacy breach affecting over 200,000 members of Georgia Blue Cross and Blue Shield. The case has implications for both consumer privacy and IT’s impact on business operations.

Failed IT causes major Georgia Blue Cross health privacy breach

Poor system testing caused a medical records privacy breach affecting over 200,000 members of Georgia Blue Cross and Blue Shield. The case has implications for both consumer privacy and IT’s impact on business operations.

In an emailed statement, Blue Cross spokesperson, Cindy Sanders, said:

[A] mailing of Explanation of Benefits (EOB) letters included EOBs sent to incorrect addresses. These EOBs may have included protected health or personal information. We are currently assessing how many people may have been affected by this incident and we will quickly notify impacted members and send them the correct EOB.

The Atlanta Journal-Constitution reports that Blue Cross blames “a change in the computer system that was not properly tested.” During a phone call, I asked Sanders for details; her vague response, “We are still going through the situation and assessing it right now.”

Commenting on the privacy breach, Georgia’s Insurance Commissioner, John Oxendine, told WALB television:

This is a very serious breach. It’s the worst breach of health care privacy I’ve seen in my 14 years in office. Obviously it was unintentional but it’s a violation of both state and federal law.

THE PROJECT FAILURES ANALYSIS

This case is significant for two reasons: most importantly, it demonstrates the need for stricter regulation regarding how organizations handle confidential consumer data. Additionally, the situation provides a clear example of the link between an organization’s technical practices and overall business operations.

On the privacy side, data breaches resulting from poor practice or carelessness are common. I continue to believe stricter government regulation and enforcement is required to solve this problem. Consumers will continue to be screwed until governments become more involved.

From an IT perspective, this data breach demonstrates how backend systems and procedures, such as software quality assurance, can directly affect business activities. Although we don’t have much detail, it appears Blue Cross didn’t properly test an upgrade or other code change before deployment. We don’t know whether this lapse was a one-time mistake or represents a deeper systemic IT issue inside Blue Cross.

Sanders emailed statement suggests the problem was straightforward enough to identify and fix quickly:

This was an isolated incident and will not impact future EOB mailings. As soon as we became aware of the mailing error, we worked to determine the exact cause and we have made changes to prevent it from happening again in the future.

Since Blue Cross knows why the problem occurred, they should be more forthcoming to the public. Sanders added no new information in response to my follow up request for more details:

There was a system change that was not comprehensively tested. We have already made changes to prevent it from happening in the future.

In my view, that response is completely unhelpful and doesn’t recognize the substantial threat of identity theft many Georgia Blue Cross subscribers now face.

[Via Risks Digest. Image via iStockphoto.]

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Michael Krigsman is a recognized authority on the causes and prevention of IT failures.

Disclosure

Michael Krigsman

Michael Krigsman writes and speaks about technology in a manner that most observers consider to be fair and balanced. Michael believes that writing about IT failures, which often have complex causes, creates a unique obligation to be reasonable and accurate in both reporting and analysis.

Michael maintains active personal and professional relationships with enterprise technology buyers, vendors, analyst firms (or individual analysts), consultants, and system integrators. As CEO of Asuret, Michael sells and delivers paid services to members of these same groups.

Vendors regularly reimburse Michael's out-of-pocket travel expenses to attend industry conferences and events. Conference organizers frequently waive entry fees when Michael attends industry events. Michael often speaks at industry conferences and events.

He is a member of the Enterprise Irregulars, a loose association of consultants, investors, industry representatives, analysts, and users of enterprise software.

For daily updates on Michael's activities, follow him on Twitter.

Biography

Michael Krigsman

Michael Krigsman is CEO of Asuret, Inc., a consulting company dedicated to reducing technology implementation failures. Asuret's suite of software tools improve the success rate of enterprise software deployments by quantifying and measuring governance issues that cause most project failures. Michael led the research effort underlying Asuret's model of collective intelligence and its practical application to reducing IT failures in consulting environments. He is a recognized authority on the causes and prevention of IT failures and is frequently quoted in the press on IT project and related CIO issues. He is considered an enterprise software industry "influencer" and provides advice to technology buyers, vendors, and services firms.

Previously, Michael served as CEO of Cambridge Publications, which develops tools and processes for software implementations and related business practice automation projects. Michael has been involved with hundreds of software development projects, for companies ranging from small startups to Fortune 500 organizations. Michael graduated with an M.B.A. from Boston University and a B.A. from Bard College. He is a Board member of the America's Cup Hall of Fame and the Herreshoff Marine Museum in Bristol, RI.

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RE: Failed IT causes major Georgia Blue Cross health privacy breach
varapetra@... 10th Aug 2008
Christ in heaven, it's in medical records...I mean, I thought it was just a fluff piece when DMX got nabbed faking a name to dodge a hospital bill...

http://blog.trustedid.com/?p=629

But if this gets common some people are going to get hurt or die. What if someone swipes your id to get a blood transfusion and the types don't match? BAM! Sorry, family, I hope we got life insurance too.
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Regulation needed
nellwal@... 4th Aug 2008
I agree that regulation is needed. But until consumers really start pitching serious fits, and/or the courts start implementing some punitive damages with teeth, it's not going to happen. http://whistlersear.wordpress.com
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Regulations, Punitive damages?
SidT 4th Aug 2008
Making the Blue Cross of Georgia pay punitive damages would simply cause them to pass that Along to US. Although something like that needs to be done, I would start with firing of the people directly responsible for the breach. After that I'm not sure what would needed to be done.
-Sid
This smells of an IT organization with no testing and signoff standards bowing to deadline pressure from outside the IT organization. The software was certainly "tested," but with obviously lacking test rigor and QA. Consequently, when asked if it was "tested," the answer was "Yes" with no ability to know otherwise. While the IT organization is fundamentally at fault, the oversight failed dismally. Unfortunately, the person most likely to be hung is the poor programmer who had to make up test data and test cases because there was nothing else available.

p.s.: This talkback process is almost beyond frustration!
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Well..
ZachE84 4th Aug 2008
While I agree with your statement 100%, I would hope any smart programmer that knew the software wasn't ready and/or faulty would 1.) send a letter to upper management 2.) make sure their concerns are at least heard. If something like this occurs you are at least protected.

Unfortunately, many people don't have the balls to say the truth - which only burns them and their company in the end. Sheep hurt everyone!
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1) First the programmer would have to know something was not right, Companies may not want to spend the money on the talent or they maybe off shoring, or they do not want to spend the money to educate their staff in understanding the Laws.

2) I have spoken up @ times for things and management
usual answers are "Cost to much" or "we do not have the time".
I agree, more regulation is needed when it comes to all forms of privacy. I hope legal action is taken against them for this misconduct. They seem to think it's not a big deal and doesn't even matter. Fines please!
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More regulation does not help
Rick VS 4th Aug 2008
Both certain comments in the article and several talk backs are illogical in their call for more regulation. What, you think somebody said "Since I'm only at risk of breaking N federal and state laws I'll go ahead, but boy, if it was N+1 I'd certainly reconsider." Laws don't prevent mistakes, they just define consequences. Enforce the laws we already have, assign the fines and penalties already described within them, and move on. The free market will thoroughly punish companies who play fast and loose with private data.
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Yes, It's the Enforcement
MichP 4th Aug 2008
But as we already know, the FDA does not have enough inspectors to watch everything all the time. So you probably won't get caught until there is a large failure.

When I coded for a medical equipment company, every test procedure had to be written, and we had a log for who ran which procedure, when, and what was found. After fixes, we had to go through all possibly affected test procedures again, ad nauseum, until everything passed. It was for FDA compliance, but I don't know how often anyone ever checked up on us.
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I agree, we already have HIPAA
elizab 6th Aug 2008
The regulation is already on the books-- HIPAA (Health Insurance Portability and Accountability Act of 1996).

The issue is how to we enforce and increase accountability? Levy penalties? How do we monitor?
Many good comments, BUT the realifty is people cannot readily chnage their health insurer if the breech privacy. Many reasons, but most deal with employer restraints in choice, pre-existing health conditions etc. Control of this has to be either regulation or severe Public Relations consquences for the offending companies.

From the CEO to the Unit Chiefs the message has to be that screwups like this will not be tolerated. Fire a few folks and this message will get through. Slap hands and nothing will chnage.
While not as serious a breach, Kaiser Permanente had a major faux pas with a system migration this Spring. Apparently, the new system, or the migration script, didn't know how to deal with doctors that were DOs, rather than MDs. So new accounts were created. John Smith, D.O. became John Smith Do. When the duplicate accounts were discovered, the new accounts were purged, triggering cancelation letters to the "new" accounts. Twice.

Then, "Welcome letters" were sent to these "new" accounts ("We would like to welcome the Smith Do family......").

Fortunately, the benefits people smoothed it over, and apologized profusely, taking the heat for botched Systems Analysis/Testing/Project Management.
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Contributr
I always wonder about the inside story
mkrigsman@... 4th Aug 2008
How do the testing folks miss stuff like this? Are they arcane cases, or are people asleep at the switch.
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It's because...
fuguein_d@... 5th Aug 2008
Half the population of this country that deal with computers have no idea what the hell they are doing. I work in IT and management has no clue and the knowledge is in the hands of the few.
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At least half the population, if not more
schmandel@... 5th Aug 2008
The really funny thing is how many of them are not at all reticent about making wildly misinformed technology decisions that are so often based more on what they want to believe vs the facts at hand. Apparently, they believe that being able to operate Windows desktop software qualifies them to do so.

Unscrupulous consultants and vendors feed on such sheep at will. Twas ever thus.
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RE: I always wonder about the inside story
fatman65535 Updated - 5th Aug 2008
Quote: Are they arcane cases, or are people asleep at the switch.

If anyone is asleep at the switch it is brain dead management.

All management is concerned about is "quick results"; not whether it is right or not. They want to boast that they 'got it done in time'.

The management person responsible should have 480 volts applied to his testicles.
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Message has been deleted.
philip_marsh@... Updated - 4th Aug 2008
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Well, just like security? If they?re innocent they?ve nothing to fear! GWB
And people ask, "How did we ever live without computers?". I say, Very well thank you. In those days you had to break into an office and then a locked file cabinet. Need I say more?
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Nobody held responsible...
Marty R. Milette 5th Aug 2008
Until laws are enforced and someone is ultimately held personally responsible -- nothing will change.

While responsibility should start at the top, unfortunately, it usually falls down-hill to the person lowest in the chain.

Again, when only the privates get punished -- the generals have no incentive to change anything.
I see the privacy concerns here, but not the elevated identity theft risk. I don't believe the BC EOBs contain SSNs. Names and addresses are easy to obtain.
MORE government involvement? Seriously? Because they did so well when that laptop was stolen with hundreds of thousands of veteran records on it. They do so well when there's any state of emergency. Christ, LESS government involvement is what we really need.
Fines abound, through HIPAA legislation. Due punishment will take place, I am sure, and testing will be more thorough next time.

However, any more regulation on the health care industry and we will have no freedom, no choice in our health care at all.

(I personally, would rather whine about the cost and headaches than to a) have to wait > 3 months to have testing or treatment for cancer, or b) NOT have access to the best, latest and greatest in pharmacy and medical technology - as has happened in countries with more mandates than ours and/or socialized medicine.)

Either way, it boils down to this: Aside from dollars charged, on the majority of those documents there is nothing more personal listed than when you sign in to see a doctor or get a bill from his/her office. Most folks whose document included their SSN simply didn't present their ID card when they sought services.

Let's be realistic, too - mistakes happen. At Credit card companies, banks, insurers of all kinds. If it's not intentional or malicious, give people a break!

~ off the soapbox
Funny that blaming an "IT System error" seems to exonerate them... at least in their own opinion. At a time like this, factual explanations seem to fall far short of what is expected. The explanation/blame doesn't fit the magnitude of the error.
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Contributr
That's not uncommon
mkrigsman@... 6th Aug 2008
I recently blogged about Levi's, who seemed to blame serious financial controls problems on an ERP implementation.
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Interesting... it seems that, beyond insufficient testing, this speaks to a lack of transparency w/r/t the relationships between IT assets (servers, software) and services handling sensitive data. It can be worse when companies think they understand these relationships, but don't. That's when change management starts to fail like this.

For further reading on this phenomenon, an article by Kosten Metreweli at Tideway: http://www.dmreview.com/issues/2007_48/10001358-1.html
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Did They Outsource IT Operartions?
elizab Updated - 6th Aug 2008
I don't know if this is true of BC/BS Georgia, but in my own state, Blue Cross has outsourced a good chunk of its IT operations. If so, could insufficient testing be the result of outsourcing and lower budgets?
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Contributr
Good question
mkrigsman@... 6th Aug 2008
The wording of Cindy Sander's comments are ambiguous. As other commenters have noted, the lack of transparency is a real issue here.
Christ in heaven, it's in medical records...I mean, I thought it was just a fluff piece when DMX got nabbed faking a name to dodge a hospital bill...

http://blog.trustedid.com/?p=629

But if this gets common some people are going to get hurt or die. What if someone swipes your id to get a blood transfusion and the types don't match? BAM! Sorry, family, I hope we got life insurance too.

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