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Marshall,

In the scenario that you have described (below), we would recommend to our
clients that they attend to the intents of both the (final) Privacy &
Security rule, AND the (proposed) Security rule.

The "reasonableness" clause is scaleable.  That is the implementation of the
security P&P's in a small provider's office (with say one administrative
position supporting the clinical work of a physician) might be relatively
simple in relationship to the implementation of security P&P's in a large,
complex hybrid entity, such as an academic medical center.  For example, the
small provider may not need an efficient log-off scheme if no one else
besides the physician and the administrator has physical access to the
computer.  Alternatively, in a larger of more complex office situation,
"smart" proximity-cards may be the rule-of-thumb to automatically close-down
an application as soon as the user walks away from the computer.  In between
those extremes, any number of progressive security measures might be
implemented.

I hope that this helps.

Your questions are always welcome.

Matt

Matthew Rosenblum
Chief Operations Officer
Privacy, Quality Management & Regulatory Affairs
http://www.CPIdirections.com

CPI Directions, Inc.
10 West 15th Street, Suite 1922
New York, NY 10011

(212) 675-6367
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-----Original Message-----
From: Marshall E. Fryman [mailto:mfryman@;futuraintl.com]
Sent: Thursday, October 24, 2002 10:23 AM
To: WEDI SNIP Privacy Workgroup List
Subject: Privacy issues


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The privacy regulation draws attention to a reasonable effort to maintain
the privacy of patient's information except on a "need to know" basis. If
we take the premise of a doctor's office where Person A types a letter to a
patient containing confidential information. If Person A then walks away
from their terminal, I would reasonably conclude that there should be some
sort of password-protected screen saver that automatically pops up to blank
the screen so that anyone passing by can not read said letter. If this
workstation is setup using Windows 9x, is it also reasonable to claim that
this machine is not securable? If I reboot the Win 9x machine, I can bypass
any password that was originally setup on this machine and still read the
letter. If I upgrade this machine to Windows NT / 2000 / XP, it is no
longer possible to bypass the security system. This is clearly a more
secure environment, but has anyone attempted to define if this falls within
the "reasonable" precautions that a practice should take?

Anyone have any ideas? I have talked to CMS and they said that they were
not really qualified to answer the question. Their initial reaction was
that this was an issue of security not privacy, but they later changed
their mind and said it might fall within the "reasonable" clause.

Thanks,
Marshall


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