FISMA still being touted as best security for health information exchange
Coming out of the recent CONNECT User Training Seminar held this week in Washington, DC is a reiteration of the opinion previous expressed by federal stakeholders working on the Nationwide Health Information Network (NHIN) that non-federal entities seeking to participate in the NHIN need to step up their security and privacy to at least meet the level of federal practices under FISMA. The suggestion once again is that security practices of private sector healthcare organizations and other businesses are less rigorous and less effective than those of public sector organizations. The recommendation is that all would-be NHIN participants should adopt a risk-based security management and security control standard such as the framework articulated in NIST Special Publication 800-53, used by all federal agencies.
There’s no question that a baseline set of security standards and practices would go a long way towards establishing the minimum level of trust needed for public and private sector entities to be comfortable with sharing health data. What seems a bit disingenuous however is the suggestion, repeated on Tuesday by the CIO of the Center for Medicare and Medicaid Services, that current government security and privacy practices are the model that should be broadened to apply to the private sector. Any organization currently following ISO/IEC 27000 series standards for risk management and information security controls is already assuming a posture commensurate with a federal agency using 800-53 — no less an authority than the FISMA team at NIST has acknowledge the substantial overlap between 800-53 and ISO 27002 controls, and NIST’s more recent released SP800-39 risk management guidance was influenced by the corresponding risk management elements in ISO 27001, 27002, and 27005 as well.
The hardest piece to reconcile may be the need for organizations to certify the security of their systems and supporting processes. Here again, it’s hard to argue that some sort of certification (or even objective validation) of security controls could help establish, monitor, and enforce necessary security measures in all participating organizations. The federal model for certification and accreditation is a self-accrediting form of security governance, so the logical extension of this model would be to have private enterprises similarly self-certify and assert their security and privacy practices are sufficient. Aside from the trust issues inherent to any subjective system of self-reported compliance, it’s not at all clear what level of oversight would be put in place under the still-emerging NHIN governance framework, or what federal laws have to offer in terms of an approach. While there are explicit legal penalties for violation of health privacy and security laws such as HIPAA, the only outcome for a federal agency failing to follow effective security practices under FISMA is a bad grade on an OMB report card. FISMA simply isn’t a best practice for verifying effective security.