Probabilistic Risk Analysis

1. Probabilistic Risk Analysis Farrokh Alemi, Ph.D.April 12, 2004

2. Why Assess Risks? • Based on experienced incidences across the industry • Allows benchmarks against peer organizations • If repeated overtime, measures progress in reducing risks • Can be used to set premiums for HIPAA insurance Not an imagined risk

3. Definitions • Risk assessment • Threat • Vulnerability • Security controls • Hazard • Risk mitigation

4. How to Assess Risks for Unauthorized Disclosures? • p(U) = ∑ i=1, .., n p(U | Hi) p(Hi) • p(Hi) = 1 / (1+ ti) • p(U | Hi) = p(Hi | U) p(U) / p(Hi)

5. Sources of Data

6. Assessment of Probability of Unauthorized Disclosure

7. Clinician using unsecured email environment Clinician gather information from patients’ family and friends after the visit Discussion of patient care with co-workers not engaged in care Medical reports or records with wrong recipient information Caring for employees’ friends and family members Benefit Organizations or employers request employee information Employees engaged in whistle blowing to uncover illegal or unacceptable business or clinical practices Patient records (paper documents) not kept in secure environment or sealed envelope; or documents displayed in plain view of others Clinician discusses patient care in a setting where others can easily hear Employee removes patient records from secure location or workplace without authorization Employee views paper documents or manipulates computer passwords to view medical records of patients not under his/her care External infection of computers / password / network Systems (e.g. computer hacker) Theft of computers or hard drives Sale of patient records Blackmail/Extortion of organization or an employee Patient using identity of another person to gain insurance benefits Changes in custody or family relationships not revealed by the patient Audit of business practices by outside firm without clinicians’ approval Business Associate violates Chain of Trust Agreement Legal System/Law Enforcement requests, subpoenas or seizes patient records Error in patient identity during data transfer to third party insurers List of Hazards

8. Prevalence of Hazards Among Unauthorized Disclosures

9. Prevalence of Hazards Among Unauthorized Disclosures

10. Prevalence of Hazards Among Unauthorized Disclosures

11. Assessment of Hazards at Health Care Organizations How often does a clinician in your organization email a message in an unsecured environment? Indicate the two most recent times, (enter number of days, weeks, months or years) prior to today when a clinician emailed a message in an unsecured environment: Please indicate the last two times when a clinician emailed a message in an unsecured environment: Enter date in the format DD/MM/YY

12. Assignment • Answer the online survey for an imaginary health care organization • Analyze responses to calculate probability of unauthorized disclosure • Discuss the assessment procedure

13. Take Home Lesson • Better rely on experienced hazards rather than imaginary ones • It is possible to estimate probability of rare events • It is possible to assess risk of unauthorized disclosures at our organizations