title: Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security.
abstract: This case study describes and analyzes a breach of the confidentiality and integrity of personally identified health information (e.g. appointment details, answers to patients' questions, medical advice) for over 800 Kaiser Permanente (KP) members through KP Online, a web-enabled health care portal. The authors obtained and analyzed multiple types of qualitative data about this incident including interviews with KP staff, incident reports, root cause analyses, and media reports. Reasons at multiple levels account for the breach, including the architecture of the information system, the motivations of individual staff members, and differences among the subcultures of individual groups within as well as technical and social relations across the Kaiser IT program. None of these reasons could be classified, strictly speaking, as "security violations." This case study, thus, suggests that, to protect sensitive patient information, health care organizations should build safe organizational contexts for complex health information systems in addition to complying with good information security practice and regulations such as the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
authors.affiliation: Georgetown University Medical Center, Washington, DC, USA. collmanj@georgetown.edu
authors.forename: Jeff
authors.initials: J
authors.lastname: Collmann
authors.forename: Ted
authors.initials: T
authors.lastname: Cooper
mesh_terms: D016494:Computer Security; D003219:Confidentiality; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D034742:Electronic Mail / Q000458:organization & administration*; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D019982:Organizational Case Studies; D012984:Software; D012985:Software Design; D013647:Task Performance and Analysis