Are covered entities unnecessarily giving fundraisers PHI on patients?

I have no doubt that numerous sites will start generating “lessons learned” or “five takeaways” from the Blackbaud breach — if they haven’t done so already.  And perhaps one of the consequences of this mega-breach needs to be a discussion of whether some entities are unnecessarily giving their fundraising arms or business associates too much protected health information (PHI).

I understand that organizations like to personalize fundraising pitches to try to boost their effectiveness.  Pitches to grateful patients or grateful family members may even want to to remind potential donors of their experience to encourage them to give more. But do they really need to give business associates or fundraising arms specific details like dates of service or the departments involved?

In the process of compiling the list of Blackbaud clients who now have to notify their patients or former patients because of the type of data they provided Blackbaud, I saw examples of what I consider to be “TMI”  (too much information).  As just two examples:

Northwestern Memorial Healthcare’s notification describes the data provided to Blackbaud as including:

donor or patient information for whom donations were made, including names, age, gender, dates of birth, medical record number, dates of service, departments of service, treating physicians, and/or limited clinical information

Community Medical Center’s notification describes their patient data provided to Blackbaud this way:

patient names, addresses, phone numbers, email addresses, dates of birth, patient complaint and diagnosis information, room numbers, patient identification numbers and/or medical record numbers, the name of the hospital where the patient was treated, and the applicable hospital department or unit.

Sadly, there are many more examples I could cite.

Trinity Health included some explanation in their breach notices to help those affected understand why some information was shared:

After a patient receives care at a Trinity Health ministry, our Philanthropy teams reach out with the opportunity to express gratitude in honor of their care teams. We call this activity our “Grateful Patient Program.” A form of grateful patient program is implemented at many major, non-profit health care institutions. University fundraisers approach their alumni in a similar way. Limited patient information is included in the database, the examples below are not all inclusive. The examples listed are meant to provide insight into how we use the information in our database.

Date of last service is included so that former patients are not contacted too soon after care.

A referring physician is included to ensure that we honor the patient’s wishes if they return a gift or thank you. Patient responses do not always include the name of the physician or there are misspellings.

Age is used to exclude minors from mailings. We consider age in order to offer information in a way that is preferred by that age group. For example, an elderly patient may prefer to receive communication via mail rather than email.

But couldn’t that PHI  be easily avoided? Instead of providing date of last service, use a field like “Initiate contact no earlier than <date>.”  Instead of “referring physician,” have a field like “In honor of” which doesn’t necessarily convey a doctor-patient relationship.  And instead of “age”, use an “exclude” field of 0/1, and then a “preferred format” field. You’ve just replaced three pieces of PHI with non-PHI. How many other data elements can be eliminated or converted to non-PHI?

 

As of today, DataBreaches.net has compiled a list of 68 entities that provided Blackbaud with data on patients or some medically related information on donors. For the 29 reports for which we have numbers, we have a total of more than 4.6 million U.S. patients affected.

What will the final total be if we get the missing numbers and find out about more reports? More than 10 million? How many notifications could have been avoided if entities did not give Blackbaud so much personally identifiable PHI?

If you disagree or have a different perspective, please use the Comments section to share your thoughts.

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