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PubMed1998

Secured medical imaging over the Internet.

The Internet has established itself as an affordable, extremely viable and ubiquitous communications network that can be easily accessed from virtually any point in the world. This makes it ideally suited for medical image communications. Issues regarding security and confidentiality of information on the Internet, however, need to be addressed for both occasional, individual users and consistent enterprise-wide users. In addition, the limited bandwidth of most Internet connections must be factored into the development of a realistic usermodel and resulting protocol. Open architecture issues must also be considered so that images can be communicated to recipients who do not have similar programs. Further, application-specific software is required to integrate image acquisition, encryption and transmission into a single, streamlined process. Using Photomailer software provided by PhysiTel Inc., the authors investigated the use of sending secured still images over the Internet. The scope of their investigation covered the use of the Internet for communicating images for consultation, referral, mentoring and education. Photomailer software was used at several local and remote sites. The program was used for both sending and receiving images. It was also used for sending images to recipients who did not have Photomailer, but instead relied on conventional email programs. The results of the investigation demonstrated that using products such as Photomailer, images could be quickly and easily communicated from one location to another via the Internet. In addition, the investigators were able to retrieve images off of their existing email accounts, thereby providing greater flexibility and convenience than other systems which require scheduled transmission of information on dedicated systems. We conclude that Photomailer and similar products may provide a significant benefit and improve communications among colleagues, providing an inexpensive means of sending secured images on the Internet.

Computer Communication Networks↗
PubMed2000

[Clinical data protection and the internet].

The benefit of using the internet in health care is growing: Information retrieval, communication, and telemedical cooperation support the physician and serve the patient. On the other hand connecting a hospital to the internet leads to considerable security problems, exposes sensible data to danger, and corrupts the professional discretion, unless the connection is installed and managed with extreme care. The state of the art for an internet connection is a firewall system. Moreover the security in a networked environment depends on a cryptographic infrastructure. This will soon be provided in Germany by Health Professional Cards.

Computer Security↗
PubMed2000

Property rights and privacy principles.

Healthcare consumers own their medical information. As paper medical folders become digital, protection of this private and confidential information falls to information specialists rather than the traditional care givers. On the basis of a nationwide market assessment study, the authors identify the key issues regarding protecting this personal digital property and outline the federal requirements stemming from the Health Insurance Portability and Accountability Act (HIPAA). Consumer informed consent over the use of specific medical data is a basic requirement, and is a concept supported by physicians and care givers who rely on consent to approve surgeries and treatment. The article concludes with a solution outline that places the patient in control of his or her personal information, meets security and privacy concerns, and facilitates the critical exchange of patient information among care givers.

Computer Security↗
PubMedDate not supplied

Recognizing and reducing risks: HIPAA privacy and security enforcement.

With the passing of the Health Insurance Portability and Accountability Act (HIPAA) privacy rule deadline and the security rule deadline looming, many covered entities are left wondering if they are doing enough to prevent privacy and security breaches and what type of exposure their organization could face in the event of a breach.

Computer Security↗
PubMedDate not supplied

HIPAA training requirements.

The addition of security standard training requirements increases the complexity of HIPAA implementation and ongoing program management. In comparison to the expectations of the Privacy Rule, security elements are more numerous and complicated--they also represent new territory for the radiology manager, who may be encountering a new language and unfamiliar technological terminology. The deadline for compliance with the Security Standard is April 21, 2005. It is, therefore, important to review training expectations as part of overall HIPAA compliance preparations.

Computer Security↗
PubMedDate not supplied

Assessing staff attitudes towards information security in a European healthcare establishment.

Information security is now recognized as an important consideration in modern healthcare establishments (HCEs), with a variety of guidelines and standards currently available to enable the environments to be properly protected. However, financial and operational constraints often exist which influence the practicality of these recommendations. This paper establishes that the staff culture of the organization is of particular importance in determining the level and types of security that will be accepted. This culture will be based upon staff awareness of and attitudes towards security and it is, therefore, important to have a clear idea of what these attitudes are. To this end, two surveys have been conducted within a reference environment to establish the attitudes of general users and technical staff, allowing the results to be fed back to HCE management to enable security policy to be appropriately defined. These results indicated that, although the establishment had participated in a European healthcare security initiative, staff attitudes and awareness were still weak in some areas.

Attitude of Health Personnel↗
PubMed1997

The help of formal models for healthcare security policies.

This article is a personal contribution (i.e., from a strict security expert point of view) towards the help for specification, validation and/or evaluation of reliable, but also secure, healthcare security policies (HSP). The first part is dedicated to show, according to the various aspects of the security policy concept, that healthcare information systems (HIS) offer such a diversity of particularities and potential security needs, that it is necessary for healthcare security policies to be defined as flexible, but also as robust, as possible. Then the formal modelling approach, a wide area of solutions providing both flexibility (by means of modelling) and robustness (by means of formalization), is presented. The most well-known examples of security models are recalled. All of them try to use formal models as a security policy specification/validation tool, but none of them can be helpfully used in the very demanding context of HIS. Lastly, a new approach for the modelling of healthcare security policies, based on modal logic (i.e., epistemic and/or deontic logic) is proposed. It permits to take into account the flexibility (by means of high expressiveness due to modality) and the robustness (by means of high provability due to modelling) needs.

Computer Security↗
PubMed2001

Human resource assignment and role representation mechanism with the "cascading staff-group authoring" and "relation/situation" model.

We have previously reported the access control mechanism and audit strategy of the "patient-doctor relation and clinical situation at the point-of-care" model with multi-axial access control matrix (ACM). This mechanism overcomes the deficit of ACM in the aspect of data accessibility but does not resolve the representation of the staff's affiliate and/or plural membership in the complex real world. Care groups inside a department or inter-department clinical team plays significant clinical role but also spend great amount of time and money in the hospital. Therefore the impact of human resource assignment and cost of such stakeholders to the hospital management is huge, so that they should be accurately treated in the hospital information system. However multi-axial ACM has problems with the representation of staff groups due to static parameters such as department/license because staffs belong to a group rather temporarily and/or a medical staff may belong to plural groups. As a solution, we have designed and implemented "cascading staff-group authoring" method with "relation and situation" model and multi-axial ACM. In this mechanism, (i) a system administrator certifies "group chief certifying person" according to the request and authorization by the department director, (ii) the "group chief certifying person" certifies "group chief(s)", (iii) the "group chief" recruits its members from the medical staffs, and at the same time the "group chief" decides the profit distribution policy of this group. This will enable medical staff to access EMR according to the role he/she plays whether it is as a department staff or as a group member. This solution has worked successfully over the past few years. It provides end-users with a flexible and time-to-time staff-group authoring environment using a simple human-interfaced tool without security breach and without system administration cost. In addition, profit and cost distribution is clarified among departments and inter-departments groups.

Computer Security↗
PubMed1996

The NUCLEUS integrated electronic patient dossier breakthrough and concepts of an open solution.

This paper addresses the requirements of healthcare providers and hospital managers vis-à-vis electronic patient records that can be integrated. It starts from some critical failure factors, found with previous attempts to standardise the electronic health record. Standardisation appears to be the key issue: the subject of standardisation requires delicate positioning. Technology must provide us with the means to obtain the standardised foundation for an integrated health record concept, which can be completely configured and customised to meet the requirements of health professionals and institutions involved. NUCLEUS, project A2025 in the AIM programme, has taken on this endeavour, and with good success. This paper summarises the benefits of this approach for various categories of people interested in using electronic patient records. Moreover, it illustrates NUCLEUS' contribution to achieving seamless integration of care. Furthermore, this paper explains the conceptual innovations that have been achieved in the NUCLEUS project. It consolidates the main concept of Act Management, structuring the professional primary process as well as the interprofessional communication. These concepts are subsequently expanded to include the key elements of the NUCLEUS integrated electronic patient record. Next, the paper reflects on what has appeared to be one of the critical success factors of the electronic patient record: its configuration and customisation facilities. These facilities make it possible to access the patient record at various intuitive aggregation levels and to make the integrated patient record 'look like' the individually specialised record of the respective healthcare professionals. Finally, the paper addresses various topics required to facilitate the successful implementation and operation of the NUCLEUS integrated electronic patient record like security, integrity, message communication, distribution, heterogeneity and the context of the hospital information system.

Communication↗
PubMed2001

Slovene smart card and IP based health-care information system infrastructure.

Slovenia initiated a nation-wide project to introduce smart cards in the health sector in 1995 and its full-scale deployment started in September 2000. Although the basic aim of the project was to support insurance related procedures, the system was designed in a flexible and open manner to present an infrastructure for the whole health sector. The functionality of the current system is described in this paper along with lessons learned so far. The upgrade of the system is outlined, with emphasis on technical details, the objective being to provide a real-time EDI based environment for a general set of applications in the medical sector, supported by the flexibility and security of modern smart card technologies. Integration with similar systems in other EU countries is discussed.

Computer Communication Networks↗
PubMed2001

A preliminary report of the virtual craniofacial center: development of Internet-/Intranet-based care coordination of pediatric craniofacial patients.

The authors present preliminary information regarding the development of an Internet-based Virtual Craniofacial Center that provides access to a patient database with visual and textual data. Patients are photographed by digital camera with standardized images. Through a Web site linked to a remote database, patient demographics, management data, reports, and acquired digital photographic images are stored and retrieved. The database can be used to sort and to present data as desired by multiple specialists. Confidentiality is maintained by unique identification numbers and password access to the server for craniofacial team members. The current system uses economical equipment (i.e., digital camera, personal computer with modem, and access to a remote Windows NT-based server), using data that can be entered in a variety of cross-platform personal computer systems and transmitted on a wide range of bandwidths-from a relatively low-bandwidth (28.8 KB per second) modem to a high-speed T-3 line connection. Long-term goals include archival data storage and analysis, as well as the development of multicenter telemedicine links for active craniofacial centers.

Child↗
PubMed1995

Development of an interactive data base management system for capturing large volumes of data.

Accurate collection and successful management of data are problems common to all scientific studies. For studies in which large quantities of data are collected by means of questionnaires and/or forms, data base management becomes quite laborious and time consuming. Data base management comprises data collection, data entry, data editing, and data base maintenance. In this article, the authors describe the development of an interactive data base management (IDM) system for the collection of more than 1,400 variables from a targeted population of 6,000 patients undergoing heart surgery requiring cardiopulmonary bypass. The goals of the IDM system are to increase the accuracy and efficiency with which this large amount of data is collected and processed, to reduce research nurse work load through automation of certain administrative and clerical activities, and to improve the process for implementing a uniform study protocol, standardized forms, and definitions across sites.

Cardiac Surgical Procedures↗
PubMed2005

[Legal aspects of teledermatology].

Teledermatology places special demanding on participating physicians who are not only required to exercise the normal standard of care in diagnosis and treatment, but must also have additional obligations. The teledermatologist must have sufficient technical background to recognize if and how information transmitted by electronic media can serve as a basis for reliable diagnosis. He must work with an information transfer system which meets technical standards and legal requirments. Patient data security and data privacy requires special attention, as does the competence and legal status of the referring physician worker.

Austria↗
PubMed1997

Smart cards--the key to trustworthy health information systems.

Some 20 years after they were first developed, "smart cards" are set to play a crucial part in healthcare systems. Last year about a billion were supplied, mainly for use in the financial sector, but their special features make them of particular strategic importance for the health sector, where they offer a ready made solution to some key problems of security and confidentiality. This article outlines what smart cards are and why they are so important in managing health information. I discuss some of the unique features of smart cards that are of special importance in the development of secure and trustworthy health information systems. Smart cards would enable individuals' identities to be authenticated and communications to be secured and would provide the mechanisms for implementing strong security, differential access to data, and definitive audit trails. Patient cards can also with complete security carry personal details, data on current health problems and medications, emergency care data, and pointers to where medical records for the patient can be found. Provider cards can in addition carry authorisations and information on computer set up.

Computer Security↗
PubMed2004

[Development of a radiation therapy information system and linked medical image server using techniques of WWW-DB].

We developed management system for medical information such as radiation therapy information and associated medical image information. Features of the system are to browse medical information with web browser through network. The system was constructed by open source software, which made proprietary client software unnecessary. Clinical studies suggested that the system proved useful in terms of paperless managemet. In addition, useful features are visibility and portability to browse medical information using PDA (Personal Data Assistant) via wireless LAN (Local Area Network). We also proposed a new approach which can contribute to remote areas by providing medical information using the Internet.

Computer Communication Networks↗