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Now that final rules are emerging related to the Health Insurance Portability and Accountability Act of 1996, it's more important than ever to make sure your facility's data security standards measure up. The best advice? 'Forget HIPAA for the moment and look at what you have in place,' says William Spooner, senior vice president and chief information officer for Sharp Healthcare in San Diego.
A critical overview of Swedish and Finnish medical web portals for doctors is presented in this article. Three Swedish and three Finnish portals were analysed using 54 dichotomous questions, derived from the guidelines of the American Medical Association (AMA), and 17 technical heuristic questions for web usability. 34 portal features were cross-tabulated with all portals. None of the portals did adhere to the AMA guidelines perfectly. Several problems with advertising, sponsorship, and website privacy were observed. Besides professional functionalities, the portals provided services for personal communication and entertainment features. The incomplete correspondence between the AMA guidelines and the current praxis of Nordic web portals for doctors may have many reasons. However, it is safe to conclude that Swedish and Finnish portals for physicians have some severe publicistic or ethical problems. Every physician should note that website privacy is not enough respected.
Healthcare providers trying to meet the April 21 deadline to comply with HIPAA's security regulations need to take several actions: Study the security regulations to determine adequate levels of security for each organization. Establish a security committee and appoint an information security officer. Identify existing security measures within the organization, including administrative, physical, and technical safeguards. Conduct a thorough risk analysis. Develop and implement remediation plans. Adequately train the workforce. Periodically review these compliance activities.
Consumers who claimed in recent surveys that they were "more afraid of cyber crimes than physical crimes" may have had reason for caution. A spate of well-publicized information thefts and security breaches at healthcare organizations have eroded trust in technology, says Carol Diamond, left, of the Markle Foundation, and that could have an adverse effect on acceptance of electronic medical records.
This paper presents results from a demonstration project of nationwide exchange of health data for the home care of diabetic patients. A consortium of industry, academic, and health care partners has developed reusable middleware components integrated using the HOLON architecture. Engineering approaches for multi-organization systems development, lessons learned in developing layered object-oriented systems, security and confidentiality considerations, and functionality for nationwide telemedicine applications are discussed.
OBJECTIVE: To evaluate an Internet-based telemedicine program designed to reduce the costs of care, to provide enhanced medical, informational, and emotional support to families of very low birth weight (VLBW) infants during and after their neonatal intensive care unit (NICU) stay. BACKGROUND: Baby CareLink is a multifaceted telemedicine program that incorporates videoconferencing and World Wide Web (WWW) technologies to enhance interactions between families, staff, and community providers. The videoconferencing module allows virtual visits and distance learning from a family's home during an infant's hospitalization as well as virtual house calls and remote monitoring after discharge. Baby CareLink's WWW site contains information on issues that confront these families. In addition, its security architecture allows efficient and confidential sharing of patient-based data and communications among authorized hospital and community users. DESIGN/METHODS: A randomized trial of Baby CareLink was conducted in a cohort of VLBW infants born between November 1997 and April 1999. Eligible infants were randomized within 10 days of birth. Families of intervention group infants were given access to the Baby CareLink telemedicine application. A multimedia computer with WWW browser and videoconferencing equipment was installed in their home within 3 weeks of birth. The control group received care as usually practiced in this NICU. Quality of care was assessed using a standardized family satisfaction survey administered after discharge. In addition, the effect of Baby CareLink on hospital length of stay as well as family visitation and interactions with infant and staff were measured. RESULTS: Of the 176 VLBW infants admitted during the study period, 30 control and 26 study patients were enrolled. The groups were similar in patient and family characteristics as well as rates of inpatient morbidity. The CareLink group reported higher overall quality of care. Families in the CareLink group reported significantly fewer problems with the overall quality of care received by their family (mean problem score: 3% vs 13%). In addition, CareLink families also reported greater satisfaction with the unit's physical environment and visitation policies (mean problem score: 13% vs 50%). The frequency of family visits, telephone calls to the NICU, and holding of the infant did not differ between groups. The duration of hospitalization until ultimate discharge home was similar in the 2 groups (68.5 +/- 28.3 vs 70.6 +/- 35.6 days). Among infants born weighing <1000 g (n = 31) there was a tendency toward shorter lengths of stay (77.4 +/- 26.2 vs 93.1 +/- 35.6 days). All infants in the CareLink group were discharged directly to home whereas 6/30 (20%) of control infants were transferred to community hospitals before ultimate discharge home. CONCLUSIONS: CareLink significantly improves family satisfaction with inpatient VLBW care and definitively lowers costs associated with hospital to hospital transfer. Our data suggest the use of telemedicine and the Internet support the educational and emotional needs of families facilitating earlier discharge to home of VLBW infants. We believe that further extension of the Baby CareLink model to the postdischarge period will significantly improve the coordination and efficiency of care.
Biometric authentication systems are widely applied because they offer inherent advantages over classical knowledge-based and token-based personal-identification approaches. This has led to the development of products using palmprints as biometric traits and their use in several real applications. However, as biometric systems are vulnerable to replay, database, and brute-force attacks, such potential attacks must be analyzed before biometric systems are massively deployed in security systems. This correspondence proposes a projected multinomial distribution for studying the probability of successfully using brute-force attacks to break into a palmprint system. To validate the proposed model, we have conducted a simulation. Its results demonstrate that the proposed model can accurately estimate the probability. The proposed model indicates that it is computationally infeasible to break into the palmprint system using brute-force attacks.
OBJECTIVE: To investigate practical solutions that can integrate cryptographic techniques and picture archiving and communication systems (PACS) to improve the security of medical images. DESIGN: The PACS at the University of California San Francisco Medical Center consolidate images and associated data from various scanners into a centralized data archive and transmit them to remote display stations for review and consultation purposes. The purpose of this study is to investigate the model of a digital trust center that integrates cryptographic algorithms and protocols seamlessly into such a digital radiology environment to improve the security of medical images. MEASUREMENTS: The timing performance of encryption, decryption, and transmission of the cryptographic protocols over 81 volumetric PACS datasets has been measured. Lossless data compression is also applied before the encryption. The transmission performance is measured against three types of networks of different bandwidths: narrow-band Integrated Services Digital Network, Ethernet, and OC-3c Asynchronous Transfer Mode. RESULTS: The proposed digital trust center provides a cryptosystem solution to protect the confidentiality and to determine the authenticity of digital images in hospitals. The results of this study indicate that diagnostic images such as x-rays and magnetic resonance images could be routinely encrypted in PACS. However, applying encryption in teleradiology and PACS is a tradeoff between communications performance and security measures. CONCLUSION: Many people are uncertain about how to integrate cryptographic algorithms coherently into existing operations of the clinical enterprise. This paper describes a centralized cryptosystem architecture to ensure image data authenticity in a digital radiology department. The system performance has been evaluated in a hospital-integrated PACS environment.
This paper describes the implementation of the Web Based Pneumonia Chemotherapeutics (WPCh) a Web-based expert system for chemotherapeutic assistantship for nosocomial and community-acquired pneumonia based on different types of data. WPCh can be accessed through World Wide Web or a mobile phone using the relevant script languages. The core of the paper focuses on the usage of security of data and the procedures used to accomplish this task. After the log in of the physician, he can take advantage of the various modules of the expert system in order to view chemotherapeutics and save the data that he prefers. The whole procedure can be followed through the interfaces of wap technology.
Information security is a must in health care as is commonly know. This paper describes the conflict between the strategic goals of an organisation and organising information security and confidentiality. Because of local strategies and the organisational effect on the need for information, it is necessary to describe the main features of the Finnish Health care system and Helsinki City Health Department.
The use of E-mail in the school setting has become a standard method of communication. E-mail can increase the efficiency of communicating with parents and students. Privacy and security considerations regarding the use of E-mail to transmit health information must be addressed. This article outlines regulations and the best practices for using E-mail in the school health office.
The Health Insurance Portability and Accountability Act of 1996 is having a profound impact on fraud and abuse detection and prevention, electronic communication standards, and health information security. Moving forward into the new millennium, we can expect acceleration of its ongoing programs, and expansion of its scope to electronic medical record standards.
As the technology of on-line healthcare information advances, hospitals and data vendors are faced with a variety of challenges. What are the accepted standard fields? What kind of DSS system should we use? Which system will give us the information we need? Does the server have enough space to handle increased business? Healthcare organizations are now looking at comparative information through the Internet instead of buying data and loading it onto their own servers. They are asking: Are servers necessary now? Is the software user-friendly? How current and accurate is the information being offered? How secure is the Web site it is on? Data vendors are asking: Is our server large enough to handle the volume of data we now have and as the company grows? How do we make sure the data are accurate? How do we keep the data secure? This article educates and informs healthcare facilities about the factors that should be considered when comparing their own data with those of other hospitals in an on-line benchmarking database warehouse.
Telemedical applications like the electronic patient file, the electronic physician's letter and the electronic consultation ("Telekonsil"), the electronic prescription, the electronic patient's card (the "patient smart card") facilitate and improve the processing of sensitive medical data as well as the possibilities for using medical resources in an unusual degree and can thereby substantially contribute to the well-being of the patient. However, improving the quality of medical supply must not lead to a degradation of the patients' rights, in particular their right of self-determination. The introduction and the use of telemedical applications do not change the legal basic conditions for medical data processing. Therefore, a patient-friendly telemedicine must include data protection as well. Data protective telemedicine requires medical secrecy ensuring the patients' rights of information and transparency, correction of false and the up-to-date deletion of information that is no longer necessary, as well as secure data processing. All electronic processing of patients' data must meet the requirements of data security, i.e. the confidentiality, the integrity, the availability of the data at any time and the verifiability of the data processing have to be guaranteed. For this, electronic signatures and encodings have to be used, medical information systems have to be protected effectively against any risks resulting from open networks, particularly the Internet, and data processing has to be monitored. Electronic patient files may be open only to the treating physician and the medical assistants up to the necessary extent, ensuring the possibility of an emergency access. Any access beyond that does require the special consent of the patient. The medical secrecy has to be ensured. The electronic prescription with a documentation of the patient's medication requires the consent of the patient and must protect the rights of the physicians. In particular it has to ensure that the respective physician's prescribing behaviour cannot be stored or become known from a third party. Furthermore it has to protect the pharmacists' right to hide their turnover from other pharmacies. So-called patient smart cards require the consent of the patient. The right of the patient to keep his information secret, must be ensured with access options to the information stored on the smart card. Electronic physician's letters and socalled Telekonsile, i.e. the consultation with professional colleagues who were not involved in the patient's treatment from the beginning, require basically the agreement of the patient--if there cannot be dealt with anonymized data already from the beginning. In emergencies, after adequate consideration and weighing of values and interests, the consent of the patient can be suspected. The adherence to these boundary conditions ensures security and trustworthiness of telemedicine regarding the security of data processing as well as the rights of self-determination of all who are concerned. Data protection is also a contribution for the acceptance of these revolutionary advancements in the medical world.
Both the United States Environmental Protection Agency (EPA) and the U.S. Food and Drug Administration (FDA) have issued regulatory documents that address the issues and requirements concerning electronic reporting to the Agencies. EPA has published two comprehensive and useful electronic data interchange (EDI) guidelines: 1) the EPA Electronic Data Interchange (EDI) Implementation Guideline, Draft of September 23, 1994 and October 18, 1994 that is available at the following EPA web site address: www.epa.gov/oppeedi1/guidelines/general.pdf and 2) the Interim Final Notice, Filing of Electronic Reports via Electronic Data Interchange, September 4, 1996, Federal Register Notice [FRL-5601-4, Volume 61, Number 172, page 46684], also available at: www.epa.gov/oppeedi1/edipoli.htm. The FDA has published a guidance document titled, "Guidance for Industry, Computerized Systems Used in Clinical Trials, April 1999" that is available at FDA's web site: www.fda.gov/ora/compliance_ref/bimo/ffinalcct.++ +htm. FDA's guidance document addresses a number of issues for electronic records that are applicable to all areas of GLP compliance. Another FDA document presently under development is titled, "Electronic Standards for the Transmission of Regulatory Information (ESTRI) Gateway." The ESTRI document defines strategic plans for electronic submissions to FDA. FDA has published a guidance document in this area titled, "Guidance for Industry: Providing Regulatory Submissions in Electronic Format--General Considerations, January 1999." This guidance document is available at: www.fda.gov/cder/guidance/index.htm. FDA has also published an important final rule applicable to all electronic records and signatures that is part of the U.S. Title 21 Code of Federal Regulations (CFR), Part 11, titled, "FDA's Final Rule, Electronic Records; Electronic Signatures, effective August 20, 1997." This FDA ruling is discussed below and is available at: www.fda.gov/cder/esig/index.htm.
EDI is expected to be the dominant form of business communication between organizations moving to the Electronic Commerce era of 2000. The healthcare sector is already using EDI in the hospital supply function as well as in the clinical area and the reimbursement process. In this paper, we examine the use of EDI in the healthcare administration sector and more specifically its application to the Medical Device Vigilance System. Firstly, the potential of this approach is examined, followed by the definition of the EDI System Reference Model and the specification of the required system architecture. Each of the architecture's components are then explained in more detail, followed by the most important implementation options relating to them.
Materials management information systems (MMISs) incorporate information tools that hospitals can use to automate certain business processes, increase staff compliance with these processes, and identify opportunities for cost savings. Recently, there has been a push by hospital administration to purchase enterprise resource planning (ERP) systems, information systems that promise to integrate many more facets of healthcare business. We offer this article to help materials managers, administrators, and others involved with information system selection understand the changes that have taken place in materials management information systems, decide whether they need a new system and, if so, whether a stand-alone MMIS or an ERP system will be the best choice.
Biometric analysis for identity verification is becoming a widespread reality. Such implementations necessitate large-scale capture and storage of biometric data, which raises serious issues in terms of data privacy and (if such data is compromised) identity theft. These problems stem from the essential permanence of biometric data, which (unlike secret passwords or physical tokens) cannot be refreshed or reissued if compromised. Our previously presented biometric-hash framework prescribes the integration of external (password or token-derived) randomness with user-specific biometrics, resulting in bitstring outputs with security characteristics (i.e., noninvertibility) comparable to cryptographic ciphers or hashes. The resultant BioHashes are hence cancellable, i.e., straightforwardly revoked and reissued (via refreshed password or reissued token) if compromised. BioHashing furthermore enhances recognition effectiveness, which is explained in this paper as arising from the Random Multispace Quantization (RMQ) of biometric and external random inputs.