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An informatics system to support knowledge management in the health sector--the South African National Health Knowledge Network.

This paper discusses the planning and development of a South African national health knowledge network. The methodology is in essence based on the principles of knowledge management and the drivers of a system of innovation. The knowledge network, SA HealthInfo, aims to provide a one-stop interactive forum/resource, for quality-controlled and evidence-based health research information, to a wide spectrum of users, at various levels of aggregation, with the necessary security arrangements and facilities for interaction among users to promote explicit (codified) and tacit knowledge flow. It will therefore stimulate the process of innovation within the South African health system.

Computer Security↗

Secure de-identification and re-identification.

Today's healthcare organizations have both an ethical and legal responsibility for protecting patient privacy. However, the HIPAA privacy rule allows for the release of de-identified patient data for certain purposes. Secure encryption technology can be used to encrypt patient identified data so only the owners of the original data can re-identify the patient. It further allows consistent de-identification over episodic collection events.

Computer Security↗

The protection of individuals by protecting medical data in EHRs.

The paper discusses the changes in the delivery of Healthcare and the ways in which individuals need to be protected by protecting their Electronic Health Records. A Code of Ethics is needed for health Information Professionals, Data Protection and Security issues need to be taken more seriously. Health Informatics needs to address the issues of safety in the delivery of Healthcare so that it provides solutions to healthcare safety problems rather than increasing the problems to be addressed.

Computer Security↗

A risk management approach to the security of hospital information systems.

Risk management in today's technologically advanced health care system demands proactive rather than reactive strategies. Risk management is defined as a planned program for liability control and involves the identification, analysis and evaluation of legal risks followed by strategies to reduce or eliminate these risks. The concept of risk management is most often associated with quality assurance and direct patient care activities. For current purposes, the risk management concept is borrowed from arena of patient care and applied to the security measures surrounding hospital information systems. In this context, risk management/liability control is viewed as proactive activities designed to protect both the hospital information system and the confidentiality of patient information.

Computer Security↗

A microprocessor card software server to support the Quebec health microprocessor card project.

The Quebec Health Smart Card Project is advocating the use of a memory card software server[1] (SCAM) to implement a portable medical record (PMR) on a smart card. The PMR is viewed as an object that can be manipulated by SCAM's services. In fact, we can talk about a pseudo-object-oriented approach. This software architecture provides a flexible and evolutive way to manage and optimize the PMR. SCAM is a generic software server; it can manage smart cards as well as optical (laser) cards or other types of memory cards. But, in the specific case of the Quebec Health Card Project, SCAM is used to provide services between physicians' or pharmacists' software and IBM smart card technology. We propose to expose the concepts and techniques used to provide a generic environment to deal with smart cards (and more generally with memory cards), to obtain a dynamic an evolutive PMR, to raise the system global security level and the data integrity, to optimize significantly the management of the PMR, and to provide statistic information about the use of the PMR.

Computer Security↗

Materials management information systems.

The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The MMIS Selection Process: Outlines steps to follow and describes factors to consider when selecting an MMIS. Also includes our Materials Management Process Evaluation and Needs Assessment Worksheet (which is also available online through ECRInet(TM)) and a list of suggested interview questions to be used when gathering user experience information for systems under consideration. Section 3A. MMIS Vendor Profiles: Presents information for the evaluated systems in a standardized, easy-to-compare format. Profiles include an Executive Summary describing our findings, a discussion of user comments, a listing of MMIS specifications, and information on the vendor's business background. Section 3B. Discussion of Vendor Profile Conclusions and Ratings: Presents our ratings and summarizes our rationale for all evaluated systems. Also includes a blank Vendor Profile Template to be used when gathering information on other vendors and systems. We found that, in general, all of the evaluated systems are able to meet most of the functional needs of a materials management department. However, we did uncover significant differences in the quality of service and support provided by each vendor, and our ratings reflect these differences: we rated two of the systems Acceptable--Preferred and four of the systems Acceptable. We have not yet rated the seventh system because our user experience information may not reflect the vendor's new ownership and management. When this vendor provides the references we requested, we will interview users and supply a rating. We caution readers against basing purchasing decisions solely on our ratings. Each hospital must consider the unique needs of its users and its overall strategic plans--a process that can be aided by using our Process Evaluation and Needs Assessment Worksheet. Our conclusions can then be used to narrow down the number of vendors under consideration...

Computer Security↗

Wireless technology infrastructures for authentication of patients: PKI that rings.

As the public interest in consumer-driven electronic health care applications rises, so do concerns about the privacy and security of these applications. Achieving a balance between providing the necessary security while promoting user acceptance is a major obstacle in large-scale deployment of applications such as personal health records (PHRs). Robust and reliable forms of authentication are needed for PHRs, as the record will often contain sensitive and protected health information, including the patient's own annotations. Since the health care industry per se is unlikely to succeed at single-handedly developing and deploying a large scale, national authentication infrastructure, it makes sense to leverage existing hardware, software, and networks. This report proposes a new model for authentication of users to health care information applications, leveraging wireless mobile devices. Cell phones are widely distributed, have high user acceptance, and offer advanced security protocols. The authors propose harnessing this technology for the strong authentication of individuals by creating a registration authority and an authentication service, and examine the problems and promise of such a system.

Cell Phone↗

Object manifestations for medical imaging applications.

As healthcare providers become increasingly decentralized and distributed, information systems support must follow suit by providing healthcare professionals with flexible, adaptable and secure views of medical data in a timely fashion. To this end, this paper introduces the notion of manifestations of medical image objects in a heterogeneous client environment. We define the fundamental building blocks of manifestations using object-oriented concepts. Examples are given of how constraints and rules can be used to govern the presentation of data within objects and for the environmental (e.g. hardware and network) and user defined factors (e.g. preferences) that act as inputs to manifestations. Using these techniques, we give several examples of user interactions with a system based on manifestations. This paper demonstrates how objects can be efficiently and effectively presented to users with various information appliances using manifestation techniques.

Computer Security↗

[User acceptance of health telematics applications].

The user acceptance of health telematics in medical care plays a critical role in mediating the success of its implementation. Model assumptions evolving from different fields such as industry, health care and medical psychology are presented, and various perspectives for patients and providers involved in these models are highlighted. The impact of health telematics on health care results from four components: (a) the improvement of work characteristics and communication processes, (b) the enhancement of diagnostic and treatment quality via telematics, (c) technical and economic advantages and (d) communication tools for patient. The evidence concerning clinical, economic and psychosocial criteria within these domains is reviewed according to the published literature. Despite the fact that a considerable benefit of health telematics has been shown in individual studies, the evidence concerning the improvement of health care, the improvement of work and communication processes as well as concerning its clinical and cost effectiveness is still scarce. It is recommended to further integrate health telematics and health service research.

Attitude of Health Personnel↗

Medical data and knowledge management by integrated medical workstations: summary and recommendations.

The health care professional workstation will function as an interface between the user and the patient data as well as an interface pertinent medical knowledge. Appropriate knowledge focus will require the workstation to recognize the concepts and structure of patient data, and understand the scope and access methods of knowledge sources. Issues are organized around five major themes: (i) structure, (ii) reliability and validation, (iii) views, (iv) location, and (v) ethical and legal. Conventional database representations can effectively address data structure and format variations that will inevitably persist in local data stores. The reliability of data and the validation of knowledge are critical issues that may determine the ultimate utility of clinical workstations. Alternative views of patient information and knowledge sources represent the true power of an intelligent data portal, represented by a well-designed clinical workstation. Both data and knowledge are optimally represented in decentralized information networks, although the confidentiality and ownership of this information must be respected. Evolutionary progress toward consistent representations of knowledge and patient data will be facilitated by the establishment of self-documentation standards for the developers of data encoding systems and knowledge sources, perhaps extended from the preliminary model afforded by the Unified Medical Language System (UMLS).

Computer Security↗

An automated patient registration and treatment randomization system.

Centralized patient registration and treatment randomization for multicenter clinical trials has many advantages over other approaches. Our Automated Patient Registration and Treatment Randomization system is a fully automated Interactive Voice Response, microcomputer-based application which can operate unattended and is continuously available to provide patient registration and treatment randomization. Several techniques are employed to ensure security of the system and validity and accuracy of the data. Several randomization methods were implemented to support different study designs including balanced block randomization, stratified permuted block scheme, and a sophisticated randomization design based on the minimization method and Zelen's adaptive randomization method for institution balancing.

Clinical Trials as Topic↗

[Security aspects on the Internet].

AIM OF THE STUDY: Is it possible to use the Internet as a secure media for transport of telemedicine? Which risks exist for routine use? In this article state of the art methods of security were analysed. Telemedicine in the Internet has severe risks, because patient data and hospital data of a secure Intranet can be manipulated by connecting it to the Web. CONCLUSIONS: Establishing of a firewall and the introduction of HPC (Health Professional Card) are minimizing the risk of un-authorized access to the hospital server. HPC allows good safety with digital signature and authentication of host and client of medical data. For secure e-mail PGP (Pretty Good Privacy) is easy to use as a standard protocol. Planning all activities exactly as well as following legal regulations are important requisites for reduction of safety risks in Internet.

Computer Security↗

How to deal with security issues in teleradiology.

The use of teleradiological systems for medical image communication is increasing significantly. Digital images can be transferred over public telephone (e.g. ISDN) lines to colleagues for interpretation and/or consultation. Thus, a new quality is being introduced into the process of radiological diagnostics. However, technical implementation of such systems is accompanied by little consideration of legal, i.e. data protection and security, issues. In this paper we describe a concept for data protection in teleradiology which unites aspects of privacy and security as well as user aspects. After highlighting the legal situation in Germany we describe the methodology used for deriving the security profile for teleradiology in Germany. As a result the set of security measures which have to be employed with a teleradiology system is listed. A detailed description follows of how the software requirements are implemented in the teleradiology software MEDICUS.

Computer Security↗

Can chief security officers protect data from prying eyes?

New rules, new laws and new technologies are a few of the reasons why more health care organizations are likely to hire chief security officers. Now more than ever, many experts contend, health care organizations need one person dedicated to the job of protecting health care information as it is created, stored, manipulated and transmitted by hundreds of people every day.

Administrative Personnel↗

Security infrastructure services for electronic archives and electronic health records.

Communication and co-operation in the domain of healthcare and welfare require a well-defined set of security services based on a Public Key Infrastructure and provided by a Trusted Third Party (TTP). These services describe both status and relation of communicating principals, corresponding keys and attributes, and the access rights to applications and data. Additional services are needed to provide trustworthy information about dynamic issues of communication and co-operation such as time and location of processes, workflow relations, and system behaviour. Legal, social, behavioural and ethical requirements demand securely stored patient information and well-established access tools and tokens. Electronic (and more specifically digital) signatures--as important means for securing the integrity of a message or file--along with certified time stamps or time signatures are especially important for purposes of data storage in electronic archives and electronic health records (EHR). While just mentioning technical storage problems (e.g. lifetime of the storage devices, interoperability of retrieval and presentation software), this paper identifies mechanisms of securing data items, files, messages, sets of archived items or documents, electronic archive structures, and life-long electronic health records. Other workshop contributions will demonstrate related aspects of policies, patient privacy, and privilege management.

Access to Information↗

Security of e-mail.

In Robert K. Englund's review of Before Writing by Denise Schmandt-Besserat (University of Texas Press, Austin, 1992) in the 11 June issue (p. 1670), two cuneiform characters in columns 1 and 2 on page 1671 were misrepresented. The correct characters are as follows.

Computer Security↗

A model driven approach for the German health telematics architectural framework and security infrastructure.

Shared care concepts such as managed care and continuity of care are based on extended communication and cooperation between different health professionals or between them and the patient respectively. Health information systems and their components, which are very different in their structure, behavior, data and their semantics as well as regarding implementation details used in different environments for different purposes, have to provide intelligent interoperability. Therefore, flexibility, portability, and future orientation must be guaranteed using the newest development of model driven architecture. The ongoing work for the German health telematics platform based on an architectural framework and a security infrastructure is described in some detail. This concept of future proof health information networks with virtual electronic health records as core application starts with multifunctional electronic health cards. It fits into developments currently performed by many other developed countries.

Computer Security↗

Quality assurance processes for designing patient education web sites.

In the future, more nurses and other healthcare professionals will be providing patient education on the Internet. Having knowledge of processes that lead to quality patient education Web site design is essential. These quality assurance processes include determining the site's purpose, selecting the user population, establishing the expected clinical and learning outcomes, providing an educational framework, incorporating specific design principles, and multiple and ongoing site evaluation. Therefore, Web site development processes designed to undergird quality patient education are presented, and an example Web site is used to illustrate them.

Computer Security↗