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Surrogate data--a secure way to share corporate data.

The privacy of chemical structure is of paramount importance for the industrial sector, in particular for the pharmaceutical industry. At the same time, companies handle large amounts of physico-chemical and biological data that could be shared in order to improve our molecular understanding of pharmacokinetic and toxicological properties, which could lead to improved predictivity and shorten the development time for drugs, in particular in the early phases of drug discovery. The current study provides some theoretical limits on the information required to produce reverse engineering of molecules from generated descriptors and demonstrates that the information content of molecules can be as low as less than one bit per atom. Thus theoretically just one descriptor can be used to completely disclose the molecular structure. Instead of sharing descriptors, we propose to share surrogate data. The sharing of surrogate data is nothing else but sharing of reliably predicted molecules. The use of surrogate data can provide the same information as the original set. We consider the practical application of this idea to predict lipophilicity of chemical compounds and we demonstrate that surrogate and real (original) data provides similar prediction ability. Thus, our proposed strategy makes it possible not only to share descriptors, but also complete collections of surrogate molecules without the danger of disclosing the underlying molecular structures.

Chemical Engineering↗

Development of an Internet Security Policy for health care establishments.

The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

Computer Communication Networks↗

Applied strategies for improving patient safety: a comprehensive process to improve care in rural and frontier communities.

CONTEXT: Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. PURPOSE: To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. METHODS: Applied Strategies for Improving Patient Safety (ASIPS) was a demonstration project designed to collect and analyze medical error reports and use these reports to develop and implement interventions aimed at decreasing errors. ASIPS participants were clinicians and staff in 2 practice-based research networks: the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN). This paper describes ASIPS in HPRN. FINDINGS: Fourteen HPRN practices with a total of 150 clinicians and staff have participated in ASIPS. Participants have submitted 128 reports. Diagnostic tests were involved in 26% of events; medication errors appeared in 20% of events. Communication errors were reported in 72%. Two learning groups developed "Principles for Process Improvement" for medication errors and diagnostic testing errors. Several safety "alerts" were issued to improve care, and 2 interventions were implemented to decrease errors. CONCLUSIONS: A safe and secure reporting system that relies on voluntary reporting from clinicians and staff can be successfully implemented in rural primary care settings. Information from reports can be used to identify processes that can be improved.

Colorado↗

Legal review: protecting the confidentiality and integrity of patient records.

Computerized patient records, like paper-based records, are subject to a number of security threats. In the context of health care networks, such as integrated delivery networks, special precautions are required to protect both the confidentiality and the integrity of patient records. The article discusses the principle threats to networked patient data and recommends practical steps to reduce the inherent risks.

Computer Security↗

Toward secure distribution of electronic health records: quantitative feasibility study on secure E-mail systems for sharing patient records.

If the quality and efficiency of medical services are to be ensured, electronic health records (EHR) and EHR-supporting infrastructure must be prevalent. Many hospitals, however, have EHR systems for their internal use only, and the standardization process for the exchange of medical information is still in process. This standardization process addresses information security and is considering public key infrastructure (PKI) as one security measure, but PKI is rarely used by medical practioners because of its poor user-friendliness. Here we propose an effective use of the identity-based encryption (IBE) system as a security measure. This system enables us to send encrypted and signed messages without requiring the receiver to get a public key, and it enables us to deliver secured messages to ambiguous receivers like those to whom letters of reference are sent. We evaluated the feasibility of this technology by using the analytic hierarchy process, which is an effective analysis tool when selection and judgment depend on nonquantitative psychological factors, to analyze the results of an experiment in which medical workers used E-mail agents with and without PKI and IBE. We found that medical practioners and researchers avoid using PKI because of its poor user-friendliness and instead use IBE even though it is harder to install. We therefore think IBE would encourage medical institutions to share patient records.

Algorithms↗

Status of clinical gene sequencing data reporting and associated risks for information loss.

Clinical gene sequencing is growing in importance and cost-effectiveness. In the past two years, the number of genes associated with disease has grown by roughly 25%. Knowledge of genetic variations will soon guide drug selection and dosages, predict risks from toxin exposures, and inform nutritional needs. Despite the significance of sequencing, methods for reporting results are problematic. Frequent use of paper and infrequent use of naming standards impede data exchange and make incorporation into the electronic medical record difficult. Reports often describe only variations found, rather than all data (all patient bases sequenced). Also, reports frequently do not describe reference data used to define variations. These practices create risks for loss of both data and information. Standardized electronic reporting of all data (all bases sequenced and all reference data) and electronic record systems capable of storing these results would both prevent data loss and simplify the preservation of information those data provide.

Computer Security↗

Quality assured trusted third parties for deploying secure internet-based healthcare applications.

In this paper we present a complete reference framework for the provision of quality assured Trusted Third Party (TTP) services within a medical environment. The main objective is to provide all the basic guidelines towards the development of a quality system for a TTP as an organisation, which could be mapped directly to the requirements of ISO-9000 standards. The important results of the implementation of a quality system, are the enhanced trustworthiness of the TTP and the confidence of the medical society in the provided services. Furthermore, the value added certification services conform to customer requirements and are characterised by efficiency, reliability, security, credibility and trust. The internal organisation acquires a clear and strict structure and maximises its effectiveness by establishing quality management, committed to control, assure and improve quality. The TTP requirements for quality are identified and the various elements of the quality system are described illustratively.

Computer Security↗

A quality evaluation methodology of health web-pages for non-professionals.

PRIMARY OBJECTIVE: The proposal of an evaluation methodology for determining the quality of healthcare web sites for the dissemination of medical information to non-professionals. METHODS AND PROCEDURES: Three (macro) factors are considered for the quality evaluation: medical contents, accountability of the authors, and usability of the web site. Starting from two results in the literature the problem of whether or not to introduce a weighting function has been investigated. This methodology has been validated on a specialized information content, i.e., sore throats, due to the large interest such a topic enjoys with target users. The World Wide Web was accessed using a meta-search system merging several search engines. A statistical analysis was made to compare the proposed methodology with the obtained ranks of the sample web pages. MAIN OUTCOME AND RESULTS: The statistical analysis confirms that the variables examined (per item and sub factor) show substantially similar ranks and are capable of contributing to the evaluation of the main quality macro factors. A comparison between the aggregation functions in the proposed methodology (non-weighted averages) and the weighting functions, derived from the literature, allowed us to verify the suitability of the method. CONCLUSIONS: The proposed methodology suggests a simple approach which can quickly award an overall quality score for medical web sites oriented to non-professionals.

Attitude to Computers↗

Electronic health records should support clinical research.

One aspect of electronic care records which has received little attention is the potential benefit to clinical research. Electronic records could facilitate new interfaces between care and research environments, leading to great improvements in the scope and efficiency of research. Benefits range from systematically generating hypotheses for research to undertaking entire studies based only on electronic record data. Researchers and research managers must engage with electronic record initiatives to realize these benefits. Clinicians and patients must have confidence in the consent, confidentiality and security arrangements for the uses of secondary data. Provided that such initiatives establish adequate information governance arrangements, within a clear ethical framework, innovative clinical research should flourish. Major benefits to patient care could ensue given sufficient development of the care-research interface via electronic records.

Biomedical Research↗

Maximizing the return on investments in information technology by incorporating best practices.

Most system administrators know what needs to be done to make their systems secure and manageable but these needs are tough to sell to upper management in a tight economy. However, system administrators using industry accepted best practices can calculate a return on investment for budgeting purposes, justifying expenses by comparing them with expected costs if such practices are not in place.

Benchmarking↗

Security aspects of Grid-based digital mammography.

OBJECTIVES: The principal aim of the eDiaMoND project is to develop a prototype Grid infrastructure to support the needs of the breast care community. The prototype system is but one major deliverable of the project; the other is a blueprint document that describes how a system such as eDiaMoND might be deployed throughout the United Kingdom to support the NHS Breast Screening Programme. A key consideration of both the prototype and the blueprint is security. In this paper we address some of the generic security issues faced by projects such as eDiaMoND. We also indicate how these problems are being overcome within our project. METHODS: In order to fully understand the security issues faced by the project a review of current initiatives within the NHS was performed. The work of the NHS Information Authority was found to be particularly significant. Also reviewed was BS7799, the British Standard for the deployment of security systems and processes. Finally, modelling of the proposed prototype was performed using methods proposed by the e-Science Security Task Force, in particular the method proposed by Flechais and Sasse. RESULTS AND CONCLUSIONS: It is felt that the issues of security surrounding the eDiaMoND project are sufficiently generic that the eHealth community can consider and criticise the work described. It is hoped that this will enable the eHealth community to move forwards with a common agenda.

Access to Information↗

The organisation and management of information security issues in health care.

An overview is given of difficulties, encountered in managing security issues in a health care environment (more specific, in hospitals). A rough analysis is presented of the underlying reasons, why the problems encountered in Health Care could be more complicated than in other fields. Indications and strategies for possible solutions are given, illustrated with an example from practice.

Computer Security↗

Error function attack of chaos synchronization based encryption schemes.

Different chaos synchronization based encryption schemes are reviewed and compared from the practical point of view. As an efficient cryptanalysis tool for chaos encryption, a proposal based on the error function attack is presented systematically and used to evaluate system security. We define a quantitative measure (quality factor) of the effective applicability of a chaos encryption scheme, which takes into account the security, the encryption speed, and the robustness against channel noise. A comparison is made of several encryption schemes and it is found that a scheme based on one-way coupled chaotic map lattices performs outstandingly well, as judged from quality factor.

Algorithms↗

Picture archiving and communication in radiology.

After over 80 years of exclusive archiving of radiologic films, at present, in Radiology, digital archiving is increasingly gaining ground. Digital archiving allows a considerable reduction in costs and space saving, but most importantly, immediate or remote consultation of all examinations and reports in the hospital clinical wards, is feasible. The RIS system, in this case, is the starting point of the process of electronic archiving which however is the task of PACS. The latter can be used as radiologic archive in accordance with the law provided that it is in conformance with some specifications as the use of optical long-term storage media or with electronic track of change. PACS archives, in a hierarchical system, all digital images produced by each diagnostic imaging modality. Images and patient data can be retrieved and used for consultation or remote consultation by the reporting radiologist who requires images and reports of previous radiologic examinations or by the referring physician of the ward. Modern PACS owing to the WEB server allow remote access to extremely simplified images and data however ensuring the due regulations and access protections. Since the PACS enables a simpler data communication within the hospital, security and patient privacy should be protected. A secure and reliable PACS should be able to minimize the risk of accidental data destruction, and should prevent non authorized access to the archive with adequate security measures in relation to the acquired knowledge and based on the technological advances. Archiving of data produced by modern digital imaging is a problem now present also in small Radiology services. The technology is able to readily solve problems which were extremely complex up to some years ago as the connection between equipment and archiving system owing also to the universalization of the DICOM 3.0 standard. The evolution of communication networks and the use of standard protocols as TCP/IP can minimize problems of data and image remote transmission within the healthcare enterprise as well as over the territory. However, new problems are appearing as that of digital data security profiles and of the different systems which should ensure it. Among these, algorithms of electronic signature should be mentioned. In Italy they are validated by law and therefore can be used in digital archives in accordance with the law.

Algorithms↗

Norms for telematics in health care: priorities in Belgium.

A Commission has been established by Royal Decree in order to make recommendations to Ministers of Social Affairs and Public Health in matters related to standards in telematics for the health care sector in Belgium. The present strategic plan has three priorities: (1) To obtain coherent information systems allowing uniform data transfer between hospital and ambulatory care, using quality labels supported financially and taking in account long-term archiving. (2) To develop secure and standardised communication systems using electronic signature and standard messages in XML. The implementation of health professionals and patient identifiers is in progress. (3) To reinforce collaboration between health care services by using a health network prototype linked both to general practitioners and hospital institutions.

Belgium↗

[A study of the security and transmission of medical information using JGN (Japan Gigabit Network)].

The telemedicine and teleconference, for example, make possible that the same qualities information can be accessed from the near facility and from the remote medical facility at 3 - 70 km away. The quality of medical care will be largely improved because high-speed network can be extended to rural areas. We set up an experimental network system to the telemedicine and teleconference using JGN (Japan Gigabit Network). The JGN is an ultra-high-speed network for the purpose of research and development. In this study, A 10 Mbps communication link of the JGN is used to transmission and reception of detailed and large medical information from remote places. Kanazawa University, NTT west kanazawa hospital, toyama city hospital and fukui red cross hospital are connected to the JGN through a router. IPsec system, which is the security protocol, is used for the security of data transmission between each facilities. In result, the date transmission rate using IPsec is 7 Mbps. The average translation rates of CT images (512 x 512, 16bit) and MRI images (256 x 256, 16bit) are 0.8 s/flame and 0.2 s/flame, respectively.

Computer Security↗

Privacy and security issues in a wide area health communications network.

In 1993 the first national health information service went live in New Zealand, using commercial network services for all communications. This system provides a point of connection for all health personnel, and for those with a legitimate interest in health care information (e.g. insurers): it also provides access to a number of information resources managed on behalf of the government of New Zealand (e.g. index of health care users), as well as to those developed by individual network service providers. Much of the data exchanged across this network is personalised. Since the recipient may not be known personally to the sender, it is vital that the sender has confidence that the recipient will treat personal information according to agreed criteria for privacy. A Code of Practice covering health information was developed under the New Zealand Privacy Act to ensure that the confidence to share confidential data was supported. For large organisations such as hospitals to function efficiently, they need the flexibility to be able quickly to assign user privileges to selected staff without the need for extra paperwork seeking approval from the centre. But the audit trail requires unique identification of the individual undertaking each transaction. This requirement has been addressed. Some of the data moved across the network relates to life-critical issues, e.g. clinical warnings about allergies or serious medical conditions. A failure of communications causing this vital information to be improperly represented in some way on the receivers system could have disastrous consequences. To ensure the integrity of data transfers, user installations have to be certified compliant with standard test scripts before they are authorized for access to these resources.

Accreditation↗

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

OBJECTIVE: The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. DESIGN: A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. METHODS: All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. RESULTS: During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. CONCLUSION: This study is the first effort to establish comprehensive criteria for evaluating handheld prescribing systems and to evaluate the performance and features of a handheld, electronic prescribing system. The results demonstrated that the evaluated system: 1) was simple to install; 2) successfully interfaced with a commonly used practice management system; 3) was user-friendly and easy to operate; 4) offered a robust variety of standard features; and, 5) resulted in a high rate of success for transmitting electronic prescriptions. The criteria established for the evaluation of features of an electronic prescribing system can be used to critically evaluate the performance and features of other handheld and personal computer-based electronic prescribing systems.

Adult↗