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PubMed2001

A novel interactive electronic protocol review system.

This report describes a new protocol review system which was designed as a Lotus Notes database. This system encompasses all elements of investigator protocol generation, review and approval by the laboratory animal veterinarian and institutional animal care and use committee (IACUC), and notification of approval to personnel responsible for animal ordering. Unique features of the system are interactive dialog between IACUC members and the investigator and confidential protocol discussion among IACUC members. The advantages of the system are multiple: 1. it allows for interactive protocol discussion online; 2. it is an essentially paperless process; 3. inclusion of the outside IACUC member is easily accomplished by using an offsite personal computer and secure remote local-area network access; 4. the time required for protocol generation, review, and approval is streamlined due to the automatic features of the database and the speed of e-mail; and 5. all documentation relating to the protocol and the approval process is archived online.

Animals↗

PubMed1994

Report on the clinical workstation and clinical data repository utilization at UNC Hospitals.

On December 1, 1993, we implemented version 2.1 of the Clinical Workstation-Clinical Data Repository application in the Ambulatory Care Center. This version of the workstation allowed access of laboratory data from the clinical data repository that had been populated by a real-time HL7 interface between the Clinical Data Repository and the Laboratory Information System. This implementation completed a major part of the Clinical Workstation project. Also in December, we implemented a security system that records the date and time, user logon code, clinical workstation functions used, and the patient medical record number on whom data were displayed. In addition to the security function, this system has proven to be a valuable tool in evaluating the utilization of the clinical workstation and is the source of the data presented in this paper.

Clinical Laboratory Information Systems↗

PubMed2003

Final HIPAA security regulations: a review.

This article examines the national standards for safeguarding the confidentiality, integrity, and availability of electronic protected health information under the final Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). The standards require entities covered by the rule to implement basic safeguards to protect electronic protected health information from unauthorized access, alteration, deletion, and transmission. The final privacy rule applies to protected health information in any form.

Access to Information↗

PubMed2004

Improving the precision of the keyword-matching pornographic text filtering method using a hybrid model.

With the flooding of pornographic information on the Internet, how to keep people away from that offensive information is becoming one of the most important research areas in network information security. Some applications which can block or filter such information are used. Approaches in those systems can be roughly classified into two kinds: metadata based and content based. With the development of distributed technologies, content based filtering technologies will play a more and more important role in filtering systems. Keyword matching is a content based method used widely in harmful text filtering. Experiments to evaluate the recall and precision of the method showed that the precision of the method is not satisfactory, though the recall of the method is rather high. According to the results, a new pornographic text filtering model based on reconfirming is put forward. Experiments showed that the model is practical, has less loss of recall than the single keyword matching method, and has higher precision.

Algorithms↗

PubMed1996

Security training and education for IT professionals.

This paper presents some of the difficulties inherent in understanding IT security as a context oriented area when it comes to practicalities. Such attributes have to be included in education and training; here presented through demands put forward by some official international bodies. A short state-of-the-art report is given and an approach to meet stated demands is presented including evaluations performed. Finally there are remarks on future work needed.

Computer Literacy↗

PubMed1997

The Internet and electronic transmission of medical records.

OBJECTIVE: To review, from a legal perspective the potential for using the Internet for inter-institutional transfer of patient medical records. METHODS: Basic issues and recent legislation that relate to protection of both medical data, and those transferring that data over public network systems is reviewed. RESULTS: Many laws already in existence can be applied to Internet transmission, but questions of jurisdiction remain. Providing signatures on requests for information, which are in essence contracts, is a problem. Signatures must both prove the identity of the participants and provide for non-repudiation of the agreement. Cryptographic digital signatures appear secure and effective, but their use is difficult to implement. Simpler methods are fraught with risks, yet are more easily accomplished. The patient's rights of privacy must be balanced against the need for access by government, physician, or healthcare institutions to confidential information. In general, information holders must put forth reasonable efforts to keep information confidential. The development of acknowledged standards will provide guidance. Multiple laws provide some deterrence and hence some reassurance to healthcare institutions, for example, by criminalizing acts of electronic interception of patient records in transit. CONCLUSION: Some believe the expense of secure transfer of medical records by electronic means is a major obstacle; this is false: such transfers are now technologically quite easy. The greatest obstacle to electronic transfer of medical records at this point is the development of workable standards for signing agreements and protecting transmissions, but the perceived advantages will likely drive the necessary developments.

Computer Communication Networks↗

PubMed2000

Intranet health clinic: Web-based medical support services employing XML.

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which operates in pilot form within the INTRANET HEALTH CLINIC project--a two-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different users. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system is designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current pilot implementations are under clinical evaluation and include oncological patients (Greece), Lupus Erythrematosis (Canada), Obstetrics (Belgium) and Chronic Obstructive Pulmonary disease (Spain).

Computer Communication Networks↗

PubMed2000

Risk management methodology for HIPAA security standard.

The Health Insurance Portability and Accountability Act (HIPAA) security standard requires a formal security management process that includes risk management. Risk management is a detailed process used to identify and assess risk, identify and accept mediation for risk, and maintain an acceptable level of risk. This chapter explains the risk management methodology developed by Providence Health System for HIPAA compliance. Providence risk management methodology includes risk analysis and assessment for both hard and soft assets.

Computer Security↗

PubMed2001

[Secure e-mail between physicians--aspect of a telemedicine platform for the health care system].

Ever since the Roland-Berger-Study in 1997, the concept of a "telematics platform" for health care describes the combination of all technical and organizational components and services for the online transmission of patient data. This platform works on an interoperable collection of standards for addressing, security and content-description. In this context the security for application and transport data is based on data protection as well as medical non-disclosure rules. The methods of cryptography can provide security services for data transmitted realizing addressed, direct and indirect privacy. The first German health professional card, the electronic physicians' ID, provides central tools for such applications. First functionally simple pilot projects will prove the effectiveness of chosen methods in this year, even if not all identified construction sites in health care telematics have yet been lead towards a finalized solution.

Computer Security↗

PubMed2005

Using software agents to preserve individual health data confidentiality in micro-scale geographical analyses.

Confidentiality constraints often preclude the release of disaggregate data about individuals, which limits the types and accuracy of the results of geographical health analyses that could be done. Access to individually geocoded (disaggregate) data often involves lengthy and cumbersome procedures through review boards and committees for approval (and sometimes is not possible). Moreover, current data confidentiality-preserving solutions compatible with fine-level spatial analyses either lack flexibility or yield less than optimal results (because of confidentiality-preserving changes they introduce to disaggregate data), or both. In this paper, we present a simulation case study to illustrate how some analyses cannot be (or will suffer if) done on aggregate data. We then quickly review some existing data confidentiality-preserving techniques, and move on to explore a solution based on software agents with the potential of providing flexible, controlled (software-only) access to unmodified confidential disaggregate data and returning only results that do not expose any person-identifiable details. The solution is thus appropriate for micro-scale geographical analyses where no person-identifiable details are required in the final results (i.e., only aggregate results are needed). Our proposed software agent technique also enables post-coordinated analyses to be designed and carried out on the confidential database(s), as needed, compared to a more conventional solution based on the Web Services model that would only support a rigid, pre-coordinated (pre-determined) and rather limited set of analyses. The paper also provides an exploratory discussion of mobility, security, and trust issues associated with software agents, as well as possible directions/solutions to address these issues, including the use of virtual organizations. Successful partnerships between stakeholder organizations, proper collaboration agreements, clear policies, and unambiguous interpretations of laws and regulations are also much needed to support and ensure the success of any technological solution.

Computer Security↗

PubMed2003

Open, flexible and portable secure web-based health applications.

This paper presents a totally generic client-server model for accessing legacy and new databases according to the three tier architecture principles. It is based on an integrated environment that eases the dynamic creation and instantiation of secure web applications that access multiple database management systems. Emphasis is placed on the ability to query almost any type of relational database and queries can simultaneously address a multitude of data sources. The information is collected, assembled and presented to users depending on a possible set of user profiles. These profiles originate from work on securing the conduct of clinical studies. This has been achieved in the context of the EU funded project HARP (Harmonisation for the Security of Web Technologies and Applications). The generic character of the model is exploited through an accompanying set of development tools. This permits efficient and effective creation and maintenance of applications in several domains of health telematics and beyond. Main merit is the lightweight character of the resulting platform, whereby all necessary instantiations are accomplished through a set of related XML documents.

Computer Security↗

PubMed2004

Practice brief. Securing wireless technology for healthcare.

Wireless networking can be a very complex science, requiring an understanding of physics and the electromagnetic spectrum. While the radio theory behind the technology can be challenging, a basic understanding of wireless networking can be sufficient for small-scale deployment. Numerous security mechanisms are available to wireless technologies, making it practical, scalable, and affordable for healthcare organizations. The decision on the selected security model should take into account the needs for additional server hardware and administrative costs. Where wide area network connections exist between cooperative organizations, deployment of a distributed security model can be considered to reduce administrative overhead. The wireless approach chosen should be dynamic and concentrate on the organization's specific environmental needs. Aspects of organizational mission, operations, service level, and budget allotment as well as an organization's risk tolerance are all part of the balance in the decision to deploy wireless technology.

Computer Communication Networks↗

PubMed1996

The doctor's view on education and training aspects of secure communication.

Using two examples of installed applications that are widely spread in a large teaching hospital, the awareness of secure communication is highlighted. Teaching to the rotating medical staff is organised on a regular basis. The physicians learn the responsibility they accept when entering the hospital information system (HIS). In a distributed environment, the confidentiality aspects change with the technology when the users perform with on-line helps and graphical interfaces.

Attitude of Health Personnel↗

PubMed2006

Risk analysis of information security in a mobile instant messaging and presence system for healthcare.

INTRODUCTION: Instant messaging (IM) is suited for immediate communication because messages are delivered almost in real time. Results from studies of IM use in enterprise work settings make us believe that IM based services may prove useful also within the healthcare sector. However, today's public instant messaging services do not have the level of information security required for adoption of IM in healthcare. We proposed MedIMob, our own architecture for a secure enterprise IM service for use in healthcare. MedIMob supports IM clients on mobile devices in addition to desktop based clients. METHODS: Security threats were identified in a risk analysis of the MedIMob architecture. The risk analysis process consists of context identification, threat identification, analysis of consequences and likelihood, risk evaluation, and proposals for risk treatment. RESULTS: The risk analysis revealed a number of potential threats to the information security of a service like this. Many of the identified threats are general when dealing with mobile devices and sensitive data; others are threats which are more specific to our service and architecture. Individual threats identified in the risks analysis are discussed and possible counter measures presented. DISCUSSION: The risk analysis showed that most of the proposed risk treatment measures must be implemented to obtain an acceptable risk level; among others blocking much of the additional functionality of the smartphone. To conclude on the usefulness of this IM service, it will be evaluated in a trial study of the human-computer interaction. Further work also includes an improved design of the proposed MedIMob architecture.

Computer Security↗

PubMed2002

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

OBJECTIVES: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. METHODS: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. RESULTS: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. CONCLUSION: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Authorship↗

PubMed1995

A new concept to ensure data privacy and data security in cancer registries.

In order to conform to the rigid German legislation on data privacy and security, a new concept of data flow and data storage for population-based cancer registries has been developed. This paper describes the basic principles of this approach and presents results from a pilot study in Rheinland-Pfalz. The cancer registry consists of two offices. The first office handles the notification of cases and communicates with the reporting physicians. It performs encryption of identifying data and passes encrypted records to the second office for permanent storage. Record linkage is performed with the encrypted data in the second office. This paper describes in detail how different encryption techniques are used for different purposes in order to ensure optimal security and the usability of the data. Our record linkage study shows that it is possible to keep both synonym and homonym error rates below 1%--acceptable both for routine performance of a registry and for scientific analyses. The methods described are not restricted to cancer registration and may therefore serve as a model for comparable MI applications.

Cohort Studies↗

PubMed1998

How to ensure data security of an epidemiological follow-up: quality assessment of an anonymous record linkage procedure.

A computerised record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the standard hash algorithm (SHA) function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks. two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by means of a statistical model, taking into account several identification variables. Quality assessment of this anonymous record linkage procedure shows a specificity of 100% and a sensitivity of 95%.

Algorithms↗

PubMedDate not supplied

Privacy. Are there any guarantees?

Many health plan members worry that their medical records no longer are kept securely in paper medical files. Electronic data, they argue, is too easy to access. But healthcare administrators often need to use personal medical information to follow trends in outcomes, quality management and utilization review. Is there a balance? Kathleen O'Connor reports that Donna Shalala, secretary of the Department of Health and Human Services, recently provided some suggestions for safeguarding medical privacy in the information age.

Computer Communication Networks↗