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PubMed1994

The development of a data security model for the Collaborative Social and Medical Services System.

This paper presents the development of the Collaborative Social and Medical Services System's (CSMSS) data security mechanism. This mechanism was synthesized from an analysis of the CSMSS problem domain, and from a study of the methods used by modern operating systems and database management systems. The resulting mechanism is more flexible and expressive than traditional access control methods and is generally applicable to the management of privacy and multi-provider access.

Ambulatory Care Information Systems↗

PubMed2002

Ethical issues in public health informatics: implications for system design when sharing geographic information.

Public health programs today constitute a multi-professional inter-organizational environment, where both health service and other organizations are involved. Developing information systems, including the IT security measures needed to suit this complex context, is a challenge. To ensure that all involved organizations work together towards a common goal, i.e., promotion of health, an intuitive strategy would be to share information freely in these programs. However, in practice it is seldom possible to realize this ideal scenario. One reason may be that ethical issues are often ignored in the system development process. This investigation uses case study methods to explore ethical obstacles originating in the shared use of geographic health information in public health programs and how this affects the design of information systems. Concerns involving confidentiality caused by geographically referenced health information and influences of professional and organizational codes are discussed. The experience presented shows that disregard of ethical issues can result in a prolonged development process for public health information systems. Finally, a theoretical model of design issues based on the case study results is presented.

Computer Security↗

PubMed2006

[A practicable model of a secure electronic medical record system].

In this article, a new application model has been given for digital signing technology used in the Electronic Medical Record system, which uses digital signature to implement authentication mechanism and doctor signing, and uses a notarial digital signature server to implement the third party's digital signature for notarial mechanism. It can prevent the others from modifying the doctor's record and prevent the doctor himself from modifying the record as well. Case history database preserves signed data to ensure the authenticity and validity, in law, of the Electronic Medical Record.

Computer Security↗

PubMed2005

Network security and data integrity in academia: an assessment and a proposal for large-scale archiving.

A direct impediment to the optimal use of online databases is the increasing prevalence, severity, and toll of computer and network security incidents. Funding agencies should set up working groups that can provide essential services such as universal backup, archival storage, and mirroring of community resources, consistent with the key goal of security in academia: to preserve data and results for posterity.

Archives↗

PubMed1998

[Data protection for the national German Central Registry of Pediatric Hearing Disorders].

The German Registry for Hearing Loss in Children (DZH) processes nationwide data from audiological centers. Coping with the accrued data and its subsequent management and analysis requires a high degree of security and control. To establish a nationwide registry it is necessary at an early stage to take into consideration the legal requirements of the participating states. Use of the DZH as an example demonstrates how a pragmatic solution can be reached. Special issues concerning data collection, transfer, storage and deletion, coding strategies to ensure anonymity, checking for duplicate entries, data separation, and automated data analysis and data protection are explained.

Adolescent↗

PubMed1996

The role of standards in a dynamic area.

It proves difficult to achieve a good measure of security in medical informatics applications. A number of reasons for this are analyzed. It is argued, that standardisation will help in solving this problem to a certain extent, but a more complete solution is possible when this is used in close conjunction with legal instruments (e.g. EU directives) and advice of a less strict nature, like guidelines. On the whole, a pragmatic step-by-step approach is needed, although there are signs that the general environment for these developments is improving.

Computer Literacy↗

PubMed2006

Secure and efficient health data management through multiple watermarking on medical images.

The landscape of healthcare delivery and medical data management has significantly changed over the last years, as a result of the significant advancements in information and communication technologies. Complementary and/or alternative solutions are needed to meet the new challenges, especially regarding security of the widely distributed sensitive medical information. Digital watermarking is a recently established research area with many applications; nevertheless, the potential of this technology to contribute value-added services to medical information management systems has only recently started to be realized by the research community. The paper presents a review of research efforts in the area of medical-oriented watermarking and proposes a wavelet-based multiple watermarking scheme; this scheme aims to address critical health information management issues, including origin and data authentication, protection of sensitive data, and image archiving and retrieval. In accordance with the strict limitations applying to medical images, the scheme allows the definition of a region of interest (ROI) whose diagnostic value is protected, since the only additional information embedded therein aims at integrity control. The robustness of the method is enhanced through a form of hybrid coding, which includes repetitive embedding of BCH encoded watermarks. The experimental results on different medical imaging modalities demonstrate the efficiency and transparency of the watermarking scheme.

Algorithms↗

PubMed2001

Telemedicine, the Internet, and world wide web: overview, current status, and relevance to surgeons.

The Information Age has made profound changes in society and is slowly entering the healthcare field. Some of the most important areas are telemedicine, the Internet, and the world wide web (www). Millions of physicians, healthcare providers, and patients are accessing the web daily for patient information, consultation, and distant learning. Telemedicine is beginning to enter the mainstream of health care after decades of demonstration projects. There are many issues which have been raised, such as access to the information, the security of the information, and the quality of the content on the web. While telemedicine is beginning to Hower, there are numerous barriers that prevent its rapid implementation, such as licensure, reimbursement, liability, quality of service, and technical issues. In spite of the numerous challenges, telemedicine over the Internet was practiced in one of the most remote areas of the world--Mt. Everest--demonstrating that it is possible to utilize all the latest healthcare telecommunications tools in even the most extreme of settings.

Computer Security↗

PubMed2003

Healthcare teams over the Internet: programming a certificate-based approach.

Healthcare environments are a representative case of collaborative environments since individuals (e.g. doctors) in many cases collaborate in order to provide care to patients in a more proficient way. At the same time modern healthcare institutions are increasingly interested in sharing access of their information resources in the networked environment. Healthcare applications over the Internet offer an attractive communication infrastructure at worldwide level but with a noticeably great factor of risk. Security has, therefore, become a major concern. However, although an adequate level of security can be relied upon digital certificates, if an appropriate security model is used, additional security considerations are needed in order to deal efficiently with the above team-work concerns. The already known Hybrid Access Control (HAC) security model supports and handles efficiently healthcare teams with active security capabilities and is capable to exploit the benefits of certificate technology. In this paper we present the way for encoding the appropriate authoritative information in various types of certificates, as well as the overall operational architecture of the implemented access control system for healthcare collaborative environments over the Internet. A pilot implementation of the proposed methodology in a major Greek hospital has shown the applicability of the proposals and the flexibility of the access control provided.

Certification↗

PubMed1997

Experiences with the german teleradiology system MEDICUS.

This paper introduces the teleradiology system, MEDICUS, which has been developed at the Deutsches Krebsforschungszentrum (German Cancer Research Center) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. The global software architecture is explained in the article. Special attention has been given to the design of the user interface and data security, integrity and authentication. The software has been evaluated in a German field test at 13 radiology departments in university clinics, small hospitals, private practices and research institutes. More than 30 thousand images have been transmitted using this system during a 9 month period. Realized application scenarios are: in-house communication, image and report delivery to referring hospitals, remote reporting, radiotherapy treatment planning and research cooperation. Experience has shown that the system is easy to use and saves time. It obviates the need for patient transport and reduces film costs. Experiences of individuals while using the system during the field test helped define the functionality of the second generation teleradiology system which is even more flexible and is also available as a commercial product.

Computer Communication Networks↗

PubMed2004

Patient data security in the DICOM standard.

The DICOM committee added the section "Security Profiles" to the DICOM standard, in order to provide the opportunity of safe communication between health care system partners. Data complying with the DICOM standard--e.g. pictures, signals or reports of examinations can be provided with one or more digital signatures. Attention should be paid to the fact that these possibilities of the DICOM standard are available or can be supplied subsequently by new acquisitions of radiological modalities. The required information to check these prerequisites are given.

Algorithms↗

PubMed2000

Electronic patient records and the impact of the Internet.

The term electronic patient record (EPR) means the electronic collection of clinical narrative and diagnostic reports specific to an individual patient. A true EPR should allow physicians and nurses to practice in a paperless fashion. The wide adoption of Internet technologies should allow truly distributed sharing of patient data across traditional organizational barriers. Hence, the meaning of an EPR, as a representation of documents, should be transformed into a collaborative environment that supports workflow, enables new care models and allows secure access to distributed health data. This paper reviews the current realization of EPRs in the context of paper-based medical records. The Internet architecture that Boston-based medical informatics researchers refer to as W3-EMRS is described in the context of a successful implementation of CareWeb at the Beth Israel Deaconess Medical center. Finally, we describe how this Internet-based approach can be extended beyond the boundaries of traditional care settings to help evolve new collaborative models of eHealth.

Computer Security↗

PubMed1999

American Academy of Pediatrics. Pediatric Practice Action Group and Task Force on Medical Informatics. Privacy protection and health information: patient rights and pediatrician responsibilities.

Pediatricians and pediatric medical and surgical subspecialists should know their legal responsibilities to protect the privacy of identifiable patient health information. Although paper and electronic medical records have the same privacy standards, health data that are stored or transmitted electronically are vulnerable to unique security breaches. This statement describes the privacy and confidentiality needs and rights of pediatric patients and suggests appropriate security strategies to deter unauthorized access and inappropriate use of patient data. Limitations to physician liability are discussed for transferred data. Any new standards for patient privacy and confidentiality must balance the health needs of the community and the rights of the patient without compromising the ability of pediatricians to provide quality care.

Computer Security↗

PubMed2003

The informatics nurse specialist as privacy officer.

HIPAA mandates the development of privacy and security standards, including the designation of a privacy officer responsible for the development and implementation of the policies and procedures. However, the rule does not give guidance as to the specific qualifications, job description, or details concerning policy and procedure development and implementation. The qualities and skills of informatics nurse specialists (INS), plus their commitment to patient advocacy and a professional code of ethics to ensure the privacy of confidential personal information, make the INS ideally suited to manage the processes necessary to achieve HIPAA compliance.

Computer Security↗

PubMedDate not supplied

Network security.

As you can see, there are a number of different ways to protect your network with different protocols, all of which can be very confusing to people whose core business process is not technology. This article is only a brief synopsis of the dangers that lurk in the corners of the technology world. Therefore, the best course of action is to do as much research as possible rather than falling into a situation of risk and vulnerability by implementing a system or network that does not work with your business. Remember, the technology is there to support your business; the business should not have to work around the technology.

Computer Security↗

PubMed2004

Cross sectional survey of multicentre clinical databases in the United Kingdom.

OBJECTIVES: To describe the multicentre clinical databases that exist in the United Kingdom, to report on their quality, to explore which organisational and managerial features are associated with high quality, and to make recommendations for improvements. DESIGN: Cross sectional survey, with interviews with database custodians and search of electronic bibliographic database (PubMed). STUDIES REVIEWED: 105 clinical databases across the United Kingdom. RESULTS: Clinical databases existed in all areas of health care, but their distribution was uneven-cancer and surgery were better covered than mental health and obstetrics. They varied greatly in age, size, growth rate, and geographical areas covered. Their scope (and thus their potential uses) and the quality of the data collected also varied. The latter was not associated with any organisational characteristics. Despite impressive achievements, many faced substantial financial uncertainty. Considerable scope existed for improvements: greater use of nationally approved codes; more support from relevant professional organisations; greater involvement by nurses, allied health professionals, managers, and laypeople in database management teams; and more attention to data security and ensuring patient confidentiality. With some notable exceptions, the audit and research potential of most databases had not been realised: half the databases had each produced only four or fewer peer reviewed research articles. CONCLUSIONS: At least one clinical database support unit is needed in the United Kingdom to provide assistance in organisation and management, information technology, epidemiology, and statistics. Without such an initiative, the variable picture of databases reported here is likely to persist and their potential not be realised.

Clinical Medicine↗

PubMed2003

European security framework for healthcare.

eHealth and telemedicine services are promising business areas in Europe. It is clear that eHealth products and services will be sold and ordered from a distance and over national borderlines in the future. However, there are many barriers to overcome. For both national and pan-European eHealth and telemedicine applications a common security framework is needed. These frameworks set security requirements needed for cross-border eHealth services. The next step is to build a security infrastructure which is independent of technical platforms. Most of the European eHealth platforms are regional or territorial. Some countries are looking for a Public Key Infrastructure, but no large scale solutions do exist in healthcare. There is no clear candidate solution for European-wide interoperable eHealth platform. Gross-platform integration seems to be the most practical integration method at a European level in the short run. The use of Internet as a European integration platform is a promising solution in the long run.

Computer Security↗

PubMed2002

Healthcare teams over the Internet: towards a certificate-based approach.

Healthcare environments are a representative case of collaborative environments since individuals (e.g. doctors) in many cases collaborate in order to provide care to patients in a more proficient way. At the same time modem healthcare institutions are increasingly interested in sharing access of their information resources in the networked environment. Healthcare applications over the Internet offer an attractive communication infrastructure at worldwide level but with a noticeably great factor of risk. Security has therefore become a major concern for healthcare applications over the Internet. However, although an adequate level of security can be relied upon digital certificates, if an appropriate security policy is used, additional security considerations are needed in order to deal efficiently with the above team-work concerns. The already known Hybrid Access Control security model supports and handles efficiently healthcare teams with active security capabilities and is capable to exploit the benefits of certificate technology. In this paper we present the way for encoding the appropriate authoritative information in various types of certificates, as well as the overall operational architecture of the implemented access control system for healthcare collaborative environments over the Internet. A pilot implementation of the proposed methodology in a major Greek hospital has shown the applicability of the proposals and the flexibility of the access control provided.

Access to Information↗