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PubMed1995

Smart practice: smart card design considerations in health care.

Recent innovations in microelectronics and advances in cryptography are driving the appearance of a new generation of smart cards with wider applications; this has important repercussions for our society in the coming years. Essentially, these breakthroughs include built-in microprocessors capable of generating cryptographic transactions (e.g.,Jelectronic blinded signatures, digital pseudonyms, and digital credentials), developments toward a single electronic card offering multi-access to services such as transport, telecommunications, health, financial, and entertainment (Universal Access Services), and incorporation of personal identification technologies such as voice, eye, or skin pattern recognition. For example, by using electronic representatives or cryptographic blinded signatures, a smart card can be used for multi transactions across different organizations and under different generated pseudonyms. These pseudonyms are capable of recognizing an individual unambiguously, while none of her records can be linked [1]. Moreover, tamper-proof electronic observers would make smart cards a very attractive technology for high-security based applications, such as those in the health care field. New trends in smart card technology offer excellent privacy and confidentiality safeguards. Therefore, smart cards constitute a promising technology for the health sector in Australia and other countries around the world in their pursuit of technology to support the delivery of quality care services. This paper addresses the main issues and the key design criteria which may be of strategic importance to the success of future smart card technology in the health care sector.

Computer Security↗

PubMed1997

Basic rules for the security of frozen section diagnosis through image transmission between anatomo-pathologists.

Telemedicine can provide an alternative solution to the lack of medical resources in areas where the population is no longer dense enough to justify the temporary or permanent presence of certain specialists such as anatomo-pathologists. In the long run certain pre-operational frozen section examinations cannot be carried out without putting the quality of healthcare at stake. The telematic transmission of macro and microscopic images of lesions, under the supervision of a surgeon, to an anatomo-pathologist consultant located off premises allows for the maintenance of equitable care of acceptable quality.

Computer Security↗

PubMed2003

Electronic signatures for long-lasting storage purposes in electronic archives.

Communication and co-operation in healthcare and welfare requires certain Trusted Third Party (TTP) services describing both status and relation of communicating principals as well as their corresponding keys and attributes. Additional TTP 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. Electronic signatures based on asymmetric cryptography are important means for securing the integrity of a message or file as well as for accountability purposes including non-repudication of both origin and receipt. These electronic signatures along with certified time stamps are especially important for electronic health records (EHR), electronic archives in general, and other typical purposes of a long-lasting storage. Apart from technical storage problems (e.g. lifetime of the storage devices), this paper needs to look for mechanisms of e.g. re-signing of messages, archive details, or whole archives.

Access to Information↗

PubMed2003

Interoperability and medical communication using "patient envelope"-based secure messaging.

The process of transmitting patient medical information between different healthcare parties involves harmonizing multiple elements: addresses, certificates, patient IDs, communication protocol, message format, and documents/EPR to be exchanged. Beyond the work done at the "information structure level" within CEN TC251, ISO TC215, HL7 and DICOM, it is necessary to focus on the "basic medical communication level." An original approach, based on the "Patient Envelope", has been developed and successfully implemented for Oncology. The operator of the National "Réseau Santé Social" is now proposing a new "secure messaging" service supporting the "Envelope"-based communication. The authors are actively involved in standardization organizations' works, including EDI Santé, DICOM, IETF, and ISO TC 215. The current "envelope" format is compatible with all the e-mail clients. It will evolve to be based on the ebXML envelope, extended with a "medical header" containing HL7/EHRCOM Data Types and C-METS/GPICs. This document describes the results from a 3-year experience, as well as the different steps included in the project.

Computer Security↗

PubMed1998

Patient health record on a smart card.

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

Computer Security↗

PubMed1994

Necessity to improve common understanding about the security issues among hospitals in Japan and some feasible approaches.

To improve common understanding about security issues, the importance of classifying the information is stressed, after describing briefly the social background concerning privacy-related problems in Japan. We discuss here the classification only from the following two points of view: (a) the ownership; and (b) how to use. We will derive a two-dimensional fuzzy membership function to describe the ownership and a 'how to use' three-dimensional one as models for describing the framework concerning access right and informed consent.

Computer Security↗

PubMed2005

Protecting medical data for decision-making analyses.

In this paper, we present a procedure for data protection, which can be applied before any model building based analyses are performed. In medical environments, abundant data exist, but because of the lack of knowledge, they are rarely analyzed, although they hide valuable and often life-saving knowledge. To be able to analyze the data, the analyst needs to have a full access to the relevant sources, but this may be in the direct contradiction with the demand that data remain secure, and more importantly in medical area, private. This is especially the case if the data analyst is outsourced and not directly affiliated with the data owner. We address this issue and propose a solution where the model-building process is still possible while data are better protected. We consider the case where the distributions of original data values are preserved while the values themselves change, so that the resulting model is equivalent to the one built with original data.

Algorithms↗

PubMed2004

Implementing MDA-based distributed, interoperable, flexible, scalable, portable, and secure EHR systems.

Electronic Health Record (EHR) systems provide the kernel application of health information systems and health networks which should be independent of complexity, localisation constraints, platforms, protocols, etc. Based on shared care information systems' requirements for high level interoperability, a generic component architecture has been introduced. For implementing, running and maintaining acceptable and useable health information systems components, all views of the ISO Reference Model-Open Distributed Processing have to be considered. Following the Model Driven Architecture paradigm, a reference model as well as concept-representing domain models both independent of platforms must be specified, which are combined and harmonised as well as automatically transferred into platform-specific models using appropriate tools.

Computer Communication Networks↗

PubMed2005

Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative.

BACKGROUND: Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients. METHODS: We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach. RESULTS: Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers. CONCLUSION: Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.

Adult↗

PubMed2003

The CORAS approach for model-based risk management applied to a telemedicine service.

The CORAS risk management process is based on the Australian standard for risk management and aims at improved methodology for precise, unambiguous, and efficient risk assessment of security critical systems. CORAS addresses security critical systems in general, but places particular emphasis on IT security. For CORAS, a system is not just technology, but also the humans interacting with the technology and all relevant aspects of the surrounding organisation and society. The use of graphical models in CORAS furthers communication between the different stakeholders of a risk assessment, and makes it easier for non-technicians to take part. Telemedicine services and electronic applications used in the health sector have a high demand for security. The medical developers, providers and users of such services and systems are important contributors in the risk assessment of these services and systems. CORAS has successfully been used to involve medical professionals in the model-based risk assessment of a telemedicine system called Tele-cardiology in Crete. This paper presents the use of the CORAS framework to assess this telemedicine system giving some conclusions on the experience gained.

Computer Security↗

PubMed2000

Towards a secure EPR: cultural and educational issues.

The broader adoption of the EPR in healthcare settings has brought with it much greater attention to the significant issues regarding security, confidentiality and privacy of healthcare information. The economic, social and political impact of these issues is also of major concern. In this paper, it is suggested that the application of contemporary evolutionary game theory has high utility for understanding the actual behaviour of stakeholders in such settings. Contemporary evolutionary game theory can explain the effects of cultural norms, institutional policies and economics on behavior. I also suggest that contemporary evolutionary game theory is sufficiently robust as to be useful in the rational design of a policy to encourage certain socially desired behaviour in this area.

Computer Security↗

PubMed2005

Long-term personality data collection in support of spaceflight and analogue research.

This is a review of past and present research into personality and performance at the University of Texas (UT) Human Factors Research Project. Specifically, personality trait data collected from astronauts, pilots, Antarctic personnel, and other groups over a 15-yr period is discussed with particular emphasis on research in space and space analogue environments. The UT Human Factors Research Project conducts studies in personality and group dynamics in aviation, space, and medicine. Current studies include personality determinants of professional cultures, team effectiveness in both medicine and aviation, and personality predictors of long-term astronaut performance. The Project also studies the design and effectiveness of behavioral strategies used to minimize error and maximize team performance in safety-critical work settings. A multi-year personality and performance dataset presents many opportunities for research, including long-term and follow-up studies of human performance, analyses of trends in recruiting and attrition, and the ability to adapt research design to operational changes and methodological advances. Special problems posed by such long-duration projects include issues of confidentiality and security, as well as practical limitations imposed by current peer-review and short-term funding practices. Practical considerations for ongoing dataset management include consistency of assessment instruments over time, variations in data acquisition from one year to the next, and dealing with changes in theory and practice that occur over the life of the project. A fundamental change in how research into human performance is funded would be required to ensure the ongoing development of such long-duration research databases.

Adaptation, Psychological↗

PubMed2006

A secure semantic interoperability infrastructure for inter-enterprise sharing of electronic healthcare records.

Healthcare professionals need access to accurate and complete healthcare records for effective assessment, diagnosis and treatment of patients. The non-interoperability of healthcare information systems means that interenterprise access to a patient's history over many distributed encounters is difficult to achieve. The ARTEMIS project has developed a secure semantic web service infrastructure for the interoperability of healthcare information systems. Healthcare professionals share services and medical information using a web service annotation and mediation environment based on functional and clinical semantics derived from healthcare standards. Healthcare professionals discover medical information about individuals using a patient identification protocol based on pseudonymous information. The management of care pathways and access to medical information is based on a well-defined business process allowing healthcare providers to negotiate collaboration and data access agreements within the context of strict legislative frameworks.

Computer Security↗

PubMed2001

Securing interoperability between chip card based medical information systems and health networks.

Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.

Computer Security↗

PubMed2002

Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care.

OBJECTIVE: To determine e-mail utilization patterns and attitudes toward e-mail use among primary care physicians and their ambulatory outpatient clinic patients. STUDY DESIGN: Cross-sectional baseline survey. PARTICIPANTS AND METHODS: Participants included 476 consecutive outpatient clinic patients, 126 general medical and family practice physicians, and 16 clinical and office staff from 2 large primary care centers within an academic teaching system. They completed a survey about e-mail usage patterns and their attitudes toward using e-mail for patient-provider communication. RESULTS: More than half of patients (52.1%) were self-defined e-mail users, yet only 10.5% of those users had ever used e-mail to communicate with their doctors. Seventy percent of all patients said they would be willing to use e-mail to communicate with their doctors. Overall, patients were concerned about logistics, such as whether the message would get to the right person and how long it would take to get a response. Physicians and staff were more optimistic than patients about the potential for e-mail to improve the doctor-patient relationship. Patient e-mail users, patient e-mail nonusers, physicians, and staff reported low levels of concern about the security and privacy of e-mail. CONCLUSIONS: Patient-provider e-mail may diffuse slowly into the primary care clinical practice setting because of patient concerns about efficiency and effectiveness and whether e-mail use will improve their relationship with providers. Managed care organizations that plan to build e-mail and Web-based patient portals will need to promote these technologies in a way that educates both patient and providers about their appropriate use.

Adult↗

PubMed2005

CIOs' views of HIPAA Security Rule implementation--an application of Q-methodology.

The purpose of this study is to uncover the attitudes held by chief information officers (CIOs) regarding the implementation of HIPAA's Security Rule. In March and April of 2004, five Chicago area CIOs were surveyed and asked to rank 26 opinion statements that presented possible implementation barriers to the Security Rule. Q-methodology, which is a powerful tool in subjective study, was employed to identify and categorize the viewpoints of CIOs toward the barriers. Two factors (opinion types) that represented two different views--socially motivated CIOs and resources-motivated CIOs--regarding the implementation barriers were extracted. The study sheds light on the attitudes and perceptions of CIOs as they begin rule implementation. Current CIOs can use this information as a way to begin to examine what the prevailing attitude may be at their institution and, therefore, how to begin building a successful implementation strategy.

Chicago↗

PubMed2003

[Construction of DICOM-WWW gateway by open source, and application to PDAs using the high-speed mobile communications network].

The author constructed a medical image network system using open source software that took security into consideration. This system was enabled for search and browse with a WWW browser, and images were stored in a DICOM server. In order to realize this function, software was developed to fill in the gap between the DICOM protocol and HTTP using PHP language. The transmission speed was evaluated by the difference in protocols between DICOM and HTTP. Furthermore, an attempt was made to evaluate the convenience of medical image access with a personal information terminal via the Internet through the high-speed mobile communication terminal. Results suggested the feasibility of remote diagnosis and application to emergency care.

Computer Communication Networks↗

PubMedDate not supplied

A hierarchical model for PACS.

In this paper, a hierarchical model for Picture Archiving and Communication Systems (HPACS) is presented and implemented at Taichung Veterans General Hospital (TCVGH) in Taiwan. Despite the fact that the HPACS is built on the architecture of the second generation PACS, it offers many improved features and has advantages over the second generation PACS, such as the user security control, fast resource dispatch and efficient resource management. This HPACS can be used as a reference model for a hospital with any scale-size. The real implementation of HPACS is currently undertaken in the Taichung Veterans General Hospital (TCVGH), Taiwan, Republic of China and consists of four phases with the first two phases already completed. It is the first pilot system ever to be implemented successfully in a large-scale hospital in Taiwan. The experiences have illustrated the great promise of the HPACS in the future.

Computer Communication Networks↗