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PubMed2001

[Efficient multicentric data acquisition via internet - a method evaluation].

Data input in web-htm-forms with a browser is much more efficient in comparison with write in paper mask documents. The specification-compliant forms for data entry as htm-forms are downloaded from the homepage of the project manager by the participants of the study. The transformation of content of different formatted htm-forms is made by the program "security-based form converter (SFC)", which is located on a web server respectively a proxy server. From there the transformed data are returned the project manager via e-mail. Those incoming data are imported into databases by means of ODBC-data source. The data are pivoted from sequential format to table format. The data entry principle presented here is a client-server-structured, web based intranet program. For this purpose only standard software and relational databases with ODBC-interfaces are used; no further registered commercial programs are needed. General data protection is ensured by encrypted data transmission.

Computer Security↗

PubMed2002

The MPEG-4 standard and electronic reporting for mobile, multimedia patient records.

Electronic reporting and transfer of confidential patient data to the electronic patient record using Internet-related and wireless technologies can pose threats to the security and integrity of data. The MPEG-4 (Moving Pictures Experts Group-Version 4) standard can enable the seamless integration of text, digitized images and video sequences, and the necessary data security protocols for mobile access to and transfer of patient information. This standard will improve the quality of the electronic patient record as well as the reliability of authentication of reports. Applying the standard for patient reporting will also improve ways for authorized users to interact with patient records. Easier access to mobile multimedia patient records will assist clinicians in documenting patient episodes in a more timely and synchronous manner. This will result in better communication between health-care team members by allowing them to stay linked and interactive even when separated by distances in a telemedicine environment.

Computer Security↗

PubMed2001

[Data protection--an obstacle for prospective studies? Solutions exemplified by a cohort study].

Prospective studies require the storage of the participants' personal data for follow-up. This demands special precautions for the protection of these data. Additional to the informed consent of the participant which enables the researchers to collect the prospective study data, the participant's right of informal self-determination should be protected. In the EPIC (European Prospective Investigation into Cancer and Nutrition) Potsdam study, therefore, an internal trustee was established that collects follow-up information from participants, physicians, clinics, health offices, tumour and population registries with the aim to obtain valid information on vital status and diseases of the participants. The internal trustee is a spatial and organizational separated working group. The isolated electronic data processing network, the alarm system which controls the rooms of the working group, the access control for employees are special security arrangements. During follow-up the individual identification number of the study data base is replaced by a specific identification number solely for the follow-up. Further, unique identification numbers are allocated to every single action and every single document such as inquiry forms which are sent to physicians, health offices, or population registries, that allow anonymous mailing and processing of the collected information. On copies of important documents, the name is erased and replaced by a specific record number. The inquiry forms for the physicians, for instance, contain the name of the participant at the head which has to be cut off before returning the form to the internal trustee. The identification number is also printed as bar code on each document facilitating its processing with technical aids such as scanners. If checkbacks are necessary, only certain work group members are able to reconnect the document number with the name. Depending on the task, the computer programmes confine automatically the details presented to the assistant. All arrangements to protect personal data do not interfere with research interests; on the contrary they lead to an efficient work routine and guarantee follow-up according to international rules.

Cohort Studies↗

PubMedDate not supplied

Managing information resources: a study of ten healthcare organizations.

This article presents the results of information technology management audits conducted by senior executives at ten healthcare organizations. The audits evaluated how well the following seven information technology management responsibilities were carried out: (1) strategic information systems planning; (2) employment of a user focus in system development; (3) recruiting of competent personnel; (4) information systems integration; (5) protection of information security and confidentiality; (6) employment of effective project management in system development; and (7) post-implementation evaluation of information systems. The audit results suggest that most of these responsibilities are being met to a considerable extent by a majority of the organizations studied. However, substantial variation across organizations was noted. Executives participating in the study were able to define areas in which the management of information resources in their organizations was in need of attention. The audit process encourages senior management to provide the leadership required to ensure that information technology is used to maximum advantage.

Computer Security↗

PubMed2004

Information governance--a view from the NHS.

In this paper, a range of issues influencing and affecting NHS information governance policy and practice will be considered. The expansion of electronic information services within the NHS and with its other information partners has reinforced the need for effective security and confidentiality arrangements to apply at multiple levels and in a variety of different business contexts. Added to these, the need to consistently address issues of data protection, records management and data quality, has resulted in a NHS information governance initiative. This initiative is intended to provide approved tools, methods and guidance that may be applied consistently throughout the NHS and that will be underpinned through appropriate support and helpdesk services. This paper emphasises the need to consider a range of applicable topics when determining a responsible and extensible approach to the governance of information collected, used and shared by healthcare organisations.

Computer Communication Networks↗

PubMed2005

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

Communication and co-operation in healthcare and welfare require a certain set of 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. Legal and ethical requirements demand securely stored patient information and well-defined access rights. Among others, 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-repudiation of both origin and receipt. Electronic signatures along with certified time stamps or time signatures are especially important for electronic archives in general, electronic health records (EHR) in particular, and especially for typical purposes of long-lasting storage. Apart from technical storage problems (e.g. lifetime of the storage devices, interoperability of retrieval and presentation software), this paper identifies mechanisms of e.g. re-signing and re-stamping of data items, files, messages, sets of archived items or documents, archive structures, and even whole archives.

Computer Security↗

PubMed1997

Approaches for certification of electronic prescription software.

The proper management of drug treatment is essential, since adverse drug reactions are common reasons of hospitalisations. Expenditure on drug therapy has also been growing faster than any other aspect of health care in many countries. Savings and quality improvements in drug treatment could be achieved with computerised prescribing. In this paper, the architecture of an electronic prescription system is described in the light of software certification and registration. An electronic prescription system is an example of a system supporting shared care and therefore it should be person based, integrated, secure and confidential and data should be shared among health care institutions. The system architecture shares the idea of a virtual patient record and a smart card will be used as a key to prescription data located on the network. The certification and registration of medical software is a difficult and costly procedure. Ensuring the quality of software can be based on; certification of development process, voluntary evaluation, and post-market surveillance. Voluntary evaluation practice would be a precious tool for both the customers and software developers, and it would also be an invaluable source of information in terms of developing new software.

Certification↗

PubMed1998

Security and electronic signature standards--HCFA. Proposed rule.

This rule proposes standards for the security of individual health information and electronic signature use by health plans, health care clearinghouses, and health care providers would use the security standards to develop and maintain the security of all electronic individual health information. The electronic signature standard is applicable only with respect to use with the specific transactions defined in the Health Insurance Portability and Accountability Act of 1996, and when it has been determined that an electronic signature must be used. The use of these standards would improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general. This rule would implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1993

Health care security and privacy, quality and safety.

Working group 6 of CEN/TC251 is concerned with the broad field of Security and Privacy, Quality and Safety in Health Care. In line with the priorities given by SOGITS, the first areas to be looked into, are those concerned with Data Protection in Health Care Information Systems. In order to successfully work on standardisation in this field, one has to take into account the generally low awareness for these problems, and the necessity to avoid increasing the gap between theory and practice. Work of WG6 will build to a large extent on the results of a related AIM-project (SEISMED). A sketch is given of ongoing work on this subject. Briefly, also other work items for WG6 are reviewed.

Computer Security↗

PubMed2000

Leveraging HIPAA to support consumer empowerment.

The consumer empowerment movement needs to provide consumers with more access and control of their healthcare records. The premise of this article is that there is a fundamental market shift towards consumer empowerment--and technology is the driving force. We contend the results will satisfy the intent of the HIPAA mandate. Two restrictions impede the market from moving toward real consumer empowerment. First, managing one's own health history record is difficult because the complete record is segmented in disparate systems that are difficult to integrate. This is because unique identifiers and consistent coding are nonexistent. Second, security and control of patient identifiable health information is still evolving. There is no consensus among providers for Internet security, as we can see by all the legislative privacy bills trying to address the issue. HIPAA is both a legislative mandate and an enabler of the next healthcare paradigm. Providers must comply with the HIPAA mandates for electronic data interchange (EDI) code sets, administrative simplification, and privacy and confidentiality protocols. By recognizing HIPAA as part of a consumer-driven movement, organizations can incorporate empowerment strategies into a planning process that creates consumer options in healthcare and leverages HIPAA compliance to benefit both providers and consumers. This article suggests methods for meeting HIPAA compliance through innovative consumer empowerment methods.

Computer Security↗

PubMed2003

The evolution of Health Information Systems, security in practice and open issues.

Security issues during development and implementation of hospital information systems are briefly reviewed. Attention is paid to current issues as to: availability, integrity, authentication and access rights. In particular are discussed: some remaining risks as to integrity, the tension between in-house acceptance of HIS access rules and standardisation needed when implementing a transmural Electronic Health Record (EHR), access rights needed for medical audit, law suits and evaluation with their far-reaching consequences. The need for harmonisation of access rights is underlined and a further study of the requirements for systems from the perspective of medical audit, evaluation and juridical procedures is advocated.

Access to Information↗

PubMed2000

Internet-based monitoring and benchmarking in ambulatory surgery centers.

BACKGROUND: Each year the number of surgical procedures performed on an outpatient basis increases, yet relatively little is known about assessing and improving quality of care in ambulatory surgery. Conventional methods for evaluating outcomes, which are based on assessment of inpatient services, are inadequate in the rapidly changing, geographically dispersed field of ambulatory surgery. Internet-based systems for improving outcomes and establishing benchmarks may be feasible and timely. METHODS: Eleven freestanding ambulatory surgery centers (ASCs) reported process and outcome data for 3,966 outpatient surgical procedures to an outcomes monitoring system (OMS), during a demonstration period from April 1997 to April 1999. ASCs downloaded software and protocol manuals from the OMS Web site. Centers securely submitted clinical information on perioperative process and outcome measures and postoperative patient telephone interviews. Feedback to centers ranged from current and historical rates of surgical and postsurgical complications to patient satisfaction and the adequacy of postsurgical pain relief. RESULTS: ASCs were able to successfully implement the data collection protocols and transmit data to the OMS. Data security efforts were successful in preventing the transmission of patient identifiers. Feedback reports to ASCs were used to institute changes in ASC staffing, patient care, and patient education, as well as for accreditation and marketing. The demonstration also pointed out shortcomings in the OMS, such as the need to simplify hardware and software installation as well as data collection and transfer methods, which have been addressed in subsequent OMS versions. DISCUSSION: Internet-based benchmarking for geographically dispersed outpatient health care facilities, such as ASCs, is feasible and likely to play a major role in this effort.

Benchmarking↗

PubMedDate not supplied

Implementation of data security and data privacy provisions will bring sweeping changes to laboratory service providers.

The Health Insurance Portability and Accountability Act included substantial changes involving handling of health information by establishing national standards for electronic transactions, data privacy, and data security. The first final rule for electronic transaction standards was published August 17, 2000. The remaining final rules are expected to be published in Winter 2000. Providers, such as clinical laboratories, will have 26 months from the data of publication to comply. The civil monetary fines for noncompliance are substantial. This article will review the key provisions of the data security and data privacy proposed rules. These provisions will touch virtually every aspect of electronic claims submissions, electronic data transactions, and the electronic storage of medical information. The proposed rules will require a coordinated approach by providers to develop the policies and procedures, and the technical and physical infrastructure to protect health information. Moreover, providers will need to identify a privacy officer, to review existing privacy policies to compare the proposed rule with any existing state laws to determine which may be more stringent, and to develop new policies to address the particular requirements of the final rule.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied

Small numbers, disclosure risk, security, and reliability issues in Web-based data query systems.

This article describes the process for developing consensus guidelines and tools for releasing public health data via the Web and highlights approaches leading agencies have taken to balance disclosure risk with public dissemination of reliable health statistics. An agency's choice of statistical methods for improving the reliability of released data for Web-based query systems is based upon a number of factors, including query system design (dynamic analysis vs preaggregated data and tables), population size, cell size, data use, and how data will be supplied to users. The article also describes those efforts that are necessary to reduce the risk of disclosure of an individual's protected health information.

Adolescent↗

PubMed2006

Multiple image watermarking applied to health information management.

Information technology advances have brought forth new challenges in healthcare information management, due to the vast amount of medical data that needs to be efficiently stored, retrieved, and distributed, and the increased security threats that explicitly have to be addressed. The paper discusses the perspectives of digital watermarking in a range of medical data management and distribution issues, and proposes a complementary and/or alternative tool that simultaneously addresses medical data protection, archiving, and retrieval, as well as source and data authentication. The scheme imperceptibly embeds in medical images multiple watermarks conveying patient's personal and examination data, keywords for information retrieval, the physician's digital signature for authentication, and a reference message for data integrity control. Experimental results indicate the efficiency and transparency of the scheme, which conforms to the strict requirements that apply to regions of diagnostic significance.

Computer Security↗

PubMed2004

The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights.

Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

Computer Security↗

PubMed2000

Practicing dentistry in the age of telemedicine.

BACKGROUND: This article examines teledentistry and some of its current legal issues. Topics include licensure, malpractice, technology and ethics. General recommendations for the dental practitioner are included. The literature review includes state and federal laws, the Telemedicine Report to Congress and numerous articles (both printed and electronic) associated with the topic. Sources were selected for timeliness and relevance to legal issues and implications of telemedicine/teledentistry for the dental practitioner. CONCLUSIONS: Numerous issues require resolution before telemedicine and teledentistry will truly realize their enormous potential to increase access to health care while decreasing health care costs. These issues include interstate licensure, jurisdiction and malpractice, as well as technological, security and ethical questions. PRACTICE IMPLICATIONS: Telemedicine and teledentistry are relatively new to the dental field. Many of the legal issues reviewed have yet to be resolved by the legislature or the courts. Furthermore, technology has not yet progressed to the point where the practitioner can be certain that no technological failure will occur during a teledental consultation. In spite of these problems, the potential of telemedicine and teledentistry is tremendous. Improvement in accessibility of health care and lowered health care costs are only two of the many advantages that will emerge as telemedicine and teledentistry become integrated with, and fundamentally change, the practice of medicine and dentistry.

Computer Graphics↗

PubMed2003

Security and privacy of EHR systems--ethical, social and legal requirements.

This paper addresses social, ethical and legal concerns about security and privacy that arise in the development of international interoperable health information systems. The paper deals with these concerns under four rubrics: the ethical status of electronic health records, the social and legal embedding of interoperable health information systems, the overall information-requirements healthcare as such, and the role of health information professionals as facilitators. It argues that the concerns that arise can be met if the development of interoperability protocols is guided by the seven basic principles of information ethics that have been enunciated in the IMIA Code of Ethics for Health Information Professionals and that are central to the ethical treatment of electronic health records.

Computer Security↗