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PubMed2006

Contemporary, emerging, and ratified wireless security standards: an update for the networked dental office.

Wireless networking is not new to contemporary dental offices around the country. Wireless routers and network cards have made access to patient records within the office handy and, thereby, saving valuable chair side time and increasing productivity. As is the case with any rapidly developing technology, wireless technology also changes with the same rate. Unless, the users of the wireless networking understand the implications of these changes and keep themselves updated periodically, the office network will become obsolete very quickly. This update of the emerging security protocols and pertaining to ratified wireless 802.11 standards will be timely for the contemporary dentist whose office is wirelessly networked. This article brings the practicing dentist up-to-date on the newer versions and standards in wireless networking that are changing at a fast pace. The introduction of newer 802.11 standards like super G, Super AG, Multiple Input Multiple Output (MIMO), and pre-n are changing the pace of adaptation of this technology. Like any other rapidly transforming technology, information pertaining to wireless networking should be a priority for the contemporary dentist, an eventual end-user in order to be a well-informed and techno-savvy consumer.

Computer Security↗

PubMedDate not supplied

Strategies for success when medical groups participate in CHINs.

A community health information network (CHIN) is a group of health care providers and others interested in health care in a community who share computerized patient information and medical records to provide comprehensive quality care at a lower cost. To protect confidential patient data, all CHIN members should sign a confidentiality agreement describing how and for what purposes health information may be used and incorporating adequate indemnification provisions for unauthorized disclosure. Further, CHIN members should implement practical security passwords which are periodically changed, and the rapid deactivation of the user identification of terminated employees. To ensure data integrity, clear policies should be established for recording, amending and destroying information stored in patient records. To preserve the availability of the network's essential software, CHIN members also should enter into software license agreements which will allow for uninterrupted use of the network software following the addition of a new member or the departure on an existing member. Medical groups participating in CHINs can utilize these strategies to minimize their liability exposure from patient data confidentiality lapses and to promote proper data management and software availability for the smooth functioning of the network.

Community Networks↗

PubMed2000

The sleep data transfer between remote and central sites.

Sleep laboratory have long waiting lists due to the high prevalence of sleep disorders and the low availability of centers. One possibility for improving patient care is an ambulatory recording at home or in a distributed center. Then the data recorded must be transferred for analysis in the specialized center. Similarly, an application is needed for the transfer of raw data when the recordings are made by a health care provider sending sleep technologists to set-up the equipment in the patient's home. It is ethically preferable that the analysis be made by a physician from an independent organization from the provider to avoid any conflict of commercial interest with the provider whose main purpose is delivering therapeutic equipment (CPAP, oxygen...). The objectives were to set-up and test the transfer of sleep data files by ISDN lines between a health care provider and an expert sleep center. The application had to take into account a wide geographical dispersion of patients, general practitioners and medical experts. For that reason, it was decided to use existing Internet Web technology to facilitate portability and interoperability, reduce design time and costs and speed up deployment. The healthcare provider is the collecting site of ambulatory sleep recordings performed at the patient's home by the sleep technician of the provider. The raw data are sent to the sleep center for expert analysis. The methods used were: a PC set-up with a Gazel pro 2B PCI board, a commercially available file transfer software (DT Winstutel from ORSENNA) and an ISDN connection at 128 Kbps. The transfer security needs a set-up to maintain the confidentiality of the personal data transmitted: this is ensured through an identification sequence with several encrypted passwords. The duration of the transfer between Paris and Clamart has been tested for a 44 Moctets file: it took 66 min instead of a theoretical duration of 50 min. This difference was explained by a slower transfer rate (93 Kbps) instead of 128 Kbps. The cost of the transfer has been estimated at 5.4 Euro. This cost can be reduced by subscribing higher transfer tariffs. It amounts to 4.5% of the total cost of the ambulatory procedure at a value of 0.12 Euro per Moctet.

Computer Security↗

PubMed1992

[Development and organization of a knowledge-based documentation system for ophthalmologic video documentation].

We introduce a system for documentation of ophthalmological video tapes. This system can be implemented without regarding the German data security law (Bundesdatenschutzgesetz), because the documentation of the patient identification and the video tape identification number is done manually and separated from the EDP-supported documentation of the video tape identification number and the contents of the tape. But the use of a controlled vocabulary framework for diagnosis and surgery can be considered as the main advantage of this system. This enables a complete and fast retrieval to all records containing the terms searched for. Our system provides additional space for non-standardized text-documentation, e.g. comments etc... The implemented search-editor allows a fast retrieval to all records by input of strings, which can be connected by boolean expressions.

Computer Security↗

PubMed2004

Access control mechanisms for distributed healthcare environments.

Today's IT-infrastructure provides more and more possibilities to share electronic patient data across several healthcare organizations and hospital departments. A strong requirement is sufficient data protection and security measures complying with the medical confidentiality and the data protection laws of each state or country like the European directive on data protection or the U.S. HIPAA privacy rule. In essence, the access control mechanisms and authorization structures of information systems must be able to realize the Need-To-Access principle. This principle can be understood as a set of context-sensitive access rules, regarding the patient's path across the organizations. The access control mechanisms of today's health information systems do not sufficiently satisfy this requirement, because information about participation of persons or organizations is not available within each system in a distributed environment. This problem could be solved by appropriate security services. The CORBA healthcare domain standard contains such a service for obtaining authorization decisions and administrating access decision policies (RAD). At the university hospital of Mainz we have developed an access control system (MACS), which includes the main functionality of the RAD specification and the access control logic that is needed for such a service. The basic design principles of our approach are role-based authorization, user rights with static and dynamic authorization data, context rules and the separation of three cooperating servers that provide up-to-date knowledge about users, roles and responsibilities. This paper introduces the design principles and the system design and critically evaluates the concepts based on practical experience.

Computer Security↗

PubMed1998

Performance improvement in telemedicine: the essential elements.

Performance improvement activities in telemedicine may be placed into five categories. (1) Licensing and credentialing. Telemedicine overcomes geographical boundaries, but its reach is constrained by state laws on licensing. Some states require a state license, whereas others grant "consultation exemptions" for out-of-state physicians. Simple renewable licenses do not guarantee quality. Potential solutions include a national telemedicine license or license reciprocity laws for telemedicine. (2) Data security and privacy. Telemedicine technology raises some security concerns. Differences in reporting requirements among states complicate the issue of privacy. Storage of telemedicine consultation records may help physicians document care decisions for risk management, but conventional long-term storage may not be feasible because of cost constraints and may not be required to document the encounter appropriately. (3) Informed consent. Potential failures in security and transmission are new, and should be communicated to the patient. (4) Peer review. Peer review findings encourage thorough, accurate, and legible documentation. Results should be recorded by provider and must be available during the recredentialing process. (5) Tailored performance improvement initiatives. By using established principles and techniques, performance improvement initiatives can gather, analyze, and communicate information about the cost-effectiveness of telemedicine. These performance improvement efforts are the heart of quality management and are critical to the justification of telemedicine. Walter Reed Telemedicine has put into effect a performance improvement plan in accordance with this outline. This article describes the plan and suggests it as a model for other telemedicine programs.

Computer Security↗

PubMed2006

Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).

Quality and efficiency of health care services is expected to be improved by the electronic processing and trans-institutional availability of medical data. A prototype architecture based on the IHE-XDS profile is currently being developed. Due to legal and organizational requirements specific adaptations to the IHE-XDS profile have been made. In this work the services of the health@net reference architecture are described in details, which have been developed with focus on compliance to both, the IHE-XDS profile and the legal situation in Austria. We expect to gain knowledge about the development of a shared electronic health record using Medical Data Grids as an Open Source reference implementation and how proprietary Hospital Information systems can be integrated in this environment.

Austria↗

PubMed2004

Using electronic health records to help coordinate care.

The use of electronic health records that can securely transmit patient data among physicians will help coordinate the care of 60 million Americans with multiple chronic conditions. This article summarizes the different organizations in the United States that are developing this technology. It discusses some of the problems encountered and the current initiatives to resolve them. The article concludes with three recommendations for enhancing care coordination: (1) a common health record, such as the Continuity of Care Record, to facilitate the exchange of clinical information among health providers; (2) regional governance structures to encourage the exchange of clinical data; and (3) payment by purchasers of care, both public and private, to physicians for using electronic health records.

Chronic Disease↗

PubMed2006

Citizen empowerment using healthcare and welfare cards.

Cards are used in health and welfare to establish the identity of the person presenting the card; to prove their entitlement to a welfare or healthcare service; to store data needed within the care process; and to store data to use in the administration process. There is a desire to empower citizens - to give them greater control over their lives, their health and wellbeing. How can a healthcare and welfare card support this aim? Does having a card empower the citizen? What can a citizen do more easily, reliably, securely or cost-effectively because they have a card? A number of possibilities include: Choice of service provider; Mobility across regional and national boundaries; Privacy; and Anonymity. But in all of these possibilities a card is just one component of a total system and process, and there may be other solutions--technological and manual. There are risks and problems from relying on a card; and issues of Inclusion for people who are unable use a card. The article concludes that: cards need to be viewed in the context of the whole solution; cards are not the only technological mechanism; cards are not the best mechanism in all circumstances; but cards are very convenient method in very many situations.

Computer Security↗

PubMed2004

An evaluation of the current state of genomic data privacy protection technology and a roadmap for the future.

The incorporation of genomic data into personal medical records poses many challenges to patient privacy. In response, various systems for preserving patient privacy in shared genomic data have been developed and deployed. Although these systems de-identify the data by removing explicit identifiers (e.g., name, address, or Social Security number) and incorporate sound security design principles, they suffer from a lack of formal modeling of inferences learnable from shared data. This report evaluates the extent to which current protection systems are capable of withstanding a range of re-identification methods, including genotype-phenotype inferences, location-visit patterns, family structures, and dictionary attacks. For a comparative re-identification analysis, the systems are mapped to a common formalism. Although there is variation in susceptibility, each system is deficient in its protection capacity. The author discovers patterns of protection failure and discusses several of the reasons why these systems are susceptible. The analyses and discussion within provide guideposts for the development of next-generation protection methods amenable to formal proofs.

Computer Security↗

PubMed2004

Authorisation and access control for electronic health record systems.

Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented.

Access to Information↗

PubMed2005

An eConsent-based System Architecture Supporting Cooperation in Integrated Healthcare Networks.

OBJECTIVES: The economical need for efficient healthcare leads to cooperative shared care networks. A virtual electronic health record is required, which integrates patient related information but reflects the distributed infrastructure and restricts access only to those health professionals involved into the care process. Our work aims on specification and development of a system architecture fulfilling these requirements to be used in concrete regional pilot studies. METHODS: Methodical analysis and specification have been performed in a healthcare network using the formal method and modelling tool MOSAIK-M. The complexity of the application field was reduced by focusing on the scenario of thyroid disease care, which still includes various interdisciplinary cooperation. RESULTS: Result is an architecture for a secure distributed electronic health record for integrated care networks, specified in terms of a MOSAIK-M-based system model. The architecture proposes business processes, application services, and a sophisticated security concept, providing a platform for distributed document-based, patient-centred, and secure cooperation. A corresponding system prototype has been developed for pilot studies, using advanced application server technologies. The architecture combines a consolidated patient-centred document management with a decentralized system structure without needs for replication management. An eConsent-based approach assures, that access to the distributed health record remains under control of the patient. CONCLUSION: The proposed architecture replaces message-based communication approaches, because it implements a virtual health record providing complete and current information. Acceptance of the new communication services depends on compatibility with the clinical routine. Unique and cross-institutional identification of a patient is also a challenge, but will loose significance with establishing common patient cards.

Communication↗

PubMed1991

Risks associated with clinical databases.

Providers will succeed who are evaluating themselves, and who are continuously striving to examine who they are and where they are going. Conscientious providers know that countless other agencies have them under the microscope and that they have to work to stay ahead in assessing their actions through their clinical database. "Medical care value purchasing" is what every employer and payor is looking for, and providers need to find ways to illustrate cost in relation to quality. The basics of data security and protection should be in place in order to concentrate on the bigger picture. The knowledge of the risk associated with individual hospital databases as well as the risk associated with comparative databases is critical. The hospital-level clinical database is the hub of the wheel. If the risk there can be minimized, the data headed for various investigative sites will have less inherent risk. When it is really recognized and accepted that all financial decisions are made based upon the clinical data generated at the site of care, then data integrity will become a strategic advantage for the industry. Clinical database goals will, over time, cause minimization of risk at all levels. As this occurs, variation in treatment will be explained artfully.

Clinical Medicine↗

PubMed1995

[Regional distribution of stomach and colon cancer mortality in the Dithmarschen and Nordfriesland districts--cartographic presentation].

In two counties (Dithmarschen and Nordfriesland) of the Federal State of Schleswig-Holstein (in the northern part of Germany) the cancer mortality rates, especially those of stomach and colon cancer, were evaluated for the time period 1980-1991. For this purpose the corresponding death certificates collected in these counties were analysed. The counties were subdivided into 16 and 17 smaller areas, respectively. The age-adjusted mortality rates were calculated and the obtained data scaled into eight sections, which were graphically mapped over the smaller areas of the two counties. The frequency of these cancer mortality rates reflects a wide range of distribution pattern in the smaller areas of the two counties, which greatly differ from the cancer mortality values calculated for the two counties as a whole. In comparison with the frequency of stomach cancer mortality for men published in the German Cancer Atlas in 1984 it could be demonstrated that this cancer mortality further decreased in these counties. However, in some smaller areas of these counties, especially in rural areas, the mortality rates of stomach cancer in men were still rather high. The opposite seems to be reflected regarding the frequency of colon cancer mortality. Here higher frequencies of mortality were seen in the small cities of these counties. We suggest that a more subtile cancer mortality mapping can be performed easily without any risk of hurting the requirements of personal data securities, because cancer mortality data are already continuously evaluated by a trained staff at the offices of statistical affairs. These data may be transferred and used for cancer mortality mapping as described in the present paper. In order to guarantee that there will be no violation of personal data secrecy the cancer mortality mapping must be restricted to cancer sites with high frequencies of mortality. All published data should be supervised by an official with special knowledge of the requirements of personal data protection. This study underlines the necessity for higher resolution (smaller areas) in cancer registries as essential prerequisite for systematical exploration of the origins of cancer mortality and as a basis for preventive measures.

Colonic Neoplasms↗

PubMed2002

A security architecture for query tools used to access large biomedical databases.

Disseminating information from large biomedical databases can be crucial for research. Often this data will be patient-specific, and therefore require that the privacy of the patient be protected. In response to this requirement, HIPAA released regulations for the dissemination of patient data. In many cases, the regulations are so restrictive as to render data useless for many purposes. We propose in this paper a model for obfuscation of data when served to a client application, that will make it extremely unlikely that an individual will be identified. At Partners Healthcare Inc, with over 1.4 million patients and 400 research clinician users, we implemented this model. Based on the results, we believe that a web-client could be made generally available using the proposed data obfuscation scheme that could allow general usage of large biomedical databases of patient information without risk to patient privacy.

Computer Security↗

PubMed2005

The Internet and clinical trials: background, online resources, examples and issues.

Both the Internet and clinical trials were significant developments in the latter half of the twentieth century: the Internet revolutionized global communications and the randomized controlled trial provided a means to conduct an unbiased comparison of two or more treatments. Large multicenter trials are often burdened with an extensive development time and considerable expense, as well as significant challenges in obtaining, backing up and analyzing large amounts of data. Alongside the increasing complexities of the modern clinical trial has grown the power of the Internet to improve communications, centralize and secure data as well as to distribute information. As more and more clinical trials are required to coordinate multiple trial processes in real time, centers are turning to the Internet for the tools to manage the components of a clinical trial, either in whole or in part, to produce lower costs and faster results. This paper reviews the historical development of the Internet and the randomized controlled trial, describes the Internet resources available that can be used in a clinical trial, reviews some examples of online trials and describes the advantages and disadvantages of using the Internet to conduct a clinical trial. We also extract the characteristics of the 5 largest clinical trials conducted using the Internet to date, which together enrolled over 26000 patients.

Computer Security↗

PubMed2001

Why some physicians envy dentists: the applications service provider.

To summarize, here's what I get from my ASP. My staff and I can access our schedules, patient information, etc, any time and from anywhere--not just from the office PC. All I need is a standard Internet browser and a connection to the Internet. Only authorized personnel have access to my data. My online practice management system is password protected and operates with Verisign SSL--the highest level of Internet security. All information is stored in my secure database, which my ASP backs up and replicates continuously. Dental. PackOnline even operates dual servers. In case one server has a problem, they just switch to the other server, so I never have to worry about "down-time." I can give patients access to their own information online-treatment plans, patient education material, balances, etc, in a highly private and confidential manner. I can share patient information, x-rays, and other materials online with colleagues, specialists, and labs, again in a highly confidential manner. I send out billing, recalls, claims, and more automatically because my ASP has real-time connections to service providers. No more time spent printing, folding, stamping cards, billing, or processing claims. This is a tremendous cost and time saver!

Computer Security↗

PubMed1994

Encrypting personal identifiers.

STUDY SETTING. A statewide patient discharge database contained only one unique identifier: the social security number (SSN). A method was developed to transform (encrypt) the SSN so that it could be made publicly available, for purposes of linking discharge records, without revealing the SSN itself. The method of encrypting the SSN into a Record Linkage Number (RLN) is described. PRINCIPAL FINDINGS. The same RLN will always result from the same SSN; it is highly improbable that the same RLN would be produced by two different SSNs; the SSN cannot be derived from the RLN, even given access to the encryption program; the encryption method cannot be determined through knowledge of a number of SSN/RLN combinations; and the method can be described, evaluated, and adapted for use by other researchers without compromising confidentiality of the RLNs resulting from the method.

Abstracting and Indexing↗