End users should be mindful that, unlike paper record activity, all EHR activity can be traced based on the login credentials. 10.1001/virtualmentor.2012.14.9.stas1-1209. Regardless of the type of measure used, a full security program must be in place to maintain the integrity of the data, and a system of audit trails must be operational. Review Security and privacy of electronic health records: Concerns and challenges Ismail Keshta a, ⇑, Ammar Odeh b a Computer Science and Information Systems Department, College of Applied Sciences, AlMaarefa University, Riyadh, Saudi Arabia b Computer Science Department, Princess Sumaya University for Technology, Amman, Jordan a r t i c l e i n f o Article history: Received 8 … Another potentially problematic feature is the drop-down menu. 2020 Oct;11(5):755-763. doi: 10.1055/s-0040-1718753. Protecting patient information. Revision of the Measurement Tool for Patients' Health Information Protection Awareness. Audit trails do not prevent unintentional access or disclosure of information but can be used as a deterrent to ward off would-be violators. This responsibility extends to protecting patient information, privacy, and confidentiality. Medical practice is increasingly information-intensive. Security refers directly toprotection, and specifically to the means used to protect the privacy of health information and support professionals in holding that information in confidence. American Health Information Management Association. Office of the National Coordinator for Health Information Technology. Record completion times must meet accrediting and regulatory requirements. Because the government is increasingly involved with funding health care, agencies actively review documentation of care. Basic standards for passwords include requiring that they be changed at set intervals, setting a minimum number of characters, and prohibiting the reuse of passwords. Electronic medical records (EMRs) have the potential to decrease health care costs, increase the quality of patient care, facilitate better departmental communication, create less paper confusion, allow use with authorized access only, allow storage of digital images, and increase overall efficiency in the health care system, but are patients really better off with a paperless system? During your most recent visit to the doctor, you may have noticed your physician entering notes on a computer or laptop into an electronic health record (EHR). Ethical Considerations on Pediatric Genetic Testing Results in Electronic Health Records. The user’s access is based on preestablished, role-based privileges. Providers and organizations must formally designate a security officer to work with a team of health information technology experts who can inventory the system’s users, and technologies; identify the security weaknesses and threats; assign a risk or likelihood of security concerns in the organization; and address them. Laurinda B. Harman, PhD, RHIA, Cathy A. Flite, MEd, RHIA, and Kesa Bond, MS, MA, RHIA, PMP, Copyright 2020 American Medical Association. Kesa Bond, MS, MA, RHIA, PMP earned her BS in health information management from Temple University, her MS in health administration from Saint Joseph's University, and her MA in human and organizational systems from Fielding Graduate University. Unauthorized access to patient information triggered no alerts, nor was it known what information had been viewed. US Department of Health and Human Services Office for Civil Rights. Others will be key leaders in building the health information exchanges across the country, working with governmental agencies, and creating the needed software. In a physician practice, for example, the practice administrator identifies the users, determines what level of information is needed, and assigns usernames and passwords. Electronic health records (EHRs) offer significant advantages over paper charts, such as ease of portability, facilitated communication, and a decreased risk of medical errors; however, important ethical concerns related to patient confidentiality remain. NIH US Department of Health and Human Services. Accessed August 10, 2012. To report the results of a systematic literature review concerning the security and privacy of electronic health record (EHR) systems. Get the latest research from NIH: https://www.nih.gov/coronavirus. This site needs JavaScript to work properly. Data may be collected and used in many systems throughout an organization and across the continuum of care in ambulatory practices, hospitals, rehabilitation centers, and so forth. 2. Data sources Original articles written in English found in MEDLINE, ACM Digital Library, Wiley InterScience, IEEE Digital Library, [email protected] , MetaPress, ERIC, CINAHL and Trip Database. Electronic health records: privacy, confidentiality, and security The HIPAA Security Rule requires organizations to conduct audit trails [12], requiring that they document information systems activity [15] and have the hardware, software, and procedures to record and examine activity in systems that contain protected health information [16]. 2012;83(4):50. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049463.hcsp?dDocName=bok1_049463. Health care is changing and so are the tools used to coordinate better care for patients like you and me. Her research interests include childhood obesity. Justices Warren and Brandeis define privacy as the right “to be let alone” [3]. A recent survey found that 73 percent of physicians text other physicians about work [12]. Patient information should be released to others only with the patient’s permission or as allowed by law. She earned her BS in health information management at Temple University, a master of education degree from Widener University, and a master of arts in human development from Fielding Graduate University. The electronic health record is interactive, and there are many stakeholders, reviewers, and users of the documentation. 2020 Apr 3;20(1):61. doi: 10.1186/s12911-020-1076-5. Her research interests include professional ethics. Medical staff must be aware of the security measures needed to protect their patient data and the data within their practices. To ensure availability, electronic health record systems often have redundant components, known as fault-tolerance systems, so if one component fails or is experiencing problems the system will switch to a backup component. In addition, both believed that the privacy law must evolve in order to keep up with technological change (Harman, Flite, & Bond, 2012). Hence, designating user privileges is a critical aspect of medical record security: all users have access to the information they need to fulfill their roles and responsibilities, and they must know that they are accountable for use or misuse of the information they view and change [7]. Concerns on privacy and security of electronic health records. Resolution agreement [UCLA Health System]. 2nd ed. It is the business record of the health care system, documented in the normal course of its activities. 2009;80(1):26-29. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_042416.hcsp?dDocName=bok1_042416. Am J Bioeth. Accessed August 10, 2012. Guide to Privacy and Security of Health Information; 2012:5. http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf. Clinical Data: Sources and Types, Regulatory Constraints, Applications. 1890;4:193. The key to preserving confidentiality is making sure that only authorized individuals have access to information. 16 .1 Electronic health records Electronic health records differ from paper health records in ways that warrant special consideration . The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. What Should Oversight of Clinical Decision Support Systems Look Like? Abstract: A systematic and comprehensive review of security and privacy-preserving challenges in e-health solutions indicates various privacy preserving approaches to ensure privacy and security of electronic health records (EHRs) in the cloud. Firstly, it is possible to have a single electronic health record simultaneously accessible at multiple sites, giving more Copy functionality toolkit; 2008:4. http://library.ahima.org/29%3Cand%3E%28xPublishSite%3Csubstring%3E%60BoK%60%29&SortField=xPubDate&SortOrder=Desc&dDocName=bok1_042564&HighlightType=PdfHighlight. The physician was in control of the care and documentation processes and authorized the release of information. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Sudbury, MA: Jones and Bartlett; 2006:53. Features of the electronic health record can allow data integrity to be compromised. http://www.hhs.gov/ocr/privacy/hipaa/news/uclahs.html. U.S. Department of Commerce. Some who are reading this article will lead work on clinical teams that provide direct patient care. When used with appropriate attention to security, electronic medical records (EMRs) promise numerous benefits for quality clinical care and health-related research. Security standards: general rules, 46 CFR section 164.308(a)-(c). According to Richard Rognehaugh, it is “the right of individuals to keep information about themselves from being disclosed to others; the claim of individuals to be let alone, from surveillance or interference from other individuals, organizations or the government” [4]. 2012;83(5):50. Some security measures that protect data integrity include firewalls, antivirus software, and intrusion detection software. There are three major ethical priorities for electronic health records: privacy and confidentiality, security, and data integrity and availability. National Institute of Standards and Technology Computer Security Division. The information can take various forms (including identification data, diagnoses, treatment and progress notes, and laboratory results) and can be stored in multiple media (e.g., paper, video, electronic files). US Department of Health and Human Services Office for Civil Rights. Although the record belongs to the facility or doctor, it is truly the patient’s information; the Office of the National Coordinator for Health Information Technology refers to the health record as “not just a collection of data that you are guarding—it’s a life” [2]. The responsibilities for privacy and security can be assigned to a member of the physician office staff or can be outsourced. The electronic health record (ERC) can be viewed by many simultaneously and utilizes a host of information technology tools. However, when a security breach occurs, patients may face physical, emotional, and dignitary harms. McGuire AL(1), Fisher R, Cusenza P, Hudson K, Rothstein MA, McGraw D, Matteson S, Glaser J, Henley DE. Following a survey of nurses’ concerns about privacy, confidentiality, security and patient safety in electronic health records, six focus groups were held to gain deeper insights about their concerns. Cyber security is required to prevent, detect, and act on unauthorized access to a health system and its information. If the system is hacked or becomes overloaded with requests, the information may become unusable. The privacy and security of patient health information is a top priority for patients and their families, health care providers and professionals, and the government. In: Harman LB, ed. Accessed August 10, 2012. American Health Information Management Association.  |  J Am Health Inf Management Assoc. Technical safeguards. If not 07 February 2005. Information from which the identity of the patient cannot be ascertained—for example, the number of patients with prostate cancer in a given hospital—is not in this category [6]. She was the director of health information management for a long-term care facility, where she helped to implement an electronic health record. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Getting out of the compliance mindset: doing more with data security. Information can be released for treatment, payment, or administrative purposes without a patient’s authorization. It was severely limited in terms of accessibility, available to only one user at a time. American Health Information Management Association. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA. Get the latest public health information from CDC: https://www.coronavirus.gov. Some will earn board certification in clinical informatics. This is not, however, to say that physicians cannot gain access to patient information. Controlling access to health information is essential but not sufficient for protecting confidentiality; additional security measures such as extensive training and strong privacy and security policies and procedures are essential to securing patient information. http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf. Encrypting mobile devices that are used to transmit confidential information is of the utmost importance. Please enable it to take advantage of the complete set of features! Rognehaugh R. The Health Information Technology Dictionary. Audit trails. 2010 Sep;10(9):30-1. doi: 10.1080/15265161.2010.494224. Staff must exit applications when leaving computer workstations unattended. Washington, DC: US Department of Health and Human Services; July 7, 2011. http://www.hhs.gov/news/press/2011pres/07/20110707a.html. Accessed August 10, 2012. HHS steps up HIPAA audits: now is the time to review security policies and procedures. Use of electronic health records (EHRs) can improve quality of care, reduce costs, enhance patient mobility, improve reliability, and enable evidence-based medicine. Kanungo S, Barr J, Crutchfield P, Fealko C, Soares N. Appl Clin Inform. Emily L. Evans, PhD, MPH and Danielle Whicher, PhD, MHS. In addition, the HITECH Act of 2009 requires health care organizations to watch for breaches of personal health information from both internal and external sources. As use of electronic health record systems grew, and transmission of health data to support billing became the norm, the need for regulatory guidelines specific to electronic health information became more apparen… Warren SD, Brandeis LD. Gaithersburg, MD: Aspen; 1999:125. In a physician practice, the nurse and the receptionist, for example, have very different tasks and responsibilities; therefore, they do not have access to the same information. Accessed August 10, 2012. Mobile devices are largely designed for individual use and were not intended for centralized management by an information technology (IT) department [13]. This paper highlights the research challenges and directions concerning cyber security to build a comprehensive security model for EHR. Epub 2019 May 9. health information management systems, and minimise the privacy and security risks . As part of the meaningful use requirements for EHRs, an organization must be able to track record actions and generate an audit trail in order to qualify for incentive payments from Medicare and Medicaid. Access multimedia content about novel coronavirus. Data were collected between January and June 2018 via questionnaires and focus group interviews. Accessed August 10, 2012. In the past, the medical record was a paper repository of information that was reviewed or used for clinical, research, administrative, and financial purposes. The same federal laws that already protect your health information also apply to Therefore, ensuring privacy, security, confidentiality, integrity, and availability of protected health information (PHI) in EHRs is absolutely necessary. Mohammadibakhsh R, Aryankhesal A, Jafari M, Damari B. J Educ Health Promot. Hudgins C, Rose S, Fifield PY, Arnault S. Fam Syst Health. Ethical Challenges in the Management of Health Information. University of California settles HIPAA privacy and security case involving UCLA Health System facilities [news release]. Alerts are often set to flag suspicious or unusual activity, such as reviewing information on a patient one is not treating or attempting to access information one is not authorized to view, and administrators have the ability to pull reports on specific users or user groups to review and chronicle their activity. Family physician model in the health system of selected countries: A comparative study summary. With the evolution of electronic health records, people’s private medical history must also be protected and be treated as confidential. Software companies are developing programs that automate this process. COVID-19 is an emerging, rapidly evolving situation. Physicians will be evaluated on both clinical and technological competence. Most medical record departments were housed in institutions’ basements because the weight of the paper precluded other locations. USA.gov. The physician, practice, or organization is the owner of the physical medical record because it is its business record and property, and the patient owns the information in the record [1]. US Department of Health and Human Services. 45 CFR section 164.312(1)(b).  |  Farzandipour M, Meidani Z, Nabovati E, Sadeqi Jabali M, Dehghan Banadaki R. BMC Med Inform Decis Mak. Federal laws require many of the key persons and organizations that handle health information to have policies and security safeguards in place to protect your health information — whether it is stored on paper or electronically. Confidentiality, privacy, and security of genetic and genomic test information in electronic health records: points to consider. Rinehart-Thompson LA, Harman LB. D. Security of Electronic Health Records 1. The Security Rule applies to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with a transaction for which the Secretary of HHS has adopted standards under HIPAA (the “covered entities”) and to … Availability. Administrators can even detail what reports were printed, the number of screen shots taken, or the exact location and computer used to submit a request.  |  We invite submission of manuscripts for peer review on upcoming theme issues. For the patient to trust the clinician, records in the office must be protected. For the Record describes two major types of privacy and security concerns that stem from the availability of health information in electronic form: the increased potential for inappropriate release of information held by individual organizations (whether by those with access to computerized records or those who break into them) and systemic concerns derived from open and widespread … J Am Health Inf Management Assoc. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record. Drop-down menus may limit choices (e.g., of diagnosis) so that the clinician cannot accurately record what has been identified, and the need to choose quickly may lead to errors. Physicians have been using computers to update patient medical files, largely due to the belief that electronic health records have many advantages. It will be essential for physicians and the entire clinical team to be able to trust the data for patient care and decision making. Your organization already must do everything possible to comply with HIPAA and other privacy regulations, and electronic health records make it easier to maintain confidentiality over paper records in this respect. Mobile device security (updated). Odom-Wesley B, Brown D, Meyers CL. To understand the complexities of the emerging electronic health record system, it is helpful to know what the health information system has been, is now, and needs to become. How to keep the information in these exchanges secure is a major concern. Ahalt SC, Chute CG, Fecho K, Glusman G, Hadlock J, Taylor CO, Pfaff ER, Robinson PN, Solbrig H, Ta C, Tatonetti N, Weng C; Biomedical Data Translator Consortium. Accessed August 10, 2012. UCLA Health System settles potential HIPAA privacy and security violations. The patient, too, has federal, state, and legal rights to view, obtain a copy of, and amend information in his or her health record. As with all regulations, organizations should refer to federal and state laws, which may supersede the 6-year minimum. Much work remains to be done on the data security front. Song Y, Lee M, Jun Y, Lee Y, Cho J, Kwon M, Lim H. Healthc Inform Res. Access was controlled by doors, locks, identification cards, and tedious sign-out procedures for authorized users. 2019 Jul;12(4):329-333. doi: 10.1111/cts.12638. Ensuring the privacy and confidentiality of electronic health records In 2004, President Bush announced his plan to ensure that more Americans would have electronic health records … Chicago: American Health Information Management Association; 2009:21. The increasing concern over the security of health information stems from the rise of EHRs, increased use of mobile devices such as the smartphone, medical identity theft, and the widely anticipated exchange of data between and among organizations, clinicians, federal agencies, and patients. Computer workstations are rarely lost, but mobile devices can easily be misplaced, damaged, or stolen. Technical requirements framework of hospital information systems: design and evaluation. Patients routinely review their electronic medical records and are keeping personal health records (PHR), which contain clinical documentation about their diagnoses (from the physician or health care websites). Under the HIPAA Privacy and Security Rules, employers are held accountable for the actions of their employees. Poor data integrity can also result from documentation errors, or poor documentation integrity. Take, for example, the ability to copy and paste, or “clone,” content easily from one progress note to another. J Am Health Inf Management Assoc. Auditing copy and paste. A simple example of poor documentation integrity occurs when a pulse of 74 is unintentionally recorded as 47. eCollection 2020. The medical record, either paper-based or electronic, is a communication tool that supports clinical decision making, coordination of services, evaluation of the quality and efficacy of care, research, legal protection, education, and accreditation and regulat… Explain the difference between an Electronic Health Record and an Electronic Medical Record. Not only does the NIST provide guidance on securing data, but federal legislations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act mandate doing so. Regardless of one’s role, everyone will need the assistance of the computer. Win suggested that close to two thirds of clients paid attention to privacy of their personal health records and only 39% of the respondents felt that their health data were safe and secure. Although legal protections have been impleme … A second limitation of the paper-based medical record was the lack of security. Clinical documentation is often scanned into an electronic system immediately and is typically completed by the time the patient is discharged. Gaithersburg, MD: NIST; 1995:5. http://csrc.nist.gov/publications/nistpubs/800-12/800-12-html/index.html. In addition to the importance of privacy, confidentiality, and security, the EHR system must address the integrity and availability of information. The information that is shared as a result of a clinical relationship is considered confidential and must be protected [5]. Many organizations and physician practices take a two-tier approach to authentication, adding a biometrics identifier scan, such as palm, finger, retina, or face recognition.
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