Acess Control How Can It Improve Patients' Healthcare

7/28/2019 Acess Control How Can It Improve Patients' Healthcare

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ICMCC 2007

Access control: how can it

improve patients healthcare

Ana FERREIRAabd

, Ricardo CRUZ-CORREIAcd

, LusANTUNESb, David CHADWICKa

aComputer Laboratory, University of Kent

bLIACC- Faculty of Science of PortocBiostatistics and Medical Informatics Dept. of Porto Faculty of Medicine

dCINTESIS Center for research in health information Systems and

technologies


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ICMCC 2007

Outline

Introduction

Objective Access control

Literature review Discussion

Case study patient access to medical records

Conclusions


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ICMCC 2007

Introduction

EMR

important support and integration tool collection, extraction, management, sharing

and searching

but

barriers to a successful integration

security, cost, time, relational and educational


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ICMCC 2007

Objective

To review how access control has been studied,designed and implemented in general and compare thisto similar research in the healthcare domain, within EMRsystems

This review will help identify the barriers that usuallyprevent the successful integration of access control

systems into EMR.


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ICMCC 2007

Access Control

Information security - CIA

3 steps to access a system - IAA Access control

is part of authorisation essential within the EMR

Challenge How to define proper policies in order tomodel all the complexity of healthcare tasks?


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Literature review

2 reviews were made

generic access control access control in healthcare

Last 10 years Searches

Medline, IEEE Xplore, ACM, SACMATS,ESORICS


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Results (1)59 articles were included in the review

1996-99 2000-03 2004-06 Total

Access Control Policy

Study/Analysis 4 12 16

Implementation 1 1

Access Control Model

Study/Analysis 4 11 37 52

Implementation 2 6 8

Authentication Mechanisms with

an implicit access control function

Study/Analysis 5 10 15



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Results (2)59 articles were included in the healthcare review

1996-99 2000-03 2004-06 Total

Access Control Policy



Access Control Model


Implementation 1 6 1 8

Authentication Mechanisms with

an implicit access control function


Implementation 1 6 1 8


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Results (3)1996-99 2000-03 2004-06 Total

Healthcare Institution

Hospital 3 10 7 20

Hospital Department 2 2

Primary Care 1 1 2

Private Care 1 3 4

Other 2 5 7

Total 3 16 16 35Healthcare Information System

EPR/EMR/CPR 5 14 15 34

Prescription 2 1 3

Consultation 1 1

Total 5 16 17 38


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Results (4)1996-99 2000-03 2004-06 Total

Portal/Internet Access

Healthcare professionals 1 1 2

Patients 1 1

Total 2 1 3

User groupsMedical doctors 2 2 4

Nurses 3 2 5

Patients 1 4 5

Others (HPs,GPs,IT,Pharmacists) 2 13 9 24

Total 2 19 17 38


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Results (5)

Problem type Number of occurrences

Educational Barriers 5

Disruption to workflow & performance 7

Relational Barriers 1

Increase in time for patient session 1

Security concerns 1

Cultural barriers 2Management problems 4


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ICMCC 2007

Discussion access control is a security service widely studied and applied in

healthcare systems such as EMR

most interested parties, the users (both healthcare professionals

and patients), are not usually consulted when the access controlpolicies are integrated into these systems

healthcare professionals usually needed to change their workflowpatterns and adapt their tasks and processes in order to use the

systems

We believe that if healthcare professionals and patients support andparticipate in the access control systems development process and

the access control policy definition then some of problems described

above can be minimized ensuring that EMR can be more effectively

used in order to provide for better healthcare


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ICMCC 2007

Why facilitate patient access

to medical recordsAna FERREIRAabd, Ana CORREIAc, Ana SILVAc, Ana CORTEc,Ana PINTOc, Ana SAAVEDRAc, Ana Lus PEREIRAc, Ana FilipaPEREIRAc, Ricardo CRUZ-CORREIAbc, Lus Filipe ANTUNESd

aComputer Laboratory at the University of KentbCINTESIS - Center for research in health information Systems and technologies

cBiostatistics and Medical Informatics Dept. at the Faculty of Medicine in Portod LIACC Faculty of Science of Porto


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ICMCC 2007

Introduction According to the European legislation

patients should be able to access their clinical informationwhenever they request and have means to control who can see

and change that information

A 2003 review analysed the effects of promoting patient access tomedical records and showed

it enhances doctor-patient communication [1] that patient satisfaction is high compared with very few records

that found that patients were upset with what they saw

also indicated that the future is likely to involve EMR and future

research will show if this technology will influence positively ornegatively patient satisfaction

[1] Ross SE, Lin CT. The effects of promoting patient access to medical records: a review. J Am Med

Inform Assoc 2003 May-J un; 10 (3):294


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ICMCC 2007

Objective

To perform a systematic review to analyze published work thatstudied the impact of facilitating patients access to their medical

record

In order to fill a gap in terms of the EMR impact within this issue, thisreview will focus on the use of EMR as well as the advantages anddisadvantages that it can bring


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ICMCC 2007

Methods

A systematic review based on articles

written between 1990 and 2005 wasperformed

Searches were made in Medline andScopus


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ResultsTopics

No of ArticlesYES NO

Patient interest and acceptance 5 [5] [10] [12] [20] [21] 1[14]

Confusion and misunderstandings 3 [15] [16] [21]

Patient education 2 [4] [17]

Creating anxiety 1 [15] 4[4] [5] [10] [16]

Providing reassurance 2[10] [17]

Promoting adherence 1[7] 1[11]

Concerns about confidentiality 3[4] [5] [17]

Improving doctor-patient relationship 2[4] [17]

Correcting errors 1[19]

The use of Electronic Medical Records 8[4] [5] [7] [9] [11] [12] [17] [21] 1[10]


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Discussion Patients access to medical records enhances communication between

patients and doctors and helps patients understand their health condition

Improves patients education and more participation in their health treatment

Patients are more careful in following medical recommendations

However, patients find some parts of the medical records difficult tounderstand because some notes are unintelligible or illegible to them

The use of EMR can facilitate the access and reading of the medical records

can reduce data errors as well as providing mechanisms to control theaccess, validate and correct information.

raises several concerns about the security. For confidentiality, thepossibility that technology gives for using security or security devicereassures patients

implies previous technological knowledge


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Final conclusions

The need for proper access control policy

that models healthcare professionals aswell as patients needs

Challenge: to build and test such anaccess control policy and model and

check whether it can improve EMRintegration and patients treatment

Acess Control How Can It Improve Patients' Healthcare

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