electronic health records: privacy, confidentiality and security

In a physician practice, for example, the practice administrator identifies the users, determines what level of information is needed, and assigns usernames and passwords. Warren SD, Brandeis LD. Creating useful electronic health record systems will require the expertise of physicians and other clinicians, information management and technology professionals, ethicists, administrative personnel, and patients. HHS Greene AH. Description: This document identifies the privacy and security (P&S) requirements that an interoperable electronic health record (EHR) must meet in order to fully protect the privacy of patient/persons and maintain the confidentiality, integrity and availability of their data. Violating these regulations has serious consequences, including criminal and civil penalties for clinicians and organizations. The process of controlling access—limiting who can see what—begins with authorizing users. 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. Accessed August 10, 2012. 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. Odom-Wesley B, Brown D, Meyers CL. A second limitation of the paper-based medical record was the lack of security. The 10 security domains (updated). The HIPAA security rule requires that covered entities implement a security technology to safeguard the integrity, confidentiality 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. The National Institute of Standards and Technology (NIST), the federal agency responsible for developing information security guidelines, defines information security as the preservation of data confidentiality, integrity, availability (commonly referred to as the “CIA” triad) [11]. American Health Information Management Association. There is no way to control what information is being transmitted, the level of detail, whether communications are being intercepted by others, what images are being shared, or whether the mobile device is encrypted or secure. Information technology can support the physician decision-making process with clinical decision support tools that rely on internal and external data and information. J Am Health Inf Management Assoc. 2020 Apr 3;20(1):61. doi: 10.1186/s12911-020-1076-5. 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. Documentation for Medical Records. 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. Medical staff must be aware of the security measures needed to protect their patient data and the data within their practices. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Technical requirements framework of hospital information systems: design and evaluation. Encrypting mobile devices that are used to transmit confidential information is of the utmost importance. 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. Mohammadibakhsh R, Aryankhesal A, Jafari M, Damari B. J Educ Health Promot. 1890;4:193. Office of the National Coordinator for Health Information Technology. 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. 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]. The right to privacy. It is the business record of the health care system, documented in the normal course of its activities. The paper-based record was updated manually, resulting in delays for record completion that lasted anywhere from 1 to 6 months or more. Accessed August 10, 2012. 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 … Rinehart-Thompson LA, Harman LB. 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. The concept of security has long applied to health records in paper form; locked file cabinets are a simple example. 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. Privacy and confidentiality. Audit trails do not prevent unintentional access or disclosure of information but can be used as a deterrent to ward off would-be violators. US Department of Health and Human Services. Family physician model in the health system of selected countries: A comparative study summary. 2020 Oct;11(5):755-763. doi: 10.1055/s-0040-1718753. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. 07 February 2005. ISSN 2376-6980, Electronic Health Records: Privacy, Confidentiality, and Security, Copying and Pasting Patient Treatment Notes, Reassessing “Minor” Breaches of Confidentiality, Ethical Dimensions of Meaningful Use Requirements for Electronic Health Records, Stephen T. Miller, MD and Alastair MacGregor, MB ChB, MRCGP. 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. 2. Her research interests include professional ethics. Physicians will be evaluated on both clinical and technological competence. 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. 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. Staff must exit applications when leaving computer workstations unattended. UCLA Health System settles potential HIPAA privacy and security violations. 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. What Should Oversight of Clinical Decision Support Systems Look Like? Integrity. This is a broad term for an important concept in the electronic environment because data exchange between systems is becoming common in the health care industry. 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. 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. Therefore, ensuring privacy, security, confidentiality, integrity, and availability of protected health information (PHI) in EHRs is absolutely necessary. However, to realize these benefits, privacy, security, and confidentiality of EHRs must be ensured. Record completion times must meet accrediting and regulatory requirements. Unauthorized access to patient information triggered no alerts, nor was it known what information had been viewed. NIH Clinicians and vendors have been working to resolve software problems such as screen design and drop-down menus to make EHRs both user-friendly and accurate [17]. Electronic health record medical healthcare systems are developing widely. Song Y, Lee M, Jun Y, Lee Y, Cho J, Kwon M, Lim H. Healthc Inform Res. Although legal protections have been impleme … http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf. 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. 45 CFR section 164.312(1)(b). 2. 2013 Mar;31(1):9-19. doi: 10.1037/a0031974. We invite submission of manuscripts for peer review on upcoming theme issues. 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). Another potentially problematic feature is the drop-down menu. Whether your health information is stored on paper or electronically, you have the right to keep it private. eCollection 2020. With the advent of audit trail programs, organizations can precisely monitor who has had access to patient information. 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]. Mobile device security (updated). 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. 2020 Jun 30;9:160. doi: 10.4103/jehp.jehp_709_19. How to keep the information in these exchanges secure is a major concern. Please enable it to take advantage of the complete set of features! J Am Health Inf Management Assoc. Accessed August 10, 2012. This practice saves time but is unacceptable because it increases risk for patients and liability for clinicians and organizations [14, 17]. A recent survey found that 73 percent of physicians text other physicians about work [12]. Most medical record departments were housed in institutions’ basements because the weight of the paper precluded other locations. Cyber security is required to prevent, detect, and act on unauthorized access to a health system and its information. Features of the electronic health record can allow data integrity to be compromised. Security standards: general rules, 46 CFR section 164.308(a)-(c). D. Security of Electronic Health Records 1. Clin Transl Sci. Ethics and health information management are her primary research interests. She has a bachelor of science degree in biology and medical records from Daemen College, a master of education degree from Virginia Polytechnic Institute and State University, and a PhD in human and organizational systems from Fielding Graduate University. University of California settles HIPAA privacy and security case involving UCLA Health System facilities [news release]. Epub 2016 Jul 31. Confidentiality, privacy, and security of genetic and genomic test information in electronic health records: points to consider. 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. US Department of Health and Human Services Office for Civil Rights. 16 .1 Electronic health records Electronic health records differ from paper health records in ways that warrant special consideration . This paper highlights the research challenges and directions concerning cyber security to build a comprehensive security model for EHR. Ethical Considerations on Pediatric Genetic Testing Results in Electronic Health Records. Accessed August 10, 2012. It will be essential for physicians and the entire clinical team to be able to trust the data for patient care and decision making. This data can be manipulated intentionally or unintentionally as it moves between and among systems. 2009;80(1):26-29. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_042416.hcsp?dDocName=bok1_042416. She was the director of health information management for a long-term care facility, where she helped to implement an electronic health record. Accessed August 10, 2012. 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. 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. 2010 Sep;10(9):30-1. doi: 10.1080/15265161.2010.494224. Accessed August 10, 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]. Today, the primary purpose of the documentation remains the same—support of patient care. The combination of physicians’ expertise, data, and decision support tools will improve the quality of care. Rognehaugh R. The Health Information Technology Dictionary. Epub 2020 Nov 11. One important aspect of any health record system is to ensure the confidentiality of the patient information because of its importance in the medical field. National Institute of Standards and Technology Computer Security Division. Getting out of the compliance mindset: doing more with data security. This is not, however, to say that physicians cannot gain access to patient information. 10.1001/virtualmentor.2012.14.9.stas1-1209. Brittany Hollister, PhD and Vence L. Bonham, JD, Ethical Considerations about EHR-Mediated Results Disclosure and Pathology Information Presented via Patient Portals, Kristina A. Davis, MD and Lauren B. Smith, MD, The “Decrepit Concept” of Confidentiality, 30 Years Later, Confidential Mental Health Treatment for Adolescents, Defining the Limits of Confidentiality in the Patient-Physician Relationship, AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information, AMA Council on Ethical and Judicial Affairs, The Evolution of Confidentiality in the United Kingdom and the West, Confidentiality/Duty to protect confidential information, Digital health care/Electronic health records, http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf, http://www.hhs.gov/news/press/2011pres/07/20110707a.html, http://www.hhs.gov/ocr/privacy/hipaa/news/uclahs.html, http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf, http://csrc.nist.gov/publications/nistpubs/800-12/800-12-html/index.html, http://www.ahimajournal-digital.com/ahimajournal/201110?pg=61#pg61, http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049463.hcsp?dDocName=bok1_049463, http://library.ahima.org/29%3Cand%3E%28xPublishSite%3Csubstring%3E%60BoK%60%29&SortField=xPubDate&SortOrder=Desc&dDocName=bok1_042564&HighlightType=PdfHighlight, http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_042416.hcsp?dDocName=bok1_042416. COVID-19 is an emerging, rapidly evolving situation. Technical safeguards. 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]. Kanungo S, Barr J, Crutchfield P, Fealko C, Soares N. Appl Clin Inform. health information management systems, and minimise the privacy and security risks .  |  Washington, DC: US Department of Health and Human Services; July 7, 2011. http://www.hhs.gov/news/press/2011pres/07/20110707a.html. The user’s access is based on preestablished, role-based privileges. Accessed August 10, 2012. J Am Health Inf Management Assoc. Should Electronic Health Record-Derived Social and Behavioral Data Be Used in Precision Medicine Research? 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