1. ICT 1 Towards an Integrated Approach to Access Control to Health Information Presented by: Inger Anne Tøndel SINTEF Co-authors: Per Håkon Meland SINTEF Lillian Røstad SINTEF Øystein Nytrø NTNU

2. ICT 2 The iAccess Project Integrated Access Control for Healthcare Information Systems (iAccess) Funded by the Norwegian Research Council 2005-2008 (++) Applied research activities + two PhD-students A research partnership between NTNU, SINTEF and UiO NTNU: Dep. of Computer and Information Science SINTEF: Dep. Software Engineering, Safety and Security UiO: Faculty of law Participants: Rikshospitalet University Hospital/The Norwegian Radium Hospital Central Norway Regional Health Authority (HEMIT)

3. ICT 3 Background – Access Control Integration Reality: Not one EHR, many clinical systems! Integration of healthcare information from several system is an emerging trend Local Regional National Access control is a key issue in order to share sensitive information Various access control mechanisms Access control in integrated systems Access control is dependent on the information Strict legal requirements for information security and patient privacy Challenges related to technology, organization and legislation

4. ICT 4 The iAccess Handbook (Norwegian) iaccess.idi.ntnu.no

5. ICT 5 The iAccess Handbook – Content (1) Part 1 – Reference Information A repository of useful information Technical viewpoint Organizational viewpoint Legal viewpoint

6. ICT 6 Overview of Central Laws and Regulations Regulations related to the access restriction to treatment of health information. Classified according to formal-, factual-, personnel regulations Regulations related to instructions, permissions and conditions for sending, receiving and exchanging health information Regulations related to information quality Regulations related to provision of the confidentiality, integrity and availability of health information Regulations related to internal control Regulations related to particular technical, physical or organisational methods of treatment

7. ICT 7 The iAccess Handbook – Content (2) Part 2 – Survey Methods Part 3 – Combining and Presenting Results  The iAccess Method

8. ICT 8 Documentation Study Examples of relevant information: legislation local policies and routines documentation of existing systems plans and strategies for the future Our experience: Hard to know what you will get...

9. ICT 9 Process Workshops Different focus groups Decision makers System developers/maintainers Process maps Activities, roles, documentation/tools Results Process maps Discussions!! Scenarios A new employee starts working at the hospital, and needs access to the IT-systems. An employee accesses the patient record of his neighbor, without having a medical responsibility for this neighbor.

10. ICT 10 Semi-Structured Interviews Experiences of system users How does the current access control solution influence their workday? Interviewees Clinical personnel – physicians, nurses, nutritionists Administrative personnel – secretaries Questions based on the scenarios used in the process workshops Enables comparison

11. ICT 11 Combining Results Show results from the different types of surveys in the same diagrams Domain models Relation between concepts Use cases/misuse cases Real world shortcomings, conflicts, grey areas Activity diagrams More structured than process maps Map activities to roles Add comments and information about documentation/tools

12. ICT 12 Example Activity Diagram: The New Employee Scenario

13. ICT 13 Experiences from the use of the methods Useful for retrieving information related to organizational issues and work processes Are often not described in one single document Information sharing between the participants The process maps are not ideal for retrieving technical information Too many details Hard to show information flow Important to combine inputs from different focus groups Grasp the full picture Makes it possible to discover differences in opinions

14. ICT 14 Input from different focus groups Decision makers Focus on routines, plans for the future System developers/maintainers Focus on the IT systems System users How does the system fit their work day Example1: Routines and responsibilities for auditing of logs Problems with checking huge logs Users have high expectations regarding detection of misuse Example 2: Routines and forms involved when access is to be assigned to a system How is this done technically in the systems? How is this process experienced by the users?

15. ICT 15 Conclusion The handbook and the methods  Starting point for working on the challenges of access control in integrated health information systems Target group PhD students Hospitals (IT departments) Many challenges Technical Organizational Juridical

16. ICT 16 Further Work Improve the iAccess handbook Test new methods Taxonomy for classification of access control Observations, logs, questionnaires???? To be decided... Focus on consent? PhD students.... We have concentrated on access control within hospitals There are also challenges regarding access to information between hospitals (and also other care givers)

17. ICT 17 Thank you!