Shared Electronic Health Record Systems: Key Legal and Security Challenges.

Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.

Making a web based ulcer record work by aligning architecture, legislation and users - a formative evaluation study.

The University Hospital of North Norway selected a web-based ulcer record used in Denmark, available from mobile phones. Data was stored in a common database and easily accessible. According to Norwegian legislation, only employees of the organization that owns an IT system can access the system, and use of mobile units requires strong security solutions. The system had to be changed. The paper addresses interactions in order to make the system legal, and assesses regulations that followed. By addressing conflicting scripts and the contingent nature of knowledge, we conducted a formative evaluation aiming at improving the object being studied. Participatory observation in a one year process, minutes from meetings and information from participants, constitute the data material. In the technological domain, one database was replaced by four. In the health care delivery domain, easy access was replaced by a more complicated log on procedure, and in the domain of law and security, a clarification of risk levels was obtained, thereby allowing for access by mobile phones with today's authentication mechanisms. Flexibility concerning predefined scripts was important in all domains. Changes were made that improved the platform for further development of legitimate communication of patient data via mobile units. The study also shows the value of formative evaluations in innovations.

Wireless transfer of sensor data into electronic health records.

The purpose of this study is to explore how wireless transfer of sensor data can be implemented in existing Electronic Health Record (EHR) systems. Blood glucose data from people with diabetes Type 1 has been selected as the case.As proof of concept, a prototype for sending blood glucose measurements into an EHR system was developed for the DIPS EHR system. For the prototype to be transferable to a general setting, care was taken not to introduce any additional workload for the diabetes nurses or the diabetes Type 1 patients. In the prototype, the transfer of blood glucose data is automatic and invisible to the user, and the data is presented to the nurses within the existing DIPS laboratory module.To determine whether deployment of such a system would present any risks or hazards to patients (medical or financial), a risk analysis was performed. The analysis indicates that storing blood glucose values in the patient's EHR does not represent any significantly increased risks for the diabetes patient.The study shows that existing EHR systems are well suited to receive sensor data. The three main EHR systems in Norwegian hospitals are all supported with application programming interfaces (APIs), enabling external vendors to add modules. These APIs are sufficient to implement modules for receiving sensor data. However, none of the systems currently have commercially available modules for receiving such data.

The CORAS approach for model-based risk management applied to a telemedicine service.

The CORAS risk management process is based on the Australian standard for risk management and aims at improved methodology for precise, unambiguous, and efficient risk assessment of security critical systems. CORAS addresses security critical systems in general, but places particular emphasis on IT security. For CORAS, a system is not just technology, but also the humans interacting with the technology and all relevant aspects of the surrounding organisation and society. The use of graphical models in CORAS furthers communication between the different stakeholders of a risk assessment, and makes it easier for non-technicians to take part. Telemedicine services and electronic applications used in the health sector have a high demand for security. The medical developers, providers and users of such services and systems are important contributors in the risk assessment of these services and systems. CORAS has successfully been used to involve medical professionals in the model-based risk assessment of a telemedicine system called Tele-cardiology in Crete. This paper presents the use of the CORAS framework to assess this telemedicine system giving some conclusions on the experience gained.