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. In the past, the medical record was a paper repository of information that was reviewed or used for clinical, research, administrative, and financial purposes. With the growing demand for the electronic health record (EHR) system, the transfer from paper to electronic can be risky. Another potentially problematic feature is the drop-down menu. U.S. Department of Commerce. Patient information should be released to others only with the patient’s permission or as allowed by law. The right to privacy. Getting out of the compliance mindset: doing more with data security. 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. In addition to the importance of privacy, confidentiality, and security, the EHR system must address the integrity and availability of information. Mohammadibakhsh R, Aryankhesal A, Jafari M, Damari B. J Educ Health Promot. 2020 Jun 30;9:160. doi: 10.4103/jehp.jehp_709_19. UCLA failed to “implement security measures sufficient to reduce the risks of impermissible access to electronic protected health information by unauthorized users to a reasonable and appropriate level” [9]. Audit trails track all system activity, generating date and time stamps for entries; detailed listings of what was viewed, for how long, and by whom; and logs of all modifications to electronic health records [14]. It was severely limited in terms of accessibility, available to only one user at a time. Odom-Wesley B, Brown D, Meyers CL. Accessed August 10, 2012. Things are being moved from the manual ways to automation and the patient records and health records are also being recorded electronically. 2020 Apr 3;20(1):61. doi: 10.1186/s12911-020-1076-5. North Memorial Health Care (NMHC) protects the confidentiality, privacy and security of all patient information according to state and federal law, ethical guidelines, and industry best practices. Chicago: American Health Information Management Association; 2009:21. In a physician practice, for example, the practice administrator identifies the users, determines what level of information is needed, and assigns usernames and passwords. A second limitation of the paper-based medical record was the lack of security. doi: 10.1001/virtualmentor.2012.14.9.stas1-1209. It will be essential for physicians and the entire clinical team to be able to trust the data for patient care and decision making. Am J Bioeth. Technical safeguards. This can be achieved through a combination of staff induction, staff meetings, training, staff newsletters, notices, posters, and so on. 2010 Sep;10(9):30-1. doi: 10.1080/15265161.2010.494224. 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. With the advent of audit trail programs, organizations can precisely monitor who has had access to patient information. Unauthorized access to patient information triggered no alerts, nor was it known what information had been viewed. Explain the difference between an Electronic Health Record and an Electronic Medical Record. Others will be key leaders in building the health information exchanges across the country, working with governmental agencies, and creating the needed software. 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]. Accessed August 10, 2012. EHRs are electronic versions of the paper charts in your doctor’s or other health care provider’s ofice. Mobile device security (updated). The 10 security domains (updated). 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. Protecting patient information. 2012;83(4):50. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049463.hcsp?dDocName=bok1_049463. Another potential threat is that data can be hacked, manipulated, or destroyed by internal or external users, so security measures and ongoing educational programs must include all users. McGuire AL(1), Fisher R, Cusenza P, Hudson K, Rothstein MA, McGraw D, Matteson S, Glaser J, Henley DE. The health system agreed to settle privacy and security violations with the U.S. Department of Health and Human Services Office for Civil Rights (OCR) for $865,000 [10]. 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… Song Y, Lee M, Jun Y, Lee Y, Cho J, Kwon M, Lim H. Healthc Inform Res. Accessed August 10, 2012. Please enable it to take advantage of the complete set of features! Her research interests include professional ethics. Accessed August 10, 2012. Computer workstations are rarely lost, but mobile devices can easily be misplaced, damaged, or stolen. 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. 10.1001/virtualmentor.2012.14.9.stas1-1209. Reliable electronic health records companies apply these enhanced security and privacy protocols. Electronic health record medical healthcare systems are developing widely. J Am Health Inf Management Assoc. US Department of Health and Human Services Office for Civil Rights. Although security and privacy are … 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. 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]. Staff accessing electronic health information management systems must be informed and regularly reminded of their responsibilities to patient privacy and confidentiality. 2009;80(1):26-29. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_042416.hcsp?dDocName=bok1_042416. 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 regulatory processes. In most cases privacy and security risks apply to both paper and electronic records. 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 (EHRs) within ten years. This data can be manipulated intentionally or unintentionally as it moves between and among systems. 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. Because the government is increasingly involved with funding health care, agencies actively review documentation of care. There are two basic approaches to countering organizational threats to the privacy and security of electronic health information: deterrence and imposition of obstacles. The wife was not one of the plastic surgeon’s patients. However, the electronic storage of healthcare records brings up key issues such as privacy and confidentiality, security, and data integrity and availability. Moreover, the advances in Information and Communications Technologies have led to a situation in which patients’ health data are confronting new security and privacy threats .The three fundamental security goals are confidentiality, integrity and availability (CIA). 07 February 2005. Electronic health records specialists also provide remote storage and data backup systems. There are three major ethical priorities for electronic health records: privacy and confidentiality, security, and data integrity and availability. The key to preserving confidentiality is making sure that only authorized individuals have access to information. 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. 2016 Jul;22(3):206-16. doi: 10.4258/hir.2016.22.3.206. Should Electronic Health Record-Derived Social and Behavioral Data Be Used in Precision Medicine Research? As with all regulations, organizations should refer to federal and state laws, which may supersede the 6-year minimum. The electronic health record is interactive, and there are many stakeholders, reviewers, and users of the documentation. http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf. Whether your health information is stored on paper or electronically, you have the right to keep it private. | 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]. Violating these regulations has serious consequences, including criminal and civil penalties for clinicians and organizations. 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. We invite submission of manuscripts for peer review on upcoming theme issues. Medical staff must be aware of the security measures needed to protect their patient data and the data within their practices. 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. 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. The concept of security has long applied to health records in paper form; locked file cabinets are a simple example. HIPAA impacting patient medical information. What Should Oversight of Clinical Decision Support Systems Look Like? HIPAA requires that audit logs be maintained for a minimum of 6 years [13]. Accessed August 10, 2012. Increasing the problem is the lack of strict data sharing and protection laws governing the healthcare industry. In MEASURE Evaluation’s new resource, A Primer on the Privacy, Security, and Confidentiality of Electronic Health Records, authors Manish Kumar and Sam Wambugu address these challenges. Security standards: general rules, 46 CFR section 164.308(a)-(c). Features of the electronic health record can allow data integrity to be compromised. This is not, however, to say that physicians cannot gain access to patient information. Technical requirements framework of hospital information systems: design and evaluation. This policy applies to each NMHC staff member, employee, volunteer, student, contractor, and vendor (collectively, “Staff”), Medical Staff and Allied Health Professionals. Resolution agreement [UCLA Health System]. 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]. Some security measures that protect data integrity include firewalls, antivirus software, and intrusion detection software. Audit trails. COVID-19 is an emerging, rapidly evolving situation. privacy, security, confidentiality, integrity, and availability of protected health information (PHI) in EHRs is absolutely necessary. Harvard Law Rev. Guide to Privacy and Security of Health Information; 2012:5. http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf. 2011;82(10):58-59. http://www.ahimajournal-digital.com/ahimajournal/201110?pg=61#pg61. Perhaps the most important security protocol is data encryption, which causes data to become unreadable to outside sources. American Health Information Management Association. Major themes that emerged from the focus groups were extracted to align with the main sections of the questionnaire. 1890;4:193. 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. Revision of the Measurement Tool for Patients' Health Information Protection Awareness. However, when a security breach occurs, patients may face physical, emotional, and dignitary harms. Rinehart-Thompson LA, Harman LB. American Health Information Management Association. 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]. EMR is said to be an electronic patient record created and maintained by a medical practice or hospital whereas the EHR is said to be an interconnected aggregate of all the patients health records, culled from multiple providers and healthcare facilities. Record completion times must meet accrediting and regulatory requirements. Cathy A. Flite, MEd, RHIA is a clinical assistant professor in the Health Information Management Department at Temple University in Philadelphia. 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. HHS steps up HIPAA audits: now is the time to review security policies and procedures. Privacy, confidentiality, and security have always been a concern whenever electronic transmission of patients data are involved The definition of privacy was explicitly explained by Justices of the Supreme Court Warren and Brandeis (1890) as the “right to be let alone,” entailing that the “the foundation of individual freedom in modern age is the protection of the private realm.” 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. The patient, too, has federal, state, and legal rights to view, obtain a copy of, and amend information in his or her health record. Hudgins C, Rose S, Fifield PY, Arnault S. Fam Syst Health. 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. 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. 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. Ethical Challenges in the Management of Health Information. Leading healthcare organizations have tackled the growing issue of data security through different technologies. 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]. In: Harman LB, ed. Accessed August 10, 2012. Clin Transl Sci. Office of the National Coordinator for Health Information Technology. Clipboard, Search History, and several other advanced features are temporarily unavailable. Access multimedia content about novel coronavirus. Electronic health records: privacy, confidentiality, and security Epub 2019 May 9. In 2011, employees of the UCLA health system were found to have had access to celebrities’ records without proper authorization [8]. How to keep the information in these exchanges secure is a major concern. If you keep a personal health record, you are responsible for keeping it safe and private. 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. 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). Deterrence seeks to prevent violations of policy by imposing sanctions on violators; these sanctions may include dismissal, civil liability, or criminal prosecution. An Introduction to Computer Security: The NIST Handbook. Auditing copy and paste. For example, a clerk in a plastic surgeon’s office repeatedly accessed the health information of her lover’s cancer-stricken wife through the provincial electronic health records system. 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. Much work remains to be done on the data security front. Security, privacy and confidentiality. | 2013 Mar;31(1):9-19. doi: 10.1037/a0031974. The user’s access is based on preestablished, role-based privileges. Confidentiality, privacy, and security of genetic and genomic test information in electronic health records: points to consider. This site needs JavaScript to work properly. Accessed August 10, 2012. J Am Health Inf Management Assoc. Information can be released for treatment, payment, or administrative purposes without a patient’s authorization. For the patient to trust the clinician, records in the office must be protected. 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. Many EMR privacy breach cases involve inappropriate access. 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. Some will earn board certification in clinical informatics. Integrity. J Am Health Inf Management Assoc. Privacy, Security, and Electronic Health Records Leon Rodriguez | December 12, 2011 Health care is changing and so are the tools used to coordinate better care for patients like you and me. 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… 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]. The push toward electronic medical records has been coupled with a concern for privacy, security, trust and confidentiality. | This research output is being tracked across social media, newspapers and reference managers by Altmetric. NIH The information that is shared as a result of a clinical relationship is considered confidential and must be protected [5]. Audit trails do not prevent unintentional access or disclosure of information but can be used as a deterrent to ward off would-be violators. National Institute of Standards and Technology Computer Security Division. 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. The paper-based record was updated manually, resulting in delays for record completion that lasted anywhere from 1 to 6 months or more. US Department of Health and Human Services. Author information: (1)From the 1Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA. USA.gov. Under the HIPAA Privacy and Security Rules, employers are held accountable for the actions of their employees. The combination of physicians’ expertise, data, and decision support tools will improve the quality of care. Accessed August 10, 2012. Laurinda B. Harman, PhD, RHIA is emeritus faculty at Temple University in Philadelphia. http://www.hhs.gov/ocr/privacy/hipaa/news/uclahs.html. The documentation must be authenticated and, if it is handwritten, the entries must be legible. 2020 Oct;11(5):755-763. doi: 10.1055/s-0040-1718753. Ethical Considerations on Pediatric Genetic Testing Results in Electronic Health Records. Given the sensitive nature of information held in the eHealth record system, a combination of legislative and technical mechanisms is used to safeguard privacy. Medical practice is increasingly information-intensive. 2nd ed. The common issues that needs to be addressed in electronic medical record system are privacy, security and confidentiality. 2012;83(5):50. Recent survey found that 73 percent of physicians ’ expertise, data, and clinical content https... 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