Security Challenges of Electronic Medical Records

CSO - Under his recently unveiled fiscal stimulus plan, President Obama seeks to invest up to US$20 Billion in federal funds to achieve widespread deployment of Electronic Medical Records (EMRs). A principal reason for his initiative is to improve our nation's health care system by reducing long term costs and increasing effectiveness of our health outlays. So what exactly is an Electronic Medical Record and what does this new direction mean for security and privacy professionals?

At its core, an Electronic Medical Record (EMR) is the effective capture, dissemination, and analysis of medical and health related information for a single patient. All participants in the health care delivery system have a stake in efficient information flows. They include health care providers, insurers, government agencies, claims processors, and patients. Thus the term EMR has a slightly different meaning depending on one's perspective. Indeed, Electronic Medical Records managed by individuals are termed Personal Health Records (PHRs). PHRs capture all relevant personal health details, including diagnoses, X-Rays, and similar items into a single repository. Individuals are then empowered to make health decisions for themselves, to easily choose among providers, to selectively disclose medical conditions, and to receive optimum care during emergencies. Both Google and Microsoft offer services for individuals to create, manage, and store their PHRs. We expect that there will be an explosion in demand as the computer-savvy population ages.

The focus of this article, however, is on the secure use of EMRs by institutions and health providers in a regulatory arena rife with complexity and with strict privacy and safety requirements. Consider a typical hospital with a relatively well functioning EMR system. Using EMRs, doctors can conduct much of their business totally electronically. This is in sharp contrast to traditional care environments where paper shuffling is the norm. Using EMRs, doctors can review patient histories and charts, obtain laboratory results, generate referrals for specialist consultations, prescribe medicines, and diagnose images all without the use of paper. This sounds utopian, and in many ways it is.

But the soft underbelly of EMRs is the difficulty in adequately securing such records. Key security and privacy concerns for EMR systems include:

-- Hacking incidents on EMR systems that lead to altering of patient data or destruction of clinical systems

-- Misuse of health information records by authorized users of EMR systems

-- Long term data management concerns surrounding EMR systems

-- Government or corporate intrusion into private health care matters

At first glance, these issues do not appear to be very difficult to solve. The reality is that hospitals and other care environments are complex institutions with complex workflows. A great many staff need immediate access to medical records. These include emergency technicians, admitting staff, doctors, nurses, and back-office personnel in billing and accounting. A quick fix might be to install role based access control (RBAC) mechanisms that allow for fine-grained permissions.