Clinical Information System Security Policy

CSC 662 Computer Security
CS2305B
Introduction
The patients information is the most important data for
clinical affairs.
ACH95 (Keeping Information Confidential)
Doctors and other clinical professionals are worried
that making personal health information more widely available may endanger patient confidentiality
Scope of the policy

Clinician
Patient System
Clinician
Clinician (licensed professional such as a doctor, nurse,
dentist physiotherapist or pharmacist) who has access in the line of duty to personal health information and is
bound by a professional obligation of confidentiality.

Social workers, students, charity workers and receptionists
may access personal health information under the supervision of a healthcare professional (but the professional remains responsible for their conduct)
Patient
Patient (the individuals concerned or the individuals
representative)
The rules may depend on the wishes of the patient If the patient is a child, parent or guardian of a child will be
acts on his behalf
System
System(hardware, software, communications and manual
procedures which make up a connected information processing system)
Threats and Vulnerabilities

The ethical basis of clinical confidentiality
In GMC (General Medical Council) booklet,
Confidentiality state that doctors who record of
confidential information must ensure that it is

effectively protected against improper disclosure
The basic ethical principle, state Confidentiality is the
privilege of the patient, so only he way waive it and the consent must be informed, voluntary and competent

The ethical basis of clinical confidentiality
for example, patients must be made aware that
information may be shared between members of a care
team, such as a general practice or a hospital

department
There is the issue of the patient's consent to have his
record kept on a computer system at all. It is unethical to discriminate against a patient who demands that his
records be kept on paper instead

Other security requirements for clinical information
we also concerned with its integrity and availability If information is corrupted, clinicians may take incorrect
decisions which harm or even kill patients.

If information is unreliable, in the sense that it could
have been corrupted then its value as a basis for clinical

decisions is decrease

Threats to clinical confidentiality
Experience shows that the main new threat comes from
insiders
Eg : most of the big UK banks now let any teller access
any customer's account (private detectives bribe tellers to get account information)

Threats to clinical confidentiality
security depends on the fragmentation and scattering
inherent in manual record systems, and these systems
are already vulnerable to private detectives ringing up

and pretending to be from another healthcare provider.

Other security threats to clinical information
Hardware failures occasionally corrupt messages Higher error rates could result from the spreading
practice of sending lab results as unstructured email

messages
Viruses have already destroyed clinical information, and
a virus could conceivably be written to make malicious alterations to records

A malicious attacker might also manipulate messages
Security Policy
Principle 1 : Access control
Each identifiable clinical record shall be marked with an
access control list naming the people or groups of
people who may read it and append data to it

The system shall prevent anyone not on the access
control list from accessing the record in any way
Security Policy
Principle 2 : Record opening
A clinician may open a record with herself and the
patient on the access control list

Where a patient has been refer, she may open a record
with herself, the patient and the referring clinician on the access control list
Security Policy
Principle 3 : Control
One of the clinicians on the access control list must be
marked as being responsible.

Only she may alter the access control list, and she may
only add other health care professionals to it
Security Policy
Principle 4 : Consent and notification
The responsible clinician must notify the patient of the
names on his record's access control list when it is
opened, of all subsequent additions, and whenever

responsibility is transferred.
His consent must also be obtained, except in emergency
case
Security Policy
Principle 5 : Persistence
No-one shall have the ability to delete clinical
information until the appropriate time period has
expired
Security Policy
Principle 6 : Attribution
All accesses to clinical records shall be marked on the
record with the subject's name, as well as the date and
time
An audit trail must also be kept of all deletions
Security Policy
Principle 7 : Information flow
Information derived from record A may be appended to
record B if and only if B's access control list is contained
in A's
Security Policy
Principle 8 : Aggregation control
There shall be effective measures to prevent the
aggregation of personal health information
Security Policy
Principle 9 : The Trusted Computing Base
Computer systems that handle personal health
information shall have a subsystem that enforces the above principles in an effective way
Its effectiveness shall be subject to evaluation by
independent experts
Conclusions
Based on the experience, we can conclude that the threats
to the confidentiality, integrity and availability of personal health information enforced the medical sector to developed a Clinical Information System that can give the high level protection to patients data.
Clinicians making decisions must be compliance with CISS
Policy
Conclusions
Nowadays, there is a lot of Clinical Information System but
still have a weakness that can cause the data of patients spread
So we need to enhance the already system so that we can
keep the data as confidentiality
Reference: Dr Rose, J. A., (1996). Security in Clinical Information System. Computer Laboratory University of Cambridge.
THE END

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CSC 662 Computer Security

Scope of the policy

bound by a professional obligation of confidentiality.

acts on his behalf

procedures which make up a connected information processing system)

Threats and Vulnerabilities

Confidentiality state that doctors who record of

confidential information must ensure that it is

Threats and Vulnerabilities

information may be shared between members of a care

team, such as a general practice or a hospital

records be kept on paper instead

Threats and Vulnerabilities

decisions which harm or even kill patients.

have been corrupted then its value as a basis for clinical

Threats and Vulnerabilities

Threats and Vulnerabilities

inherent in manual record systems, and these systems

are already vulnerable to private detectives ringing up

Threats and Vulnerabilities

practice of sending lab results as unstructured email

a virus could conceivably be written to make malicious alterations to records

access control list naming the people or groups of

people who may read it and append data to it

control list from accessing the record in any way

patient on the access control list

marked as being responsible.

only add other health care professionals to it

names on his record's access control list when it is

opened, of all subsequent additions, and whenever

information until the appropriate time period has

record with the subject's name, as well as the date and

record B if and only if B's access control list is contained

aggregation of personal health information

keep the data as confidentiality

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