Balancing Access and Security: If a User Walks Away from a Computer for Only a Few Seconds, the Privacy of Patient Data Can Be Compromised

By Berkowitz, Lyle; Brostoff, George | Behavioral Healthcare, December 2007 | Go to article overview

Balancing Access and Security: If a User Walks Away from a Computer for Only a Few Seconds, the Privacy of Patient Data Can Be Compromised


Berkowitz, Lyle, Brostoff, George, Behavioral Healthcare


A psychiatrist notes worsening symptoms in his patient and thus increases the dose of her SSRI medication. He documents this encounter in his computer system, which both he and his patient assume keeps the data confidential. But what if the doctor is paged and forgets to sign off from the system when he walks away from his computer? Could another medical colleague then view any information under this physician's log-in (referred to in IT circles as "tailgating")? Or possibly worse, could the patient access the system and view or edit data on herself or others?

The answer to these questions is "yes" in hospitals and clinics around the nation. And if your organization does not have a solution that addresses this type of major security loophole in a simple and quick way, then it is time to start understanding the options.

Privacy Issues

In today's increasingly electronic world, safeguarding healthcare data has spawned countless debates over best practices for processes, implementations, and technologic options. Striking the right balance between easy access and tight security is challenging for healthcare providers and the IT staff who serve their needs. Organizations need to ask questions such as:

* What is the best way to effectively comply with security regulations and protect patient privacy?

* How do you securely share records among providers given these regulations?

* What is the best method for protecting patient privacy when multiple staff members use shared workstations?

* How do you ensure the highest staff mobility and productivity while still maintaining confidentiality of patient data?

For behavioral healthcare environments, these issues are heightened further because mental health and substance abuse patient records require even more sensitivity and security than a typical medical patient record. Furthermore, behavioral healthcare settings are quite diverse, including psychiatric hospitals, community mental health centers, residential addiction treatment centers, private-practice offices, and even home offices. And while some behavioral healthcare organizations have robust IT resources, the majority have limited IT resources to deal with these issues.

Authentication and Security

Regardless of your particular organizational setting, two distinct issues need to be fully understood and considered: authentication and security.

Authentication: A good first step. Authentication is the process that allows a user to log into a system via passwords, tokens (e.g., smart cards and RSA cards), or biometric processes (e.g., fingerprint, voice, or facial recognition). An organization might use a multioption authentication scenario (e.g., a staff member's fingerprint is scanned to allow access to the system but a password can be entered if the biometric process does not work). An organization also might use a mandatory combination scenario (e.g., a password and a token must be used together to access the system).

Authentication can become time-consuming and expensive with more technical gadgets due to such issues as setup, configuration, and hardware maintenance. In addition, many organizations mistakenly focus just on the authentication process and don't deal with the much more important security process.

Security: The real key to protecting privacy. Security is the process that ensures the user logs out of the system by using either "time-outs" or continuous sensing technology. With time-outs, an application (or the whole computer) will "suspend" itself after a defined period of inactivity. A user then has to "reauthenticate" himself to log back into the application or computer.

While time-outs can be easy to set up, they offer few advantages. If set too short (e.g., ten seconds), the user needs to keep signing back into the system every time he takes a short break from typing to talk to the patient. …

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