First Steps Towards Process Mining in Distributed Health Information Systems

Business Intelligence approaches such as process mining can be applied to the healthcare domain in order to gain insight into the complex processes taking place. Disclosing as-is processes helps identify room for improvement and answers questions from medical professionals. Existing approaches are based on proprietary log data as input for mining algorithms. Integrating  the  Healthcare  Enterprise (IHE) defines in its Audit  Trail  and  Node Authentication (ATNA) profile how real-world events must be recorded. Since IHE is used by many healthcare providers throughout the world, an extensive amount of log data is produced. In our research we investigate if audit trails, generated from an IHE test system, carry enough content to successfully apply process mining techniques. Furthermore we assess the quality of the recorded events in accordance with the maturity level scoring system. A simplified simulation of the organizational workflow in a radiological practice is presented. Based on this simulation a process miing task is conducted

Tutorial: Identity Management Systems and Secured Access Control

Identity Management has been a serious problem since the establishment of the Internet. Yet little progress has been made toward an acceptable solution. Early Identity Management Systems (IdMS) were designed to control access to resources and match capabilities with people in well-defined situations, Today’s computing environment involves a variety of user and machine centric forms of digital identities and fuzzy organizational boundaries. With the advent of inter-organizational systems, social networks, e-commerce, m-commerce, service oriented computing, and automated agents, the characteristics of IdMS face a large number of technical and social challenges. The first part of the tutorial describes the history and conceptualization of IdMS, current trends and proposed paradigms, identity lifecycle, implementation challenges and social issues. The second part addresses standards, industry initia-tives, and vendor solutions. We conclude that there is disconnect between the need for a universal, seamless, trans-parent IdMS and current proposed standards and vendor solutions

Comparative study of healthcare messaging standards for interoperability in ehealth systems

Advances in the information and communication technology have created the field of "health informatics," which amalgamates healthcare, information technology and business. The use of information systems in healthcare organisations dates back to 1960s, however the use of technology for healthcare records, referred to as Electronic Medical Records (EMR), management has surged since 1990’s (Net-Health, 2017) due to advancements the internet and web technologies. Electronic Medical Records (EMR) and sometimes referred to as Personal Health Record (PHR) contains the patient’s medical history, allergy information, immunisation status, medication, radiology images and other medically related billing information that is relevant. There are a number of benefits for healthcare industry when sharing these data recorded in EMR and PHR systems between medical institutions (AbuKhousa et al., 2012). These benefits include convenience for patients and clinicians, cost-effective healthcare solutions, high quality of care, resolving the resource shortage and collecting a large volume of data for research and educational needs. My Health Record (MyHR) is a major project funded by the Australian government, which aims to have all data relating to health of the Australian population stored in digital format, allowing clinicians to have access to patient data at the point of care. Prior to 2015, MyHR was known as Personally Controlled Electronic Health Record (PCEHR). Though the Australian government took consistent initiatives there is a significant delay (Pearce and Haikerwal, 2010) in implementing eHealth projects and related services. While this delay is caused by many factors, interoperability is identified as the main problem (Benson and Grieve, 2016c) which is resisting this project delivery. To discover the current interoperability challenges in the Australian healthcare industry, this comparative study is conducted on Health Level 7 (HL7) messaging models such as HL7 V2, V3 and FHIR (Fast Healthcare Interoperability Resources). In this study, interoperability, security and privacy are main elements compared. In addition, a case study conducted in the NSW Hospitals to understand the popularity in usage of health messaging standards was utilised to understand the extent of use of messaging standards in healthcare sector. Predominantly, the project used the comparative study method on different HL7 (Health Level Seven) messages and derived the right messaging standard which is suitable to cover the interoperability, security and privacy requirements of electronic health record. The issues related to practical implementations, change over and training requirements for healthcare professionals are also discussed

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Identity Management and Authorization Infrastructure in Secure Mobile Access to Electronic Health Records

We live in an age of the mobile paradigm of anytime/anywhere access, as the mobile device is the most ubiquitous device that people now hold. Due to their portability, availability, easy of use, communication, access and sharing of information within various domains and areas of our daily lives, the acceptance and adoption of these devices is still growing. However, due to their potential and raising numbers, mobile devices are a growing target for attackers and, like other technologies, mobile applications are still vulnerable. Health information systems are composed with tools and software to collect, manage, analyze and process medical information (such as electronic health records and personal health records). Therefore, such systems can empower the performance and maintenance of health services, promoting availability, readability, accessibility and data sharing of vital information about a patients overall medical history, between geographic fragmented health services. Quick access to information presents a great importance in the health sector, as it accelerates work processes, resulting in better time utilization. Additionally, it may increase the quality of care. However health information systems store and manage highly sensitive data, which raises serious concerns regarding patients privacy and safety, and may explain the still increasing number of malicious incidents reports within the health domain. Data related to health information systems are highly sensitive and subject to severe legal and regulatory restrictions, that aim to protect the individual rights and privacy of patients. Along side with these legislations, security requirements must be analyzed and measures implemented. Within the necessary security requirements to access health data, secure authentication, identity management and access control are essential to provide adequate means to protect data from unauthorized accesses. However, besides the use of simple authentication models, traditional access control models are commonly based on predefined access policies and roles, and are inflexible. This results in uniform access control decisions through people, different type of devices, environments and situational conditions, and across enterprises, location and time. Although already existent models allow to ensure the needs of the health care systems, they still lack components for dynamicity and privacy protection, which leads to not have desire levels of security and to the patient not to have a full and easy control of his privacy. Within this master thesis, after a deep research and review of the stat of art, was published a novel dynamic access control model, Socio-Technical Risk-Adaptable Access Control modEl (SoTRAACE), which can model the inherent differences and security requirements that are present in this thesis. To do this, SoTRAACE aggregates attributes from various domains to help performing a risk assessment at the moment of the request. The assessment of the risk factors identified in this work is based in a Delphi Study. A set of security experts from various domains were selected, to classify the impact in the risk assessment of each attribute that SoTRAACE aggregates. SoTRAACE was integrated in an architecture with requirements well-founded, and based in the best recommendations and standards (OWASP, NIST 800-53, NIST 800-57), as well based in deep review of the state-of-art. The architecture is further targeted with the essential security analysis and the threat model. As proof of concept, the proposed access control model was implemented within the user-centric architecture, with two mobile prototypes for several types of accesses by patients and healthcare professionals, as well the web servers that handles the access requests, authentication and identity management. The proof of concept shows that the model works as expected, with transparency, assuring privacy and data control to the user without impact for user experience and interaction. It is clear that the model can be extended to other industry domains, and new levels of risks or attributes can be added because it is modular. The architecture also works as expected, assuring secure authentication with multifactor, and secure data share/access based in SoTRAACE decisions. The communication channel that SoTRAACE uses was also protected with a digital certificate. At last, the architecture was tested within different Android versions, tested with static and dynamic analysis and with tests with security tools. Future work includes the integration of health data standards and evaluating the proposed system by collecting users’ opinion after releasing the system to real world.Hoje em dia vivemos em um paradigma móvel de acesso em qualquer lugar/hora, sendo que os dispositivos móveis são a tecnologia mais presente no dia a dia da sociedade. Devido à sua portabilidade, disponibilidade, fácil manuseamento, poder de comunicação, acesso e partilha de informação referentes a várias áreas e domínios das nossas vidas, a aceitação e integração destes dispositivos é cada vez maior. No entanto, devido ao seu potencial e aumento do número de utilizadores, os dispositivos móveis são cada vez mais alvos de ataques, e tal como outras tecnologias, aplicações móveis continuam a ser vulneráveis. Sistemas de informação de saúde são compostos por ferramentas e softwares que permitem recolher, administrar, analisar e processar informação médica (tais como documentos de saúde eletrónicos). Portanto, tais sistemas podem potencializar a performance e a manutenção dos serviços de saúde, promovendo assim a disponibilidade, acessibilidade e a partilha de dados vitais referentes ao registro médico geral dos pacientes, entre serviços e instituições que estão geograficamente fragmentadas. O rápido acesso a informações médicas apresenta uma grande importância para o setor da saúde, dado que acelera os processos de trabalho, resultando assim numa melhor eficiência na utilização do tempo e recursos. Consequentemente haverá uma melhor qualidade de tratamento. Porém os sistemas de informação de saúde armazenam e manuseiam dados bastantes sensíveis, o que levanta sérias preocupações referentes à privacidade e segurança do paciente. Assim se explica o aumento de incidentes maliciosos dentro do domínio da saúde. Os dados de saúde são altamente sensíveis e são sujeitos a severas leis e restrições regulamentares, que pretendem assegurar a proteção dos direitos e privacidade dos pacientes, salvaguardando os seus dados de saúde. Juntamente com estas legislações, requerimentos de segurança devem ser analisados e medidas implementadas. Dentro dos requerimentos necessários para aceder aos dados de saúde, uma autenticação segura, gestão de identidade e controlos de acesso são essenciais para fornecer meios adequados para a proteção de dados contra acessos não autorizados. No entanto, além do uso de modelos simples de autenticação, os modelos tradicionais de controlo de acesso são normalmente baseados em políticas de acesso e cargos pré-definidos, e são inflexíveis. Isto resulta em decisões de controlo de acesso uniformes para diferentes pessoas, tipos de dispositivo, ambientes e condições situacionais, empresas, localizações e diferentes alturas no tempo. Apesar dos modelos existentes permitirem assegurar algumas necessidades dos sistemas de saúde, ainda há escassez de componentes para accesso dinâmico e proteção de privacidade , o que resultam em níveis de segurança não satisfatórios e em o paciente não ter controlo directo e total sobre a sua privacidade e documentos de saúde. Dentro desta tese de mestrado, depois da investigação e revisão intensiva do estado da arte, foi publicado um modelo inovador de controlo de acesso, chamado SoTRAACE, que molda as diferenças de acesso inerentes e requerimentos de segurança presentes nesta tese. Para isto, o SoTRAACE agrega atributos de vários ambientes e domínios que ajudam a executar uma avaliação de riscos, no momento em que os dados são requisitados. A avaliação dos fatores de risco identificados neste trabalho são baseados num estudo de Delphi. Um conjunto de peritos de segurança de vários domínios industriais foram selecionados, para classificar o impacto de cada atributo que o SoTRAACE agrega. O SoTRAACE foi integrado numa arquitectura para acesso a dados médicos, com requerimentos bem fundados, baseados nas melhores normas e recomendações (OWASP, NIST 800-53, NIST 800-57), e em revisões intensivas do estado da arte. Esta arquitectura é posteriormente alvo de uma análise de segurança e modelos de ataque. Como prova deste conceito, o modelo de controlo de acesso proposto é implementado juntamente com uma arquitetura focada no utilizador, com dois protótipos para aplicações móveis, que providênciam vários tipos de acesso de pacientes e profissionais de saúde. A arquitetura é constituída também por servidores web que tratam da gestão de dados, controlo de acesso e autenticação e gestão de identidade. O resultado final mostra que o modelo funciona como esperado, com transparência, assegurando a privacidade e o controlo de dados para o utilizador, sem ter impacto na sua interação e experiência. Consequentemente este modelo pode-se extender para outros setores industriais, e novos níveis de risco ou atributos podem ser adicionados a este mesmo, por ser modular. A arquitetura também funciona como esperado, assegurando uma autenticação segura com multi-fator, acesso e partilha de dados segura baseado em decisões do SoTRAACE. O canal de comunicação que o SoTRAACE usa foi também protegido com um certificado digital. A arquitectura foi testada em diferentes versões de Android, e foi alvo de análise estática, dinâmica e testes com ferramentas de segurança. Para trabalho futuro está planeado a integração de normas de dados de saúde e a avaliação do sistema proposto, através da recolha de opiniões de utilizadores no mundo real

Continuous Process Auditing (CPA): an Audit Rule Ontology Approach to Compliance and Operational Audits

Continuous Auditing (CA) has been investigated over time and it is, somewhat, in practice within nancial and transactional auditing as a part of continuous assurance and monitoring. Enterprise Information Systems (EIS) that run their activities in the form of processes require continuous auditing of a process that invokes the action(s) speci ed in the policies and rules in a continuous manner and/or sometimes in real-time. This leads to the question: How much could continuous auditing mimic the actual auditing procedures performed by auditing professionals? We investigate some of these questions through Continuous Process Auditing (CPA) relying on heterogeneous activities of processes in the EIS, as well as detecting exceptions and evidence in current and historic databases to provide audit assurance

Cross-enterprise access control security for electronic health records: Technical, practical and legislation impact

In this thesis we investigate the relationship of security, privacy, legislation, computational power in relation to Cross-Enterprise User Assertions (XUA), which allows us to develop the recommendations for the appropriate, architecture, functionality, cryptographic algorithms, and key lengths. The evolution of health records from paper to electronic media promises to be an important part of improving the quality of health care. The diversity of organizations, systems, geography,laws and regulations create a significant challenge for ensuring the privacy of Electronic Health Records (EHRs), while maintaining availability. XUA is a technology that attempts to address the problem of sharing EHRs across enterprise boundaries. We rely on NSA suite B cryptography to provide the fundamental framework of the minimum security requirements at the 128 bit security level. We also recommend the use of the National Institute of Standards and Technologys (NIST) FIPS 140-2 specification to establish confidence in the software\u27s security features