The document discusses authentication, authorization, and auditing for access to patient medical records. It involves: 1) Authenticating users based on their computer's IP address, with static addresses having full access and others requiring additional authentication like public key infrastructure. 2) Authorizing access to patient data based on three criteria and the user's role, with physicians having full access, private physicians limited access to their patients, and nurses/staff having access only to non-sensitive data. 3) Maintaining audit logs of access for over a decade to monitor for inappropriate access, with study patients flagged for easier auditing.

2. Authentication
It’s also based on the beliefis based on the separation of trusting bothof
The authentication policy that authentication involves the network the
authentication information and the computer it is coming from.
all computers on two domains:
2.) everything else
1.) Those computers specifically
known to the project as identified by
static IP addresses
Conventional UserID/Password authentication is
adequate if source computer is trusted
In other cases, stronger
authentication is required

3. Authentication
1.) Those computers specifically
known to the project as identified by
static IP addresses
Access granted.
UserID: Jdoe
Welcome to
Password: ****
Home
Telemedicine

4. Authentication
2.) everything else
IfPatients and clinicians
accessing from an
can access through
unknown/unauthorized IP address
Public Key Infrastructure
(Click on the mouse)

5. Public Key Infrastructure

6. Authentication
2.) everything else
UserID: Jsmith
Password: ****
Once certificate is granted, the user
can use the login page to enter userID
and password to access the home
telemedicine.

7. Encryption

8. Encryption

9. Authorization
Three step process:
1. Patient categories were defined by 3 criteria relevant to
security needs:
a. Whether patient has existing relationship with the
medical center
b. Whether the patient’s primary care physician was
credentialed or not by the medical center
c. Whether the patient’s Nurse Case Manager was an
employee of the medical center or its affiliate.

10. Authorization
2. Extensive discussions with nurse case
managers and doctors to determine which data
items each class of care provider needed in
order to provide optimal care.
3. The physicians of the medical center will have
full access to all data in WebCIS including
individual patients in the CM system.

11. Authorization
Private primary care physicians have access
only to project specific data on their own
patients in the case management system.
The medical center’s nurse case managers and
nursing staff have access to non-sensitive data
on all patients in WebCIS.
Affiliate staff will allowed access to nonsensitive data on project patients.

12. Medical Center
Physician
Private
primary
Care
Physician
Affiliates
of the
medical
center
Nurse
case
manager
& nursing
staff
WebCIS
Case management System
Patients Under
Private PCP
Project Patients
Patients under
medical center
physician
Non-sensitive data
Non-Sensitive data
Non-sensitive data
Sensitive data
Sensitive data
Sensitive data

13. Access Control
Once authorization levels were defined, they need to be
mapped to the technologically available software access
controls in WebCIS and the CM software.
The WebCIS system supports access controls by patient,
patient-list, patient class and data type. Within WebCIS,
patients can be flagged as “VIP”, this is typically done for
celebrities and for employees of the medical center and
access to it can be restricted.
If a user has access to a particular patient, WebCIS can
limit that access to non sensitive data, or to specific data
types.

14. Access Control
Types of Access Control
WebCIS
Case Management
All Patients
ACCESS GRANTED
ACCESS GRANTED
Non-VIP Patients
ACCESS GRANTED
Enumerated Patient List
ACCESS GRANTED
ACCESS GRANTED
All Data
ACCESS GRANTED
ACCESS GRANTED
Non-Sensitive Data
ACCESS GRANTED
Enumerated Data Types
ACCESS GRANTED
By Patient Type:
By data:

15. Auditing
Audit logs of computer access to clinical data in
the medical center can be maintained for over a
decade. Recorded information includes: user, IP
address, patient, data type, access type, and
time of access. Audit trails are periodically
monitored for inappropriate access.

16. Sample of Audit log

17. Auditing
In order to facilitate auditing, all patients added
to the WebCIS repository specifically for the
study will be flagged as VIP. Use of such flags
represents a compromise between allowing
access to these patients’ data in case of
emergency while discouraging inappropriate
access not related to the study.

18. Physical Security
All servers containing clinical and evaluation data are
housed in the main computer facility in the medical center
which is staffed 24 hours a day. It is physically secured
with biometric access controlled locks.

19. Physical Security
To reduce tampering with HTUs, the units have
neither floppy, nor CD-ROM drives and are
configured to prevent installation of
unauthorized software.