By Alan Gahtan and J. Fraser Mann - August 1997
The implementation of new technology has provided hospitals with many benefits. However, without proper attention, the same technology can create vulnerabilities and can compromise the privacy of patient information.
Once upon a time, data was stored on mainframes and had to be accessed through "dumb terminals". These lacked any ability to store information internally. Today, such terminals are being replaced with PCs that can hold data on internal hard disks or can allow users to download data to floppy diskettes. These PCs are not connected directly to the server but rather utilize local area networks (which is the computer equivalent of a telephone party line). A device known as a "protocol analyser" can be connected in place of any PC and used to eavesdrop on any information exchanged on the LAN.
The utilization of wireless LANs by some hospitals can mean that physical access to the LAN is not even required in order to intercept data. A person in the visitor area with a properly equipped laptop can "tap in" unless encryption technology is implemented on the hospitals wireless LAN.
Even without access to the hospitals LAN, files stored on laptop computers can be compromised if such computers are lost or stolen. The "power up password" feature on such computers can be easily by-passed. The only effective solution is to prevent sensitive data from being stored on laptop hard disks or to use special encryption programs which scramble all data on a hard disk unless the proper password is supplied by the user.
Another area that should be reviewed is the process for disposing of used computers. Any hard disks on such computers should be erased using special utility programs before such computers are sold to staff or to external resellers. The hospital should also ensure it has the right to retain any defective hard disk that is replaced (as in many cases, these can be refurbished and supplied to other customers). Similarly, supplies such as diskettes and magnetic tape must be properly erased or destroyed prior to disposal.
The growing level of computerization is also encouraging the migration of an increasing amount of information from paper files (which were easy to lock in filing cabinets and offices) to electronic form. CD-ROM "jukeboxes" can allow a substantial quantity of data to be made available on-line. Unless access control systems are implemented, confidential patient data can be available for review by any employee.
Hospitals have been quick to take advantage of the Internet for research purposes and to exchange medical information for diagnosis and treatment. Absent the use of encryption, these messages can be intercepted en route. Also, unless reliable "fire wall" gateways are installed, the connection of the hospitals internal network to the Internet can expose the system to infiltration by hackers.
Even without Internet connections, some hospitals are establishing community health networks to facilitate the sharing of data between various providers of health care services. In some cases, such inter-hospital networks can allow access to patient data by users at other hospitals and/or outside service providers who may be responsible for the operation and maintenance of such systems.
Remote access is another area that needs to be secured. Many hospitals provide dial-up access to physicians. Systems based on passwords alone can compromised. Prudent institutions are utilizing a token device (small credit-card sized device) to positively authenticate remote users.
Hospital staff need to also be made aware that deleting data on a computer system doesnt always result in an erasure. In many cases, deleted files can be "unerased" using special utility programs. Even text deleted from a word processing document can sometimes be recovered by a recipient.
Technology can also be used to protect against some of the vulnerabilities it can create. For instance, encryption can be used to protect the confidentiality of data while en route and digital signature technology can be used to authenticate individuals and systems attempting to access data from or feed new data into the system. Unauthorized access should be tracked and logged.
However, technology is not the only solution. Implementation of internal policies governing security and the use of computers can also be a very effective tool to enhance patient privacy and the protection of the hospitals systems.
As well, appropriate confidentiality agreements should be put in place with all employees, contractors and service providers. These provide the hospital with a legal basis to protect confidential information and also help reinforce to such individuals the importance of maintaining the confidentiality of hospital data.
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