https://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&feed=atom&action=historyComprehensive management of the access to the electronic patient record: Towards trans-institutional networks - Revision history2024-03-29T15:06:19ZRevision history for this page on the wikiMediaWiki 1.22.4https://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=13523&oldid=prevAnnathehybrid at 14:51, 18 November 20112011-11-18T14:51:52Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 14:51, 18 November 2011</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>This article describes a method for providing <ins class="diffchange diffchange-inline">[[access control|</ins>access rights<ins class="diffchange diffchange-inline">]] </ins>and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">== Methodology ==</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>#User login and authentication through use of smartcard and ID number;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>#User login and <ins class="diffchange diffchange-inline">[[</ins>authentication<ins class="diffchange diffchange-inline">]] </ins>through use of smartcard and ID number;  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access profiles for each type of role of a user;   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access profiles for each type of role of a user;   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;   </div></td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">At the organizational level, the </del>definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized. <del class="diffchange diffchange-inline">  </del>Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification. <del class="diffchange diffchange-inline">  </del>All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">== Validation ==</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">The </ins>definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized. Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification. All accesses of this type are automatically reviewed.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Access tracking is vital to security and is visible to all providers, managers, and patients. <del class="diffchange diffchange-inline">  </del>This allows patients to monitor the security of their own information.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Access tracking is vital to security and is visible to all providers, managers, and patients. This allows patients to monitor the security of their own information.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">[[clarka|Amanda Clark]] </del>[[Category:OHSU-SP-07]]</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
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</table>Annathehybridhttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=13222&oldid=prevAnnathehybrid: moved Lovis C, Spahni S, Cassoni N, Geissbuhler A. Comprehensive management of the access to the electronic patient record: Towards trans-institutional networks. to [[Comprehensive management of the access to the electronic patient record: Toward...2011-11-16T21:48:58Z<p>moved <a href="/wiki/index.php/Lovis_C,_Spahni_S,_Cassoni_N,_Geissbuhler_A._Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks." class="mw-redirect" title="Lovis C, Spahni S, Cassoni N, Geissbuhler A. Comprehensive management of the access to the electronic patient record: Towards trans-institutional networks.">Lovis C, Spahni S, Cassoni N, Geissbuhler A. Comprehensive management of the access to the electronic patient record: Towards trans-institutional networks.</a> to [[Comprehensive management of the access to the electronic patient record: Toward...</p>
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</td></tr></table>Annathehybridhttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=8868&oldid=prevArildf: Reverted edit of AmandaCusack, changed back to last version by DeanSittg2010-07-19T11:33:15Z<p>Reverted edit of AmandaCusack, changed back to last version by DeanSittg</p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards;  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access is granted for a given time period, and must be renewed periodically;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access is granted for a given time period, and must be renewed periodically;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc. <del class="diffchange diffchange-inline">[http://www.casino-spielen.biz online casino spiele]</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
</table>Arildfhttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=8865&oldid=prevAmandaCusack at 08:39, 14 July 20102010-07-14T08:39:59Z<p></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards;  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access is granted for a given time period, and must be renewed periodically;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#Access is granted for a given time period, and must be renewed periodically;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>#Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc. <ins class="diffchange diffchange-inline">[http://www.casino-spielen.biz online casino spiele]</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
</table>AmandaCusackhttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5135&oldid=prevDeanSittg at 21:50, 30 April 20072007-04-30T21:50:22Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
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<col class='diff-marker' />
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<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:50, 30 April 2007</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 12:</td>
<td colspan="2" class="diff-lineno">Line 12:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline"> </del>Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. <del class="diffchange diffchange-inline"></nowiki> </del>[[clarka|Amanda Clark]] [[Category:OHSU-SP-07]]</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment.  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>[[clarka|Amanda Clark]] [[Category:OHSU-SP-07]]</div></td></tr>
</table>DeanSittghttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5134&oldid=prevDeanSittg at 21:49, 30 April 20072007-04-30T21:49:40Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:49, 30 April 2007</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline"><nowiki>    </del>This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:   </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#User login and authentication through use of smartcard and ID number;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>#User login and authentication through use of smartcard and ID number;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>#Access profiles for each type of role of a user;  <del class="diffchange diffchange-inline">3)  </del>Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;  <del class="diffchange diffchange-inline">4)  </del>Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards; <del class="diffchange diffchange-inline">5) </del>Access is granted for a given time period, and must be renewed periodically; <del class="diffchange diffchange-inline">6) </del>Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>#Access profiles for each type of role of a user;   </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;   </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards;  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>Access is granted for a given time period, and must be renewed periodically;  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
</table>DeanSittghttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5133&oldid=prevDeanSittg at 21:47, 30 April 20072007-04-30T21:47:53Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:47, 30 April 2007</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div><nowiki>    This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div><nowiki>    This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:  <del class="diffchange diffchange-inline">1) </del>User login and authentication through use of smartcard and ID number; <del class="diffchange diffchange-inline">2) </del>Access profiles for each type of role of a user;  3)  Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;  4)  Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards; 5) Access is granted for a given time period, and must be renewed periodically; 6) Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:   </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>User login and authentication through use of smartcard and ID number;  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">#</ins>Access profiles for each type of role of a user;  3)  Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;  4)  Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards; 5) Access is granted for a given time period, and must be renewed periodically; 6) Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
</table>DeanSittghttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5118&oldid=prevClarka at 05:34, 30 April 20072007-04-30T05:34:42Z<p></p>
<table class='diff diff-contentalign-left'>
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<col class='diff-marker' />
<col class='diff-content' />
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 05:34, 30 April 2007</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 7:</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>  Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>  Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. </nowiki> [[Category:OHSU-SP-07]]</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. </nowiki> <ins class="diffchange diffchange-inline">[[clarka|Amanda Clark]] </ins>[[Category:OHSU-SP-07]]</div></td></tr>
</table>Clarkahttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5117&oldid=prevClarka at 22:07, 28 April 20072007-04-28T22:07:46Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 22:07, 28 April 2007</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"><nowiki>    </ins>This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals.  The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>The conceptual framework for the methodology is that <del class="diffchange diffchange-inline">''</del>“(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”<del class="diffchange diffchange-inline">'' </del>  The system in built upon the following components:  1) User login and authentication through use of smartcard and ID number; 2) Access profiles for each type of role of a user;  3)  Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;  4)  Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards; 5) Access is granted for a given time period, and must be renewed periodically; 6) Demonstration of an <del class="diffchange diffchange-inline">''</del>a priori<del class="diffchange diffchange-inline">'' </del>therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called <del class="diffchange diffchange-inline">''</del>“breaking the glass”<del class="diffchange diffchange-inline">'' </del>is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed. </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>The conceptual framework for the methodology is that “(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”  The system in built upon the following components:  1) User login and authentication through use of smartcard and ID number; 2) Access profiles for each type of role of a user;  3)  Atomic rights of users, such as “signing a medical record, ordering  a radiology exam, ordering ward materials.”  Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications;  4)  Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed.  For example, a nurse may access patients in his/her ward, but not in other wards; 5) Access is granted for a given time period, and must be renewed periodically; 6) Demonstration of an a priori therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. [[Category:OHSU-SP-07]]</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized.  Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care.  An additional escape mechanism, called “breaking the glass” is provided to some users such as physicians who can escape system constraints by providing justification.  All accesses of this type are automatically reviewed.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"> </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"> </ins>Access tracking is vital to security and is visible to all providers, managers, and patients.  This allows patients to monitor the security of their own information.   </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. <ins class="diffchange diffchange-inline"></nowiki> </ins>[[Category:OHSU-SP-07]]</div></td></tr>
</table>Clarkahttps://clinfowiki.org/wiki/index.php?title=Comprehensive_management_of_the_access_to_the_electronic_patient_record:_Towards_trans-institutional_networks&diff=5116&oldid=prevClarka at 21:58, 28 April 20072007-04-28T21:58:48Z<p></p>
<p><b>New page</b></p><div> This article describes a method for providing access rights and assuring security and privacy for electronic medical records across the four campus network of the University Geneva Hospitals. The authors posit that this methodology could be expanded to manage access and security for trans-institutional networks.<br />
The conceptual framework for the methodology is that ''“(i) accesses to the patient record must fit within a therapeutic relationship or one associated to (medical clerks) and (ii) the extent to which this is possible will vary according to the needs, i.e. according to the role of the user at the time of the access.”'' The system in built upon the following components: 1) User login and authentication through use of smartcard and ID number; 2) Access profiles for each type of role of a user; 3) Atomic rights of users, such as “signing a medical record, ordering a radiology exam, ordering ward materials.” Various rights are assigned to profiles, the rights behave according to the context of care, and are independent from the applications; 4) Validity domains describe the context of care, such as medical service (cardiology) or care location (ward) that limit the domain in which an atomic right is executed. For example, a nurse may access patients in his/her ward, but not in other wards; 5) Access is granted for a given time period, and must be renewed periodically; 6) Demonstration of an ''a priori'' therapeutic relationship between the user and the patient is the most challenging aspect of the system due to call schedules, care provided by telephone, and transfers of care, etc. <br />
At the organizational level, the definition and validation of users, profiles and rights are managed centrally, while the granting process is decentralized. Access can thus be granted by people working very close to users with a very fast response time, as is needed during emergency care. An additional escape mechanism, called ''“breaking the glass”'' is provided to some users such as physicians who can escape system constraints by providing justification. All accesses of this type are automatically reviewed. <br />
Access tracking is vital to security and is visible to all providers, managers, and patients. This allows patients to monitor the security of their own information. <br />
The authors report that this system has been successfully operational for 5 years and conclude that this system of access and security can manage the greater complexity of a multi-institutional environment. [[Category:OHSU-SP-07]]</div>Clarka