We are frightened and bombarded with news in everyday basis that data collected in medical or dental procedures could be compromised. That is true, but that was also true in the time of paper medical charts. Today, I want to emphasize few important security tips.

When we organize access for doctors, nurses and administrative personnel, we have to select their rights wisely. It is not needed for one nurse to see doctor’s professional memo on patient condition and it is not needed for one administrative officer to see if the patient has genital herpes in the medical history. As a doctor and a professional developer I work on both sides so I see many not needed security restrictions that influence productivity but also many freely available information which is not needed and could lead to data breach.

Many medical and dental programs have a problem with separation of data and data access. In most cases it is because of wrong approach toward planning where developer wants to satisfy all requests. By interviewing users we do collect very important information about needs, but also we can expect from all parties to express their need for accessing all data. Of course that we should take care on user’s needs, but access rights should be properly fine tuned and adjusted by following rules of good practice and after talks and understanding with management.

Second, but not less important is to be aware that there could not be successful separation of rights if we employ people without awareness that they are working with sensitive and confidential data. For example, I have had requests from my managements to limit IT administrator’s rights or to limit developer’s rights, but it is not possible. You cannot take someone without professional attitude and to employ him/her as a chief database administrator and after that to ask if there is any way to limit his/her access to the database. That would definitively prevent him/her to do anything, even good. The same thing is with users like doctors, nurses and administratives.

Statistically, the highest risk of data breaches occurs because of users. It cannot be eliminated, but it can be effectively decreased by security controls, by logging and by assigning of patients. For example, doctor needs to see data only for patients that he administers. When patient arrives the receptionist assigns him/her to first available doctor and from that time doctor sees all data related to that patient. There is some modern ideas that the system should not be very restrictive on access rights but to inform all employees that everything done is logged and to monitor their activity in regular intervals. That could be even more successful than restrictions without logging.

To summarise all: you cannot project a secure system if it will be used by people without any trust from the management. If you do have some level of trust, you have to adjust personal access level accordingly to that trust and to person’s professional needs.


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