Both users and application are subject to authentication. EHRS application must provide mechanisms for users and applications to be authenticated. Users will have to be authenticate when they attempt to use the application, the applications themselves must authenticate themselves before accessing EHR information managed by other application or remote EHR Systems. Examples of entity authentication are: • Username/ password • Digital certificate • Secure token • Biometrics
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: There exists authenticity with the users being required to log in with a secured password and a username, password and user name is different for all practitioners depending on the device being used. Information gotten also depends on who is viewing therefore is customized for the viewer to ensure patient confidentiality is upheld
Disadvantages: user interphase is not the easiest with practitioners complaining that it can be difficult to use. The pop-up brings more confusion than help to the users.
Advantages: There exists authenticity with the users being required to log in with a secured password and a username, password and user name is different for all practitioners depending on the device being used. Information gotten also depends on who is viewing therefore is customized for the viewer to ensure patient confidentiality is upheld
Disadvantage: individuals with the correct log in details can be used by those with ill intention to access information they are not supposed to obtain
Advantages: There exists authenticity with the users being required to log in with a secured password and a username. The password and user name are different for all practitioners depending on the device being used. Information gotten also depends on who is viewing therefore is customized for the viewer to ensure patient confidentiality is upheld. Organized and easy to use.
Disadvantage: Contains a lot of information that is not exactly necessary therefore one has to go through a lot of information to get what they need. This takes much time.
I.1.1.5
Patient Privacy
Protect the patient’s privacy according to personal, local, and national rules.
Functionality allows for compliance with personal, local, and national rules.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: Patient privacy is upheld with the authentication making the access to information more secure. Only those authorized can access. This ensures that there is patient confidentiality and safety from people with ill intent
Disadvantages: It is controlled by human beings who can decide to grant access to non-authorized personnel breeching the contract of patient privacy.
Advantages: Patient privacy is upheld with those who have the right access being allowed to obtain any information, this ensures that doctor patient confidentiality is upheld and keeps of unauthorizes personnel with bad intentions.
Disadvantages: It is controlled by human beings who can decide to grant access to non-authorized personnel breeching the contract of patient privacy
Advantages: Patient confidentiality is upheld with only those authorized having the access to view patient information. Patient privacy is therefore upheld along with safety from people with ill intent
Disadvantages: It is controlled by human beings who can decide to grant access to non-authorized personnel breeching the contract of patient privacy
I.1.1.5.3
Advisement of Patient Privacy Rights
Record that the patient was informed of current privacy policies practices.
The EHRS will allow for the dispensing and tracking of patient education regarding current privacy policies and procedures.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: Contains information of all what the patient needs to know in terms of their privacy right. That the information contained in the system is between the patient and the healthcare facility.
Disadvantages: Patients hardly get the chance to go through that information.
Advantages: Has information on what the patients need to know concerning their privacy rights with regards to what is stored in the system
Disadvantages: patients hardly get the chance to go through that information.
Advantages: Information of the patients’ right with regards to what is stored in the system concerning them is available. It points out the rights of the patient to have the information kept confidential
Disadvantages: Patients hardly get the chance to go through that information.
I.1.2.1
Information Integrity
Ensure that clinical information is valid according to the healthcare-specific business rules.
An important aspect of maintaining a legally sound health record is securing the record to prevent loss, tampering, or unauthorized use. The integrity of the health record may be questioned in a legal proceeding if concerns are raised about the security of paper-based or electronic records. The Rules of Evidence require an organization to have policies and procedures in place to protect against alterations, tampering, and loss. Systems and procedures should also be in place to prevent loss (such as tracking and sign-out procedures), secure record storage areas or systems, and limit access to only authorized users. For example, • Entered data must be validated based on system edit rules and valid code sets. These may be field specific (i.e. valid list of values), intra-record (i.e. date deceased) date of birth), or they may extend across multiple related records (i.e. test order must exist before test results can be recorded). • Healthcare documents must not be altered as dictated by the “Uniform Rules of Evidence” and the ”Federal Rules of Evidence”. • Translations between numbering systems and written languages must not result in substantive document alterations.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: Clinical information is preserved from the time the information is logged in. it is ensured to be kept safe at all times. There are electronic signatures of the practitioner in charge of the information. Any alteration of the signature is indicated with the date and the person who has altered the signature
Advantages: Alteration of any signature or marking is indicated. Access must be granted in order to do this. It indicates who has altered any information and when it was altered
Advantages: The application requires that any alteration be indicated in terms of signatures or any information on the patient files. The date of the alteration is recorded for future reference.
I.1.2.2
Document Retention
Retain all clinical documents (including complex standards-based clinical documents) for the policy-designated or legally-designated time period.
Each healthcare provider should develop a retention schedule for patient health information that meets the needs of its patients, physicians, researchers, and other legitimate users, and complies with legal, regulatory, and accreditation requirements. EHRS applications must conform to the current rules.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: There is no limit to how long information can be stored by the servers because there is unlimited space with cloud based computing. Information can be terminated upon request by the client.
Disadvantages: This costs the facilities more to store all this information and therefore can opt to free up space after a number of years.
Advantages: there is no limit to how long information can be stored by the servers because there is unlimited space with cloud based computing. Information can be terminated upon request by the client.
Disadvantages: This costs the facilities more to store all this information and therefore can opt to free up space after a number of years
Advantages: There is no limit to how long information can be stored by the servers because there is unlimited space with cloud based computing. Information can be terminated upon request by the client.
Disadvantages: It costs the facilities more to store all this information and therefore can opt to free up space after a number of years
I.1.2.5
Confidentiality
Promote patient confidentiality by enforcing the privacy rules that apply to various parts of the EHR.
This section deals with the enforcements of the privacy rules. Patients may be harmed if their privacy is invaded (including unauthorized access to Electronic Healthcare Records), or if the patient a part of their records that they must not access or view.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: this system promotes patient safety and privacy. It only allows authorized personnel to acquire information stored needing them to use the necessary authentication to access the information
Disadvantages: other people can access the information with the right authorization even if not theirs.
Advantages: patient safety is guaranteed with access to information being granted only to those with the correct credentials.
Disadvantages: other people can access the information with the right authorization even if not theirs.
Advantages: patient safety is guaranteed with access to information being granted only to those with the correct credentials.
Disadvantages: other people can access the information with the right authorization even if not theirs.
I.1.2.6
Audit trail
Track changes to EHR data to verify enforcement of business, security, and access-control rules.
Most information systems benefit from the quality control offered by an audit trail. All systems that are backed up, for example, also note the date and time of the backup in an audit log. Healthcare-related information systems, however, have many additional events and controls that must be audited (tracked) due to the sensitive (personal) nature of the healthcare data itself. For example: HIPAA Security Rule Section 164.308(a)(1)(i) Security Management Process requires Information System Activity Review, which means to "Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports."
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: backed up information has a date and time stamp on it indicating when any new information was included. The dates of the updates can then be obtained and used or future reference.
Advantages: information backed up over time can be indicated as to when the information was backed up. The date is indicated for every update.
Advantages: there is continuous backing up of newly added information with a date of when the information was added and by whom.
I.1.2.6.1
Amendment history
Track amendments to clinical documents.
Once a clinical document receives a mark of attestation by a healthcare provider, (e.g., a signature), it becomes a legal document and must be preserved in an unaltered fashion. Sometimes, however, corrections or amendments need to be made to the document. In these cases, the EHRS must keep track of the corrections or amendments such that the integrity of the original (signed) document is still preserved.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: signatures can be put on the documents electronically and subjected to alteration only when one is authorized to do so. It indicated when and who altered the signatures
Disadvantages: altering of the signatures can be done carelessly and interfere with the law in the case of a criminal offence
Advantages: signatures can be put on the documents electronically and subjected to alteration only when one is authorized to do so. It indicated when and who altered the signatures
Disadvantages: altering of the signatures can be done carelessly and interfere with the law in the case of a criminal offence
Advantages: signatures can be put on the documents electronically and subjected to alteration only when one is authorized to do so. It indicated when and who altered the signatures
Disadvantages: altering of the signatures can be done carelessly and interfere with the law in the case of a criminal offence
I.1.2.6.3
Information Lifecycle Access-Event audit
Track who, when, and by which system an EHR record was viewed or extracted.
The EHRS application must be able to record information required to determine who viewed or extracted EHR related information from that application.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: this system can record information of who viewed patient information by indicating their log in credentials.
Disadvantages: one person can you the information of another to get on the system and view confidential information.
Advantages: this system can indicate individual and practitioners who log into the system by the use of their authentication credential.
Disadvantages: one person can you the information of another to get on the system and view confidential information
Advantages: the system can indicate who viewed information on it with the information of their log ins, and their usernames. It can tell the time of the log in.
Disadvantages: one person can you the information of another to get on the system and view confidential information
I.1.2.6.4
Record audit
Generate an audit report for an EHR record (or for a set of EHR records).
Differing care-settings benefit from being able to identity the various people or systems that viewed or altered a patient's (or set of patient's) EHR's. For example, a judge might want to know how many patients a given healthcare provider treated while the provider's license was suspended. Similarly, in some cases a report detailing all those who modified or viewed a certain patient record might be needed.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: it does record and generate and audit report showing the different people that received treatment and what the treatment was for.
Disadvantages: providers can bypass the system and fail to document what they have done therefore fail to be implicated for the wrongs they have done
Advantages: generates an audit report for all the patients treated, who did the treating and for how long.
Disadvantages: providers can bypass the system and fail to document what they have done therefore fail to be implicated for the wrongs they have done
Advantages: generates the audit report for the total number of patients treated in the facility, by who, for how long and any procedures performed in the patients.
Disadvantages: providers can bypass the system and fail to document what they have done therefore fail to be implicated for the wrongs they have done
I.1.2.6.6
Information-Exchange audit
Retain any information exchange details along with any amendment history sent with clinical documents by an external clinical or EHR system.
If EHR information is exchanged between EHRS application for viewing or other purposes, the receiving application must log information about the sender and the nature, history, and content of the information exchanged in the transaction If any translations are necessary (.e.g. vocabulary lookup) then a record of the transformation must be created by the receiving application. For example, in addition to receiving an EHR from an external system, receive the amendment history for that record, the identity of the originating system, and details about the receiving system’s reception event (including, when and by whom the EHR and its audit trail were received).
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: the system allows exchange of information with other application on the request of a patient or in the case of referrals. Different hospitals using the same application have the patient information updated regularly
Disadvantages: it cost the patients some fees to have them exchange information from one application to another.
Advantages: information within the same application can be updated regularly regardless of the facility the patient seeks treatment provided that facility uses this application.
Disadvantages: it cost the patients some fees to have them exchange information from one application to another.
Advantages: information is updated on a regular. Different hospitals using the same application have the patient information updated regularly
Disadvantages: it cost the patients some fees to have them exchange information from one application to another. The servers can experience down time slowing down the running of the facilities.
I.1.2.7.4
Data Availability
Make clinical information readily available (as required by a clinical care setting).
Not only must clinical information be available for recall, in certain care-settings the data must also be available within a proscribed period of time. For example, if the EHRS fails to present a report that it has received from a laboratory in a timely fashion, the patient may die. Depending on the care setting, the EHRS must make all or some of the EHR information available when, where, and how the users need it.
1. Support delivery of effective healthcare 2. Improve patient safety 3 Facilitate management of chronic conditions 4. Improve efficiency 5. Facilitate self-health management 6. Ensure privacy, confidentiality
Advantages: clinical information is readily available with it being a cloud based forum. The information can be transferred from one care giver to another fast and easy. Information gets to the required department as soon as it is logged in therefore procedures to be done are done as fast as the information is available
Disadvantages: time is consumed when it comes to the use of the system which is not the easiest to use.
Advantages: delivery of information from one department to another is fast and can be obtained as soon as logged in. ensures that information needed to perform procedures is delivered on time to the laboratory to perform procedures.
Disadvantages: transferred information may be overlooked to the presence of already existing information. Time must be spent to look for existing information.
Advantages: fast transfer of information from one department to another and form one caregiver to another.
Disadvantages: there is the burden of too much information that one must go through to obtain what they really need and this consumes a lot of time
