J Am Med Inform Assoc - Explaining accesses to electronic medical records using diagnosis information.

Tópicos

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Resumo

JECTIVE: Ensuring the security and appropriate use of patient health information contained within electronic medical records systems is challenging. Observing these difficulties, we present an addition to the explanation-based auditing system (EBAS) that attempts to determine the clinical or operational reason why accesses occur to medical records based on patient diagnosis information. Accesses that can be explained with a reason are filtered so that the compliance officer has fewer suspicious accesses to review manually.METHODS: Our hypothesis is that specific hospital employees are responsible for treating a given diagnosis. For example, Dr Carl accessed Alice's medical record because Hem/Onc employees are responsible for chemotherapy patients. We present metrics to determine which employees are responsible for a diagnosis and quantify their confidence. The auditing system attempts to use this responsibility information to determine the reason why an access occurred. We evaluate the auditing system's classification quality using data from the University of Michigan Health System.RESULTS: The EBAS correctly determines which departments are responsible for a given diagnosis. Adding this responsibility information to the EBAS increases the number of first accesses explained by a factor of two over previous work and explains over 94% of all accesses with high precision.CONCLUSIONS: The EBAS serves as a complementary security tool for personal health information. It filters a majority of accesses such that it is more feasible for a compliance officer to review the remaining suspicious accesses manually.

Resumo Limpo

jectiv ensur secur appropri use patient health inform contain within electron medic record system challeng observ difficulti present addit explanationbas audit system eba attempt determin clinic oper reason access occur medic record base patient diagnosi inform access can explain reason filter complianc offic fewer suspici access review manuallymethod hypothesi specif hospit employe respons treat given diagnosi exampl dr carl access alic medic record hemonc employe respons chemotherapi patient present metric determin employe respons diagnosi quantifi confid audit system attempt use respons inform determin reason access occur evalu audit system classif qualiti use data univers michigan health systemresult eba correct determin depart respons given diagnosi ad respons inform eba increas number first access explain factor two previous work explain access high precisionconclus eba serv complementari secur tool person health inform filter major access feasibl complianc offic review remain suspici access manual

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