In medical organizations, healthcare providers need to have fast access to patients' medical information in order to make accurate diagnoses as well as to provide appropriate treatments. Efficient healthcare is thus highly dependent on doctors being provided with access to patients' medical information at the right time and place. However it frequently happens that critical pieces of pertinent information end up not being used because they are located in information systems that do not inter-operate in a timely manner. Unfortunately the standard operational mode for many healthcare applications, and even healthcare institutions, is to be managed and operated as isolated islands that do not share information in an efficient manner. There are many reasons that contribute to this grim state of affairs, but what interests us the most is the lack of enforceable security policies for systems interoperability and data exchange and the existence of many heterogeneous legacy systems that are almost impossible to directly include into any reasonable secure interoperable workflow. In this paper we propose a RBAC mobile agent access control model supported by a specially managed public key infrastructure for mobile agent's strong authentication and access control. Our aim is to create the right means for doctors to be provided with timely accurate information, which would be otherwise inaccessible, by the means of strongly authenticated mobile agents capable of securely bridging otherwise isolated institutional eHealth domains and legacy applications.

BackgroundAudit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information.MethodsThe responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour.ResultsThe interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT – 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS.ConclusionsExisting AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal.

No abstract