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.

The amount of data currently being produced, stored and used in hospital settings is stressing information technology infrastructure, making clinical reports to be stored in secondary memory devices. The aim of this work was to develop a model that predicts the probability of visualization, within a certain period after production, of each clinical report. We collected log data, from January 2013 till May 2011, from an existing virtual patient record, in a tertiary university hospital in Porto, Portugal, with information on report creation and report first-time visualization dates, along with contextual information. The main factors associated with visualization were defined using logistic regression. These factors were then used as explanatory variables for predicting the probability of a piece of information being accessed after production, using Kaplan-Meier analysis and the Weibull probability distribution. Clinical department, type of encounter and report type were found significantly associated with time-to-visualization and probability of visualization.