Anatomy of log files: Implications for information accountability measures

Wickramage, Chathurika; Sahama, Tony; Fidge, Colin

doi:10.1109/healthcom.2016.7749426

Cited by 9 publications

(2 citation statements)

References 13 publications

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“… 87 Intended for troubleshooting technical problems and HIPAA compliance, EHR usage logs originate from many interconnected information systems and sources (eg, devices). 93 Vendor-defined time metrics may not be generalizable between, or within, institutions or provide precise estimates in real-world settings. Therefore, given the value in measuring clinician EHR time, researchers should explore novel algorithmic methods to validate these metrics and EHR usage log data.…”

Section: Discussionmentioning

confidence: 99%

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

129

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Background Objective Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout. While clear classifications and validated measures of burnout exist, documentation burden remains ill-defined and inconsistently measured. We aim to conduct a scoping review focused on identifying approaches to documentation burden measurement and their characteristics. Materials and Methods Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews (ScR) guidelines, we conducted a scoping review assessing MEDLINE, Embase, Web of Science, and CINAHL from inception to April 2020 for studies investigating documentation burden among physicians and nurses in ambulatory or inpatient settings. Two reviewers evaluated each potentially relevant study for inclusion/exclusion criteria. Results Of the 3482 articles retrieved, 35 studies met inclusion criteria. We identified 15 measurement characteristics, including 7 effort constructs: EHR usage and workload, clinical documentation/review, EHR work after hours and remotely, administrative tasks, cognitively cumbersome work, fragmentation of workflow, and patient interaction. We uncovered 4 time constructs: average time, proportion of time, timeliness of completion, activity rate, and 11 units of analysis. Only 45.0% of studies assessed the impact of EHRs on clinicians and/or patients and 40.0% mentioned clinician burnout . Discussion Standard and validated measures of documentation burden are lacking. While time and effort were the core concepts measured, there appears to be no consensus on the best approach nor degree of rigor to study documentation burden. Conclusion Further research is needed to reliably operationalize the concept of documentation burden, explore best practices for measurement, and standardize its use.

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Section: Discussionmentioning

confidence: 99%

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

129

View full text Add to dashboard Cite

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“…auditing, is an essential part of access control as it ensures that users are held responsible for their actions by tracing the actions performed on a system to a particular user (Gregg, 2017). In the absence of auditing, the security and privacy of patients' information cannot be ensured through the use of security controls that merely limit access to information (Wickramage et al, 2016). For example, without auditing, any misuse of patient information by an authorised clinician would go undetected.…”

Section: Accountabilitymentioning

confidence: 99%

A Clark-Wilson and ANSI role-based access control model

Tsegaye

Flowerday

2020

ICS

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Purpose An electronic health record (EHR) enables clinicians to access and share patient information electronically and has the ultimate goal of improving the delivery of healthcare. However, this can create security and privacy risks to patient information. This paper aims to present a model for securing the EHR based on role-based access control (RBAC), attribute-based access control (ABAC) and the Clark-Wilson model. Design/methodology/approach A systematic literature review was conducted which resulted in the collection of secondary data that was used as the content analysis sample. Using the MAXQDA software program, the secondary data was analysed quantitatively using content analysis, resulting in 2,856 tags, which informed the discussion. An expert review was conducted to evaluate the proposed model using an evaluation framework. Findings The study found that a combination of RBAC, ABAC and the Clark-Wilson model may be used to secure the EHR. While RBAC is applicable to healthcare, as roles are linked to an organisation’s structure, its lack of dynamic authorisation is addressed by ABAC. Additionally, key concepts of the Clark-Wilson model such as well-formed transactions, authentication, separation of duties and auditing can be used to secure the EHR. Originality/value Although previous studies have been based on a combination of RBAC and ABAC, this study also uses key concepts of the Clark-Wilson model for securing the EHR. Countries implementing the EHR can use the model proposed by this study to help secure the EHR while also providing EHR access in a medical emergency.

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