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Balancing access and security

December 1, 2007
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If a user walks away from a computer for only a few seconds, the privacy of patient data can be compromised

A psychiatrist notes worsening symptoms in his patient and thus increases the dose of her SSRI medication. He documents this encounter in his computer system, which both he and his patient assume keeps the data confidential. But what if the doctor is paged and forgets to sign off from the system when he walks away from his computer? Could another medical colleague then view any information under this physician's log-in (referred to in IT circles as “tailgating”)? Or possibly worse, could the patient access the system and view or edit data on herself or others?

The answer to these questions is “yes” in hospitals and clinics around the nation. And if your organization does not have a solution that addresses this type of major security loophole in a simple and quick way, then it is time to start understanding the options.

Privacy Issues

In today's increasingly electronic world, safeguarding healthcare data has spawned countless debates over best practices for processes, implementations, and technologic options. Striking the right balance between easy access and tight security is challenging for healthcare providers and the IT staff who serve their needs. Organizations need to ask questions such as:

  • What is the best way to effectively comply with security regulations and protect patient privacy?

  • How do you securely share records among providers given these regulations?

  • What is the best method for protecting patient privacy when multiple staff members use shared workstations?

  • How do you ensure the highest staff mobility and productivity while still maintaining confidentiality of patient data?

For behavioral healthcare environments, these issues are heightened further because mental health and substance abuse patient records require even more sensitivity and security than a typical medical patient record. Furthermore, behavioral healthcare settings are quite diverse, including psychiatric hospitals, community mental health centers, residential addiction treatment centers, private-practice offices, and even home offices. And while some behavioral healthcare organizations have robust IT resources, the majority have limited IT resources to deal with these issues.

Authentication and Security

Regardless of your particular organizational setting, two distinct issues need to be fully understood and considered: authentication and security.

Authentication: A good first step.Authentication is the process that allows a user to log into a system via passwords, tokens (e.g., smart cards and RSA cards), or biometric processes (e.g., fingerprint, voice, or facial recognition). An organization might use a multioption authentication scenario (e.g., a staff member's fingerprint is scanned to allow access to the system but a password can be entered if the biometric process does not work). An organization also might use a mandatory combination scenario (e.g., a password and a token must be used together to access the system).

Authentication can become time-consuming and expensive with more technical gadgets due to such issues as setup, configuration, and hardware maintenance. In addition, many organizations mistakenly focus just on the authentication process and don't deal with the much more important security process.

Security: The real key to protecting privacy.Security is the process that ensures the user logs out of the system by using either “time-outs” or continuous sensing technology. With time-outs, an application (or the whole computer) will “suspend” itself after a defined period of inactivity. A user then has to “reauthenticate” himself to log back into the application or computer.

While time-outs can be easy to set up, they offer few advantages. If set too short (e.g., ten seconds), the user needs to keep signing back into the system every time he takes a short break from typing to talk to the patient. On the other hand, if time-outs are set too long (e.g., two minutes), there is ample time for tailgating. For example, a clinician could walk away from his computer for a few minutes to answer a page or call and depending on the setting (e.g., hospital workspace or outpatient exam room), a time-out longer than 30 seconds would give another provider or a patient enough time to mistakenly (or purposely) jump on the doctor's application and see or do things under his login. Therefore, the concept of continuous sensing has created great interest. With continuous sensing, the security application knows at all times whether the user is in the direct vicinity of the computer and automatically secures it when the user is out of range.


For maximum protection, an IT system needs initial authentication and then continuous security that is quick and easy for both users and IT support staff. Therein lies the challenge because the most secure systems often require users to sacrifice speed and ease of access, which is unacceptable in healthcare settings. Below we describe the variety of solutions available.

Passwords. Passwords are the easiest authentication option to implement, but they have limitations. First, organizations are requiring increasingly complex passwords (e.g., at least six to eight characters and a mix of numbers and letters) that must be changed regularly. The irony is that this complexity may result in poorer security since users often write down their passwords to remember them and often leave this information in easily accessible places (e.g., a note taped to the computer). Second, the time it takes to enter a user name and password can be cumbersome to most healthcare practitioners if they log in at different computers multiple times each day.