ACWP Typical AC Scenarios in Healthcare

IHE White Paper on Access Control

Typical Access Control Scenarios in Healthcare

• Internal Resource Security: Within a hospital access to a patient's medical data is restricted to personal who is involved with the patient's acute medical treatment and the corresponding administrative activities (e. g. billing). Access to certain sensitive information is further limited to certain functional roles in order to ensure that this information is only disclosed to people who need to know it for a dedicated purpose.
• Treatment Contract: When signing the treatment contract the patient grants access right to certain administrative and medical data to a commercial organization that provides billing services for the hospital.
• Patient Privacy Consent: Within a regional healthcare network the ability is provided to exchange medical patient data among the participating medical organizations (e. g. using IHE XDS). When signing to this network a patient may determine which organizations are allowed to request his medical data from other organizations within the network on a regular base.
• Application Policy: A hospital offers its patients the opportunity to use a medication record where all dispensed pharamceutical products are recorded in order to discover potential interactions. To ensure the consistence and a proper use of this record a policy is agreed upon which states that only pharmacists and the patient itself may add entries to the record while only physicians and the patient itself are allowed to run a check against a new medication against the record.
• Secondary Use: A patient grants access to certain of his medical data to a medical study provided that all data is pseudonymized before use.
• Breaking Glass: In case of an emergency access restrictions from patient provided policies and internal security regulations are overwritten by a dedicated emergency policy which allows any physician to access all medical data of the patient. Part of this emergency policy is that the physician has to legitimate his access following the first aid treatment by filling an emergency access form.

A use case that is often stated as an access control scenario is a patient consent where access to medical data is explicitly forbidden for a certain person (e. g. the patient's neighbor). A pointed out in the discussion on the needs-to-know principle this use case should not be handled by technical access prtection means but rather by organizational means (e. g. by not assigning this person the team that treats the patient). E. g. a situation where a patient requests cardiologic treatment by a hospital and the only cardiologist available is just the person the patient did not allow to access his data leads to a problem with the hospitals organization of labour that cannot be solved by technical means.

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