Difference between revisions of "ACWP Motivation"

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IHE White Paper on Access Control
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[[ITI_Access_Control_White_Paper|IHE White Paper on Access Control]]
  
 
== Motivation ==
 
== Motivation ==
=== Privacy and Data Security ===
 
=== Access Control vs. Perimeter Protection ===
 
  
=== Needs-to-Know Principle ===
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The exchange of medical data among enterprises is subject of multiple IHE integration profiles. E. g. XDS allows for sharing data among physicians within an affinity domain while XCA even enables the sharing of medical data across multiple of such domains. As with any processing of personal data, various constraints (laws, regulations, and policies) apply to these data-sharing use cases. These regulations point out different aspects of medical data processing and therefore follow different objectives:
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* protecting the patient's privacy and right to self-determination (e. g. HIPAA in the US and the European privacy directive)
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* full compliance to professional codes of conduct, such as professional discretion
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* ensuring the integrity and proper handling of health data (e. g. regulations for the handling of radiologic data)
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* enforcing an adequate risk management within organizations (e. g. KonTraG in Germany)
  
[[Image:WPAC_need_to_know_v01.png|Needs-to-Know Principle]]
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With respect to the prevention of inappropriate disclosure it is crucial that providers of medical data can be sure that data consuming parties enforce access constraints conformant to the purposes under which that data was provided. Therefore the definition and enforcement of access rules for medical data and services throughout clinical workflows is a precondition for any cooperative patient treatment.  
  
* the objective of access control is to enable every medical staff member to perform all data processing operations that he needs to do in order to fill his role within the medical treatment process - but no more!
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Perimeter protection (e. g. firewalls) and mutual node authentication (e. g. as provided by ATNA) are laying ground for any secure healthcare infrastructure, but they fall short if fine-grained access rules  - potentially making use of multiple policies and distributed attribute sources - have to be enforced.
* the organization of labour and separation of duty within a medical organization or a healthcare network determines who is allowed to perform what (medical) activities within which contexts (e. g. for what purpuses)
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* Permissions for the processing of medical data are derived from the permitted activities of a role within a certain context. Following the needs-to-know principle these permissions reflect the operations on medical data which are part of the activity.
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This white paper points out (1) how access control services should be integrated into healthcare IT infrastructures, (2) how IHE can be used to support such policy-aware healthcare solutions, and (3) where there are opportunities for new IHE Profiles. A dedicated focus will be on opportunities for preserving patient safety by keeping data accessible, even in cases where the security subsystem is partly or totally unavailable.
* Access control should always follow the needs-to-know principle. Therefore the objective is that the set of permitted operations of a user always contains the permissions that are required to fill the current job role.
 
* The needs-to-know principle couples permissions with the organization of labour. Therefore the permissions granted by an access control system that follows the needs-to-know principle are always as compliant with legal regulations and privacy restrictions as the underlying organization of work. If the orhganization of work within a medical organization or within amedical network violates legal regulations or a patient's consent, the access control system will implicitly do so as well.
 
* The needs-to-know principle has impact on the design of an access control system, because it differentiates between restrictions on the assignment of people to activities and restrictions on the accessability of medical data within certain activities. '''In an ideal access control system a patient consent should always focus on the first (e. g. by opting-in or -out certain people, job roles, or organizations from performing a medical activity) while resource protection should focus on the second (e. g. by stating clear rules which activities require which permissions)'''.
 
  
'''''Authors Note:''' We will come back to this during the discussion of the various access control paradigms, because this statement implies a strong relationship between patient consents and discretionary access control''
 
  
 
<hr>
 
<hr>
  
== Discussion ==
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== Open Issues ==
place issues to be discussed among the editorial team here...
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:TC090213 (integrate): Healthcare IT is characterized by independent data managing systems (HIS, PACS, ...) without a central point of control. There is no single point for controling the security of protected resources, therefore ACS must be federable.
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:TC090213 (add): audit trails as a reactive access control measure should be mentioned when appropriate (but no more...)
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== Closed Issues ==
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:TC090213 (decision): the objective of the WP to provide direction for future IHE profiles should explicitely be mentioned
  
== Change Requests ==
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:in the January f2f ''patient safety'' was pointed out as yet another aspect that should be mentioned. A link to this issue (just one sentence) should be part of the introduction.
place your change requests here...
 

Latest revision as of 14:41, 19 February 2009

IHE White Paper on Access Control

Motivation

The exchange of medical data among enterprises is subject of multiple IHE integration profiles. E. g. XDS allows for sharing data among physicians within an affinity domain while XCA even enables the sharing of medical data across multiple of such domains. As with any processing of personal data, various constraints (laws, regulations, and policies) apply to these data-sharing use cases. These regulations point out different aspects of medical data processing and therefore follow different objectives:

  • protecting the patient's privacy and right to self-determination (e. g. HIPAA in the US and the European privacy directive)
  • full compliance to professional codes of conduct, such as professional discretion
  • ensuring the integrity and proper handling of health data (e. g. regulations for the handling of radiologic data)
  • enforcing an adequate risk management within organizations (e. g. KonTraG in Germany)

With respect to the prevention of inappropriate disclosure it is crucial that providers of medical data can be sure that data consuming parties enforce access constraints conformant to the purposes under which that data was provided. Therefore the definition and enforcement of access rules for medical data and services throughout clinical workflows is a precondition for any cooperative patient treatment.

Perimeter protection (e. g. firewalls) and mutual node authentication (e. g. as provided by ATNA) are laying ground for any secure healthcare infrastructure, but they fall short if fine-grained access rules - potentially making use of multiple policies and distributed attribute sources - have to be enforced.

This white paper points out (1) how access control services should be integrated into healthcare IT infrastructures, (2) how IHE can be used to support such policy-aware healthcare solutions, and (3) where there are opportunities for new IHE Profiles. A dedicated focus will be on opportunities for preserving patient safety by keeping data accessible, even in cases where the security subsystem is partly or totally unavailable.



Open Issues

TC090213 (integrate): Healthcare IT is characterized by independent data managing systems (HIS, PACS, ...) without a central point of control. There is no single point for controling the security of protected resources, therefore ACS must be federable.
TC090213 (add): audit trails as a reactive access control measure should be mentioned when appropriate (but no more...)

Closed Issues

TC090213 (decision): the objective of the WP to provide direction for future IHE profiles should explicitely be mentioned
in the January f2f patient safety was pointed out as yet another aspect that should be mentioned. A link to this issue (just one sentence) should be part of the introduction.