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 regulations 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. HIPPA in the US and the European privacy directive)
- 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 illegal disclosure it is crucial that providers of medical data can be sure that data consuming parties enforce the common understanding of the purposes of use that data was originally provided for. Therefore the definition and enforcement of access rules for medical data and services throughout clinical workflows is a precondition for any co-operative 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 have to be enforced or if the decision on the [Zulässigkeit] of a resource access depends on information that is either encoded within the (potentially encrypted) message payload or even not part of the message at all.
This white paper points out how access control services should be integrated into healthcare IT infrastructures and how IHE can be used to support such policy-aware healthcare solutions.
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