Electronic Health Records (EHR) systems have changed the way patient information is managed, offering unprecedented efficiency and accessibility and making possible much more seamless and accurate medical services. EHR systems have transformed healthcare organizations by streamlining patient data management and improving care delivery.
However, this digital transformation also brings significant challenges and concerns about personal and medical information privacy and security, especially in critical systems such as the healthcare industry. The importance of healthcare security cannot be overstated, as protecting sensitive patient information and maintaining compliance with regulations like HIPAA and HITRUST are critical for healthcare organizations. Ensuring data integrity is also crucial in securing patient data, as it guarantees the accuracy and consistency of information over its lifecycle.
What is the Difference Between EHR, EMR, and PHR?
Electronic Health Record (EHR)
EHRs are comprehensive digital records of personal identifying information (PII) and personal health information (PHI).
Usually, they are the most possible amount of sensitive data, such as health history, including all interactions and treatments a patient has received over time.
They are designed to enable seamless patient data exchange among various healthcare providers and organizations, support the entire care continuum, and allow healthcare professionals to provide better, more integrated care.
EHRs are primarily used in hospitals and clinics to manage patient data efficiently and improve patient outcomes through collaboration with other medical providers and services, including clinical decision support.
Electronic Medical Record (EMR)
EMRs are digital versions of paper charts in the doctor’s office that contain detailed information about a patient’s medical history, diagnoses, medications, care plans, and immunization dates.
The main difference with EHRs is that EMRs are typically limited to a single physician’s practice and cannot quickly transfer information to other facilities. They are primarily used within a specific organization and focus on the provider’s facility. This limitation can create data silos, restricting the sharing of information across different healthcare providers.
Personal Health Record (PHR)
PHRs are health records designed for patient self-management and control. They allow individuals to maintain their health information securely and privately and include data from multiple sources.
They can incorporate data from various healthcare services, personal health devices, and wellness apps and be used later across different medical providers with the records provided by clinicians. One key benefit of PHRs is enhancing patient engagement by empowering individuals to actively participate in their healthcare.
Electronic Health Records Compomizing Factors
Patient confidentiality can be compromised with Electronic Health Records (EHRs) due to flaws in digital, physical, or overall security policies. Protecting sensitive patient data, known as protected health information, is crucial for maintaining compliance with regulations like HIPAA. Digitalization makes it much more difficult to compromise confidentiality, eliminating the human factor and physical control drawbacks. However, digital systems bring risks, especially if the right solutions are not used, or there are misconfigurations.
Cybersecurity threats
External Attacks and Data Breaches. Cybercriminals seek to exploit software vulnerabilities to gain unauthorized access to confidential patient information for resale. Because medical records contain the most comprehensive data, they are the most lucrative, even more so than bank records.
It could be neglecting to use secure protocols or insufficiently strong encryption for traffic interception. Or unprotected from injection databases or trivial vulnerabilities in the code to increase privileges for unauthorized access to the provider’s internal resources.
Ransomware and Other Purposeful Attacks. Also, EHRs may not be just sold; they can be encrypted and require a key to decrypt. Or vice versa, encrypting them until a ransom is paid to customize the provider’s reputation and destroy patient trust.
Insider Threats
Unauthorized Access and Social Engineering. While technology can minimize human error, it is currently impossible to eliminate it completely. Medical staff may be routinely working with patients’ medical data and not realize how they were forced to share this information with third parties.
Also, some internal actors may be compromised from the beginning and deliberately exceed their authority, maliciously taking advantage of their official position to gain access to patient data. Implementing access controls can help mitigate these insider threats.
Third-Party Threats
Sharing Risks and Third-Party Vendors
EHRs involve collaboration between service providers, sharing data across multiple platforms, such as billing, data analytics, etc.
Thus, if this medical data exchange is not configured correctly with all security measures and controls in place, it implies additional points of failure and potential security gaps. Effective vendor management is crucial in mitigating these third-party risks.
Main Access Control Requirements for Processing Electronic Health Records
User Authentication in EHR
EHR access needs to be protected by strong passwords, as well as multi-factor authentication methods and tools.
Role-Based Access Control (RBAC) in EHR
Each type of medical information must be strictly divided by the specialists’ roles in operating it during their duties (e.g., physician, nurse, admin) with predefined access levels and access policies to ensure users can only access information necessary for their job functions.
The principle of the Last Privilege needs to be implemented. It means that users have data access to the minimum necessary information to perform their regular duties. Even if additional patient information might be necessary in specific cases, an additional request must be made to access it.
Access Control Lists (ACLs) in EHR
Implement ACLs based on the degree of data sensitivity to accurately understand the degree of risk and appropriate measures to address it.
ACLs should also be reviewed and updated regularly to reflect changes in user roles or status and ensure that employees are kept from having the access they should no longer have.
Session Management in EHR
All user sessions need to be fully transparent and controlled so that the security team can detect abnormal behaviors or extended activity periods, enabling prompt response to potential threats.
Also, additional measures during the session, like automatic logouts, session timeouts, or timeouts for inactive sessions, are needed to reduce the risk of unauthorized access from unattended devices.
Data Encryption in EHR
Not all attackers will directly hack into your service, but they may try to intercept your data. Therefore, strong encryption protocols are required for data at rest when stored on your side and during data exchange with various vendors and parties, i.e., in transit.
This makes no practical value for the data, even if it has been stolen, because decrypting is too time-consuming and nearly impossible for most hackers.
Training and Awareness in EHR
Even the greatest security controls are the realization of previously lined security measures, and medical staff must understand and adhere to them correctly.
Security awareness training is essential to educate medical staff to support patient-centered care processes and enhance the overall healthcare system. They need to be aware of possible security incidents, how to avoid them, and the tools that will help them if used correctly. They need to know cyber social engineering, like phishing, physical social engineering, like tailgating, and others. Also, they need to be aware of common cyber incidents and avoid them, like sharing access credentials, keeping credentials in an unsafe place, etc.
Complexity of EHR Systems and Limited Resources
Healthcare providers face significant challenges in implementing effective privileged access management within EHR systems, most of which stem from the complexity and the often limited resources available for managing access effectively.
Effective resource allocation is crucial in managing these EHR systems efficiently.
Complexity of EHR Systems
Diverse Technologies Integrations. Managing diverse technologies in EHR systems presents significant challenges, particularly in system integration with various clinical applications, laboratory systems, and medical devices, each with unique access requirements. Ensuring seamless access management across these disparate systems is a daunting task.
Varied User Roles and Permissions. EHR systems support a wide range of users, including physicians, nurses, administrative staff, and IT personnel, each needing different access levels. Defining and maintaining appropriate permissions for these varied roles can be complex and prone to errors.
Regulatory Compliance. Healthcare providers must adhere to stringent regulatory requirements, such as HIPAA in the U.S. or GDPR in the EU. These regulations necessitate meticulous tracking and auditing of access to EHRs, further complicating the implementation of effective access management.
Limited Resources
Budget Constraints. Many healthcare organizations operate under tight budget constraints, limiting their ability to invest in advanced access management solutions or hire dedicated security personnel. Budget limitations further complicate managing limited resources by restricting financial flexibility.
Staff Expertise. There is often a shortage of staff with the necessary expertise to manage complex EHR systems and their access controls. Training existing staff on these systems requires time and resources that are frequently in short supply.
Ongoing Maintenance and Updates. Effective access management is not a one-time setup but requires continuous monitoring, updating, and adjusting to respond to new threats and changes. This ongoing effort can be resource-intensive and challenging to sustain with limited resources.
Balancing Security and Accessibility
Need for Immediate Access. Healthcare organizations often need rapid access to patient data to make critical decisions. Implementing stringent access controls can slow down this access, potentially impacting patient care.
User Convenience. Striking the right balance between robust security measures and user convenience is critical. Overly restrictive access controls can lead to workarounds that compromise security.
Emergency Access Protocols. Provisions must be made for emergency access (e.g., break-glass scenarios) so that clinicians can access information quickly during critical situations without going through the usual access control procedures while still maintaining an audit trail for such access. Balancing security and accessibility must also consider emergency access to ensure patient safety in critical situations.
Effective Privileged Access Management Best Strategies And Solutions
Implementing the Principle of Role-Based Access Controls
- Permission Assignment. Assign permissions to roles rather than individuals.
- Hierarchical Role Structure. Using a hierarchical role structure to simplify role management. Higher-level roles inherit permissions from lower-level roles, reducing redundancy.
Segregation of Duties (SoD)
- Critical Function Separation. Ensure critical functions are distributed among multiple roles to prevent any user from having excessive control. For example, the roles of a system administrator and a security auditor should be separate to avoid conflicts of interest and mitigate any potential conflict of interest.
How Can Fudo Security PAM Help with RBAC and SoD in EHR Systems?
Centralized and Simplified Role Management. The Fudo PAM solution provides centralized management of user roles and permissions, simplifying access control administration, optimizing resource management, and ensuring EHR system consistency.
Implementing the Principle of Least Privilege Controls (PoLP)
- Minimal Access Assignment. Assign the minimal level of access necessary for users to perform their job functions. For example, a receptionist should only access patient appointment schedules, not medical records.
- Just-in-Time (JIT) Access. Implement JIT access controls that grant temporary elevated permissions only when necessary and automatically revoke them after use.
- Regular Access Reviews. Conduct regular reviews of user access rights to ensure they align with current job functions and maintain minimal access.
- Access Certification Campaigns. Perform systematic access certification campaigns where managers review and validate the access rights of their team members.
How Can Fudo Security PAM Help with PoLP in EHR Systems?
Fine-Grained Access Control. At its core, Fudo Security PAM implements key security principles such as Zero Trust and The Least Privilege. It provides administrators with robust but flexible tools to define and maintain granular access policies and access controls. Users are granted the minimum permissions necessary for their job functions, reducing the risk of unauthorized access.
Just-in-Time (JIT) Access. JIT access controls are also implemented in the core of our solutions, enabling you to define privileges and rules to provide access only for a specific time and task and only access requests approved by a few administrators. Once the task is completed, the elevated privileges are automatically revoked, minimizing the risk window.
Implementing Strong Authentication and Authorization (MFA)
Knowledge Factors. The user knows something, such as a password and PIN.
Possession Factors: Something the user has, such as a hardware token, smart card, or mobile device.
Inherence Factors: Something the user is, such as biometric identifiers (fingerprint, facial recognition, iris scan). Biometric authentication is a common example of inherence factors.
How Can Fudo Security PAM Help with Authorization Controls in EHR Systems?
Integrated MFA. Our PAM solution is built with multi-factor authentication (MFA) into the authentication process, enabling you to define multiple verification methods before granting access to sensitive EHR data. You can choose or combine Static password, Public key, CERB, RADIUS, LDAP, Active Directory, OATH, SMS, DUO, and Certificate.
AAPM (Application to Application Password Manager). This feature provides you with a simple and safe way to manage account credentials between different applications, and avoid credential storage and sharing risks.
Ensuring Regulatory Compliance and Accountability
- Regulation Mapping. Map access controls to specific regulatory requirements such as HIPAA and HITECH and ensure all necessary controls are in place to meet legal obligations.
- Compliance Reporting. Implement tools to reach all data needed to generate compliance reports, ensuring all necessary controls are in place to meet legal obligations.
- Regular Monitoring and Updating. Constantly access security measures and controls, as well as user activity, to ensure policy adherence and relevance.
- External Audits. Third-party auditors should also periodically be engaged to assess access control measures independently.
How Can Fudo Security PAM Help to Ensure Regulatory Compliance and Accountability in EHR
Regulatory Compliance. Fudo Security PAM solutions were initially built and focused on providing a simple but robust way to implement and manage all security tools required by industry regulations, such as HITECH and HIPAA compliance, as well as frameworks like NIST SP 800-53 or ISO/IEC 27001 compliance. It enables you to get the all-in-one solution and eliminate additional integrations to achieve that, risking creating additional points of failure.
Audit and Reporting Features. Also, our PAM solutions provide comprehensive reporting features. Because it initially focused on regulatory compliance with regulations such as HIPAA and GDPR, it helps healthcare organizations demonstrate their adherence to all legal statements and requirements. Additionally, Fudo Security PAM offers advanced audit features to ensure thorough and accurate compliance tracking.
Accountability Mechanisms
- Continuous Monitoring. Implement continuous monitoring tools to track user activity in real time and detect suspicious actions without delay.
- Automated Anomaly Detection: Use automated anomaly detection systems to identify deviations from standard behavior patterns.
How Can Fudo Security PAM Help to Implement Accountability Mechanisms in EHR
Real-Time Alerts. Fudo Security PAM solutions provide real-time monitoring of privileged accounts and privileged access activities. Automated alerts notify administrators of any abnormal behavior or potential security breaches, enabling rapid response based on regular expression- or AI-based security policies.
AI-Powered Session Monitoring. Fudo Security PAM is an AI-powered solution with built-in machine-learning features. It enables you to incorporate advanced analytics to detect suspicious patterns in user activity and network traffic, and identify more sophisticated threats and compromised accounts early, allowing for proactive security measures.
Contact us to get a consultation with our specialists to explore the solution that suits you best, making your systems fully compliant, truly effective, and advanced.
Conclusion
EHR systems help take the patient care journey to the next level, making it more continuous and efficient. They help ensure that medical records are efficiently shared across multiple providers, enable the healthcare team to work collaboratively, share decision-making, and ensure that important data about the patient and their treatment is not missed. However, this requires additional safeguards against unauthorized access and theft or other manipulation of medical data.
This is where PAM solutions come into play. They became a single and comprehensive point of control by providing easy-to-use tools to manage access, assign roles and rules, monitor user activity, and comply with all regulatory requirements. This allows healthcare organizations to reduce the burden on the staff because of medical records security management, eliminate potential human error, and eliminate real data availability and integrity risks.
