and authenticated, his actions within the health system must still be controlled. Applications can offer varying roles of different privileges and capabilities — the nurse may have access to restricted medications in a dispensary but not the ability to order intravenous fluid. Once an individual is properly identified and authenticated, the actions taken within information systems must also be able to be audited. Audits in healthcare frequently require answers to five basic questions: • Who had access to patient information? • What information did the person access? • Where was the person when accessing the information? • When did the person access the information? • Why did the person access the information? A health system might perform an
audit of information access to affirm or refute a violation of an IAM policy or process, to create utilisation reports after staff training, or simply to reinforce to staff that use of HIT and access of patient information can be audited. Audits identify violators of policies as well as weaknesses in processes and technologies. An IAM system is only as strong and complete as the processes in place to support the system and the staff who implement the policies. Of critical importance is creating IAM policies and processes that support the care of patients by providers; a flexible IAM approach which enables, or enhances, quality healthcare delivery while
safeguarding patient information is more important that a foolproof IAM approach that overburdens providers.
Healthcare Differentiators There are several characteristics of healthcare that differentiate it from other sectors:
The Patient A key differentiator in healthcare, unlike other industries, is that the customer really does come first. On a regular basis in all health systems, policies and procedures are broken to address a critical need for patient care — IAM is no exception. If a physician needs emergent access to patient information that would not be available under routine processes (i.e. access to psychiatric notes or medications during treatment in the Emergency Department), there must be a way for the physician to access this information. Effective IAM solutions will, in balance, create an event log for later review.
The Staff Health systems often depend on employed staff, affiliated staff, students, and even volunteers for many tasks. Usually, many different offices maintain different databases to track these varied individuals, which impedes the monitoring of all persons who deliver care and access patient information. Additionally, some staff may be transient (i.e. students and trainees) and others might start on minimal notice (i.e. new hires and temporary nurses). An IAM system must
be flexible enough to support the staffing requirements of health systems, easy enough to be used by transient staff, and robust enough to be effective.
The Workflow Unique workflows are the failure point for many HIT projects. As more HIT projects require providers to enter documentation or orders for a patient, rather than just reviewing results or information about a patient, applications and systems need to link the provider to the work performed. Signing on to multiple applications and searching them all to find information on the same patient slows down a busy provider and can be confusing. Spending 30-60 seconds to sign on to an application when the provider only needs to use an application for 1-2 minutes to check a test result or enter an order, before moving on to another computer at another patient bedside, is not feasible.
The Culture The healthcare focus on patients and team care contribute to the shared access to patient information that occurs in many health systems. Providers share access to patient records with colleagues to facilitate care, usually so a colleague can save time and avoid having to sign on to an application. Once providers enter computerised orders or documentation in applications for patients, sharing access creates new problems. Privacy regulations in most countries also prohibit such practices. A great opportunity for healthcare IAM
www.pulseitmagazine.com.au www.pulseitmagazine.com.au Pulse+IT 39
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