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Healthcare Management


percentages of false positives. This can take multiple iterations of testing and report improvements.


Since the intent of such accountability reports is deterrence of privacy breaches, not workforce reduction, the next step is a concerted communication and education campaign to alert all system users that “the sheriff is coming to town”, and that enhanced privacy reports will start being run on a date certain in the near future. As the reports start getting run, the results investigated, and the guilty sanctioned, privacy breaches – and “hits” to the privacy reports – will drop dramatically. Continued reporting and investigating will keep the rate low, as people deter themselves from giving in to temporary temptations and question their own rationalizations.


The temptation to access some patient’s information is sometimes especially high – when the patient is a prominent person, such as a celebrity or leader. In such cases, additional deterrence may be needed, and can be provided by a “Break the Glass” (BTG) alert. These alerts require users to enter a reason for entering the chart, and to re-enter their password, thereby exploding rationalizations for snooping and avoiding the “it wasn’t me” defense. BTG alerts can reduce privacy violations by as much as 100% in my experience, but at the cost of systematic delay in accessing information. This delay cost can be mitigated by suppressing the firing of BTG in low risk situations and for defined time periods after each “glass breakage”.


The combination of forensic audit data mining, selective application of Break the Glass alerts and application of access restrictions in situations where access to certain patients or information types is never needed can greatly reduce privacy risk without impairing the quality or safety of care delivery, and so can optimally reduce the net aggregate risk to patients.


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