As the authors point out in the introduction, “the domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy.” Healthcare organizations are putting the famous information security triad--confidentiality, integrity, and availability--to the test: patient privacy versus the healthcare provider’s need for patient data in order to provide high-level care.
Chapter 1 starts with a thorough and enlightening overview of trends in the so-called electronic healthcare (e-healthcare) environment. The book presents Canada and five European countries as examples. This overview leads to a discussion of the requirements for a robust framework for e-healthcare management and risk evaluation. The authors conclude that the current trends in e-healthcare development, such as the increased pressure to exchange medical data between market players and the interconnectivity of a myriad of systems, pose a threat to e-healthcare security.
The second chapter delves into methods for securing medical information. Throughout the book, the authors mainly consider information security through the lens of privacy, thus neglecting other highly important aspects such as redundancy and high availability. The authors provide security principles from the rather obscure International Information Security Foundation (a quick Google search did not reveal its Web site). The authors seem to misunderstand several principles. For example, they explain the accountability principle as “information is not disclosed to unauthorized persons or processes,” when the correct definition should be “the traceability of one’s actions.”
The remainder of chapter 2 covers the need for and the risks associated with unique personal identifiers (UPIs). The authors then discuss personally identifiable information (PII), though without first explaining this new acronym to readers. Next, they describe anonymization and pseudonymization, two ways to protect patient confidentiality by removing PII from an e-healthcare record. The authors conclude the chapter by describing secure engineering practices and possible security metrics tailored to e-healthcare systems.
Chapter 3 contains an in-depth overview of laws and regulations from many different countries. Equally thorough is its coverage of healthcare security standards, which are linked to deploying technology to support such standards, such as radio-frequency identification (RFID), encryption, and security in Web-based contexts. This chapter is a good primer on relevant laws, regulations, and standards, and its “References” section includes a wealth of articles and books for further reading.
Chapter 4 covers the security requirements for both electronic healthcare records (EHRs) and (the patient-centric) electronic personal healthcare records (EPHRs). This is followed by a brief discussion of example EPHRs--namely, Google Health, Microsoft HealthVault, and Indivo’s open-source system. Interestingly, in a survey of patients who use the system, a majority of the respondents did not express any privacy concerns. (Either ignorance is bliss or security practitioners are just overly worried.) The chapter concludes with an overview of the future of e-healthcare information systems. The authors foresee a future where patients will have more control over the information stored in their e-healthcare records and an increased need for security controls.
Chapters 5 and 6 try to bring all of the previous elements together in a comprehensive framework for securing and evaluating the security of e-healthcare information systems. Such a framework should support the emerging trend toward increased patient control, which must be evaluated against the need of clinicians to be able to trust the system. Basically, if patients can freely control their data, and possibly modify their personal data, then doctors can no longer accept that information as a basis for their medical decisions.
As for evaluating security, the authors point out that this is a new field in the information security domain. They suggest that the Assurance-Compliance-Infrastructure-Organization (ACIO) framework is the most suitable approach for evaluating security and privacy, as it integrally addresses compliance and assurance aspects.
The book ends with chapter 7, “Discussions,” which provides interesting food for thought on the current and expected security developments in the e-healthcare field.