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The Health Department has conceded the Gillard government's personally controlled e-health record system is vulnerable to attack at the users' end.

Health chief information officer Paul Madden said clinical data would be encrypted during transmission between medical providers or patients and the national infrastructure, "so that it cannot be interfered with or intercepted".

"But at the point of viewing, the security risks start to turn into the level of protection on the PC," he told a Cybersafety for Seniors inquiry last week in Sydney, where he also touched on the future of the National E-Health Transition Authority.

"The mitigations are about consumer or health-provider information and education about securing and eradicating the risks that exist at the PC level," he said.

"We need to take every step we can to make sure that everybody's informed of the need for end-to-end security, and what their part in that may be to ensure that we have dealt with the risks as best we possibly can."

The independent computer emergency response team, AusCERT, had warned that the PCEHR system would be wide open to hacking.

"Online criminals have for many years been attacking PCs at work and home to gain access to the systems and data they desire," its submission to the recently completed senate PCEHR bills inquiry said. "There's no reason to think criminals won't actively target these computers once the PCEHR system goes live.

"If any end-user computer is already compromised by malicious software, the PCEHR may be easily compromised."

The Australian Federal Police and Australian Crime Commission agree, saying seniors are seen as "attractive targets for fraud", with new evidence suggesting stolen identity information is being used to access people's superannuation funds.

Mr Madden said only authorised users authenticated to the PCEHR system via digital certificates could access patient records.

"The infrastructure itself and storage of records will be under an encryption regime, so if somebody manages to hack in they probably can't decrypt the data," he said. "We have a range of audit and logging techniques that will track all traffic, including inquiries and posting transactions.

"But we also have intrusion detection and patterning software that will allow us to detect abnormal access patterns, such as machine-led attacks."

He said health providers' digital certificates would be tracked so the system operator knew who had accessed a record by time, and which records had been viewed.

"Consumers or their representatives will also be authenticated by the system, and they'll be systemically tracked and logged in a big audit file which can be interrogated," he said.

On registering for a PCEHR, consumers will choose between "basic" and "advanced" access controls, a Health spokeswoman told the inquiry. "With basic controls, all health providers will be able to view the clinical documents contained in the record.

"If the consumer chooses advanced controls, at that point they will create a seven-digit PIN code, either numeric or alphabetic. Then when they go to their doctor, they will provide that code to the (doctor's) office, and it will be stored in the (provider's) system. That's a code we're asking consumers to keep secure, obviously."

Mr Madden told the inquiry the operation of the national infrastructure would be contracted out by Health.

"The National E-Health Transition Authority has been working as the department's managing agent for much of the design and (build)," he said. "They're working under contract to do that work to a specific timeframe and to specific qualities.

"That relationship changes once the system is operating, with the department becoming the PCEHR operator."

Mr Madden said NEHTA would have a continuing role in improvements and extensions to the system.

"NEHTA will also have a specific role in providing advice around the security and authentication frameworks," he said.

"They have connections to particular research facilities in things like cybercrime, so they will advise on the emergence of risks and how we might evolve the system in response."

Mr Madden said the system would launch on schedule "and Australians will be able to register and set their control mechanisms" from July 1.

"The technical operation will be outsourced by Health, and the assisted registration facilities, helplines and information provision will generally be done by Human Services through their shopfronts and call centres," he said. "Consumers will access the PCEHR online via the Australian Government Information Management Office's australia.gov.au portal."

But it will take some time for the system to provide real benefits for healthcare providers and consumers. "There will be better availability of information for co-ordinated care, and patients will be able to manage their healthcare records as time goes on," Mr Madden said. "As the records start to accumulate, consumers will have portability, and (the system) will start to get us to the stage of better diagnoses and better access to information."

PIN and token needed to access system

DOCTORS will have to enter a PIN with their hardware token each time they log on to the personally controlled e-health record system.

The electronic signature processes for individual health providers and organisations were revealed in a paper released by the National E-Health Transition Authority last week.

The paper says federal, state and territory governments have differing electronic transaction laws and requirements for doctors' signatures on prescriptions. "During 2011, the Electronic Signatures initiative gained consensus on the personal e-signing of clinical documents like e-referrals, specialist letters, diagnostic requests and reports, and hospital discharge summaries.

"The mechanisms for digitally signing clinical documents using an identity credential are well understood.

"Within Australia, these will be provided by the National Authentication Service for Health (NASH)."

Digital signatures are used in IT systems to "seal" messages with a secret key, verifying the identity of the sender and showing a document or message has not been tampered with during transmission.

Medical professionals and organisations will be given a NASH-compliant token or smartcard to log on to the PCEHR system.

But individual health providers will also have to use a PIN to identify themselves, so that audit trails can track access to patient records.

The paper says the initiative did not explore "specific implementation issues, as they will be many and varied".

It also says the jurisdictions will "each approve a form of legal electronic prescription" sometime in the future.

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Autor(en)/Author(s): Karen Dearne

Quelle/Source: Australian IT, 27.03.2012

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