Blobel B, Pharow P, Spiegel V, Engel K, Engelbrecht R
Department of Medical Informatics, Medical Faculty, Institute of Biometry and Medical Informatics, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Saxony-Anhalt, Germany.
Int J Med Inform. 2001 Dec;64(2-3):401-15. doi: 10.1016/s1386-5056(01)00193-9.
Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.
支持共享医疗的健康信息系统将是分布式且可互操作的。由于要处理敏感的个人医疗信息，此类信息系统必须提供适当的安全服务，仅允许授权用户根据“需要知晓”原则对患者数据享有受限的访问权。特别是在医疗保健领域，基于芯片卡的信息系统以患者数据卡的形式出现，为用户提供信息自决权和移动性，以及卡上存储数据的质量、完整性、可问责性和可用性，从而改善患者的共享医疗。DIABCARD项目旨在实施和评估一个基于芯片卡的医疗信息系统（CCMIS），以促进不同组织或部门中照顾同一位糖尿病患者的医护人员之间的沟通与合作。与欧盟资助的TrustHealth(2)项目合作，提供所需的通信和应用安全服务，如强身份验证以及诸如授权、访问控制、可问责性、保密性等派生服务。该解决方案基于健康专业人员卡和可信第三方服务。除了在DIABCARD工作站中安全处理患者的芯片卡和数据外，还实现了这些工作站与相关部门系统之间的安全通信。基于此可行性研究的结果，提供了针对CCMIS的DIABCARD示例的增强安全服务规范，该规范将在德国巴伐利亚州正在建立的健康网络框架内实施。除了患者识别卡和患者数据卡组合的首选解决方案外，还详细解释了使用卡可验证证书的较低级替代方案。最后，简要讨论了一些法律问题、诸如XML标准集等未来趋势及其对所提出的解决方案以及对一般分布式健康信息系统的影响。
