Analysis of the quality of hospital information systems audit trails

Ricardo Cruz-Correia,Luís Lapão,Pedro Pereira Rodrigues,Ana Margarida Ferreira,Isabel Boldt,Cátia Santos-Pereira,Alberto Freitas

doi:10.1186/1472-6947-13-84

Abstract

BackgroundAudit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information.MethodsThe responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour.ResultsThe interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT – 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS.ConclusionsExisting AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal.

Highlights

Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused
Aim This paper aims to address the issues related to the existence and quality of AT regarding patient records, to describe the Hospital’s scenario and to produce recommendations
These interviewees were only certain of one IS allowing AT in each of their institutions

Summary

Introduction

Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused. An important challenge is to guarantee the good working conditions for health professionals to access clinical data while Hospital Information Systems (HIS) are still being developed [2]. Retention requirements that show who has accessed what in a HIS, when and what operations were involved are properly collected. These records are called Audit Trails (AT) [7]. Some attention as already been given define the requirements of AT in healthcare, namely by RFC 3881, IHE-ATNA, DICOM. These standards are being referenced in some of the most important projects today (e.g. epSOS or “Meaningful use stage 2” proposed rule)

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