Security Confidentiality Research Articles

Applying World Wide Web Technology to the Study of Patients with Rare Diseases

Randomized, controlled trials of sporadic diseases are rarely conducted. Recent developments in communication technology, particularly the World Wide Web, allow efficient dissemination and exchange of information. However, software for the identification of patients with a rare disease and subsequent data entry and analysis in a secure Web database are currently not available. To study cholangiocarcinoma, a rare cancer of the bile ducts, we developed a computerized disease tracing system coupled with a database accessible on the Web. The tracing system scans computerized information systems on a daily basis and forwards demographic information on patients with bile duct abnormalities to an electronic mailbox. If informed consent is given, the patient's demographic and preexisting medical information available in medical database servers are electronically forwarded to a UNIX research database. Information from further patient-physician interactions and procedures is also entered into this database. The database is equipped with a Web user interface that allows data entry from various platforms (PC-compatible, Macintosh, and UNIX workstations) anywhere inside or outside our institution. To ensure patient confidentiality and data security, the database includes all security measures required for electronic medical records. The combination of a Web-based disease tracing system and a database has broad applications, particularly for the integration of clinical research within clinical practice and for the coordination of multicenter trials.

Use of novel World-Wide-Web technology to find and study patients with cholangiocarcinoma

Cholangiocarcinoma is a sporadic cancer of the bile ducts with an estimated incidence in the USA between two to three thousand cases per year. Randomized-controlled trials are seldom undertaken for cholangiocarcinoma, as patient identification and acquisition into trials can take many years. Even in a major institution, it is unlikely that One physician will see many cases per year, unless a system is in place that either refers patients with cholangiocarcinoma or actively searches among all patients seen in that institution for patients with the disease. AIM: To develop software allowing us to identify and study patients with cholangiocarcinoma. METHODS: We investigated the data collected in the various computerized medical and nonmedical data bases available within the Mayo Clinic, and used ICD-9 codes to develop a computerized disease tracing system. The disease tracing system was coupled to a World-Wide-Web (WWW) accessible UNIX data base using HTML, JavaScript, Java and Ingres software. RESULTS: We designed a disease tracing system that scans computerized information systems on a daily basis, and forwards demographics of patients with abnormalities of the bile ducts to an electronic mail box. If informed consent is given, the patients' demographic as well as pre-existing medical information on a variety of medical data base servers are electronically forwarded to a UNIX research data base. In addition, further patient-physician interactions and procedures are entered into this data base. To accomplish this, the data base is equipped with a WWW user interface, allowing data entry via a Web browser from a variety of platforms (PC-compatible, Macintosh, UNIX work stations) anywhere inside or outside our institution. To assure patient confidentiality and data security, the data base includes all security measures required for electronic medical records. CONCLUSIONS: We have designed a computerized disease tracing system as well as a WWW interface connected to a research data base permitting (1) identification of patients with cholangiocarcinoma, and (2) data entry and analysis from any location equipped with a Web-enabled workstation. This system has broad applications, in particular for integration of clinical practice with clinical research and coordination of multi-center trials.

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.

Protection boundary for internetwork security

A new protection boundary model for internetwork security is presented, and a security protocol suitable for the model proposed. Intermediate systems of the model do not fulfill security of service or confidentiality but authentication and integrity. The system does not require that the intermediate systems be fully secure, thus it is practical and can be easily implemented. Data between destination hosts are also protected through the confidentiality service, for which session keys are distributed under the proposed protocol with peer entity authentication.

Multimedia Communications Networks: Patient Care Through Interactive Point-of-Care Testing

This decade will see a historical convergence of technologic and socioeconomic events that will merge interactive multimedia communications with longitudinal participatory health care systems. Diagnostic testing will extend from the home to the most sophisticated acute care settings. Point-of-care testing networks will resemble modern electrical utility power grids with workload distributed to optimize test turnaround time and economic effectiveness. Throughout the network, clinical and managerial information will be accessible as needed at all points of use. The networks will become "physician extenders" by allowing broad interactive geographic and mobile accessibility to clinical information in a context that maintains patient confidentiality and data security.

Employees as Offenders

This study examines patterns of trust violation based on inspection of the confidential security records of three depart ment store companies which apprehended 1,681 dishonest em ployees between 1949 and 1964. The data are particularly interesting because of the so-called "respectable, middle class" population of offenders, a substantial proportion of whom were female salesclerks and virtually all of whom had no prior criminal record. The substantive areas of offense patterns studied included the following: how employees were discovered, prompt ness with which stores took action against suspects, collusive versus solitary nature of acts, rates of apprehension, size of theft, object of theft (merchandise and/or cash), modus operandi, and recovery characteristics. Variation in offense patterns is related to demographic data and employment information, especially to position in the company and length of service.