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Key security and privacy issues from implementing the National Electronic Health Record in the Islamic Republic of Iran

Short research communication

Seyedesedigheh Seiedfarajollah,1 Reza Safdari,1 Marjan Ghazisaeedi 1 and Leila Keikha1

1Department of Health Information Management, School Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran. (Correspondence to: Leila Keikha: This email address is being protected from spambots. You need JavaScript enabled to view it.).

Abstract

Background: In countries that have not implemented Electronic Health Records (EHR) comprehensively, international organizations are important steps in the development of EHR.

Aims: The objective of this study was to compare different dimensions of privacy in the EHR systems in terms of the following standards organizations: ASTM, Health Level Seven (HL7), and International Organization for Standardization (ISO), in order to create a security and privacy model for EHR.

Methods: This study was done in two steps: 1) survey of standards organizations, and 2) compare standards in comparative tables.

Results: Standards 12, 1 and 5 were extracted from the ASTM, HL7 and ISO respectively.

Conclusions: Evidence shows that the goal of standards was to create EHR systems that identified not only the access level of users, but taking consent for reveal information of people and also approved data by authorized persons in a secure framework. In this regard, ASTM looks comprehensive for privacy issues, while ISO18308 focuses on security issues and data interoperability simultaneously, while Hl7 has emphasized access.

Keywords:privacy, standards, confidentiality, electronic health record, informed consent

Citation: Seiedfarajollah S; Safdari R; Ghazisaeedi M; Keikha L. Key security and privacy issues from implementing the National Electronic Health Record in the Islamic Republic of Iran. East Mediterr Health J. 2019;25(9):656–659. https://doi.org/10.26719/emhj.19.006

Received: 28/08/17; accepted: 04/12/17

Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Introduction

In countries that either have not implemented electronic health records (EHRs) comprehensively, or have had unsuccessful experiences with the implementation of EHRs, utilizing the experiences of international organizations for the acceptance and incorporation of international standards are important steps in developing EHRs (1–3). However, using approved standards and modifying them according to the conditions and infrastructures of the country are key points for their successful implementation. Thus, it is necessary to assess the existing systems by current international standards and find practical solutions to close identified gaps before allocating resources.

Security and privacy are the key issues for EHRs implementation systems. A literature review highlighted that technical and legal details, individual’s right to privacy and policy-making are the major challenges to the development of EHRs systems in low- and middle-income countries (4–11). The objective of this article was to study current international standards in order to create a security and privacy model for EHRs. Therefore, the authors compared the different dimensions of privacy including access control, authentication / signature, consent, and security in EHRs systems in the ASTM, Health Level Seven (HL7), and International Organization for Standardization (ISO). Standards 12, 1 and 5 were extracted from ASTM, HL7 and ISO respectively. Extracted standards were entered into comparison tables and evaluated in terms of number, diversity and content (Table 1).

Security and privacy

According to ASTM, guidelines must be established that all patients and health care providers become aware of the content of their EHRs. In contrast to ASTM, HL7 does not consider any guidelines in this subject, but addresses this issue through various standards with regard to the exchange of data. However, ISO’s stated key guidelines in terms of security include validation, data integration, confidentiality and audit. In addition, ISO 18308 requirements cover legal and ethical aspects of personal information as one of the main prerequisites for the development of EHRs.

Access control

ASTM recommends the management policy should contain licenses for authorized access. HL7 considers access control via different standards (14,15), while ISO suggests that guidelines are established to define, attach, modify and delete access to the EHRs system.

Authentication / signature

According to ASTM, all data entries must be confirmed by the user identifiers. HL7 defines the vocabulary related to it and also the stated digital signature (16–18). However, according to ISO the authentication includes data source and user verification (19).

Consent

ASTM approves informed consent and recommends two types of consent; treatment and discharge consent. In HL7, the DC1.5 standard examines the creation, maintenance and verification for access to consents, licenses and advanced guides. ISO 18308 requirements also address this issue (20). Evidence suggests that security and privacy under ASTM is approached as a comprehensive subject in security and privacy, access, electronic signature and consent issues. Moreover, ASTM has a more practical view on this by assigning category data into three categories; very restricted, restricted and usual control. HL7 has focuses on the subject of access, while ISO not only proposes requirements for security and privacy, access and consent in ISO18308, but also discusses the issue of forensic medicine and medical ethics.

Conclusion

ASTM is comprehensive with regard to the issue of privacy, but for forensic and medical ethics, ISO 18308 may be applied. Therefore, before any planning for the design and development of a national EHRs, it is essential to consider the confidentiality and security subjects when examining the interoperability of data. In addition, it is important to note that such research in those countries that have not yet succeeded in implementing the EHRs completely, will prevent duplication and save time and cost.

Acknowledgment

We sincerely appreciate the directors of ASTM, HL7 and ISO organizations for their cooperation with this study.

Funding: None.

Competing interests: None declared.

Questions essentielles concernant la sécurité et la protection de la sphère privée dans la mise en place du dossier médical électronique national en République islamique d’Iran

Résumé

Contexte : Dans les pays qui n’ont pas mis en place le dossier médical électronique (DME) de manière généralisée, les organismes internationaux jouent un rôle important dans les étapes permettant l’instauration du DME.

Objectifs : La présente étude avait pour objectif de comparer les différentes dimensions de la protection de la sphère privée dans les systèmes de DME dans les organismes de normalisation suivants : ASTM, Health Level Seven (HL7), et l’Organisation internationale de normalisation (ISO), afin de créer un modèle de sécurité et de protection de la sphère privée pour le DME.

Méthodes : La présente étude s’est déroulée en deux étapes : 1) enquête sur les organismes de normalisation, et

2) comparaison des normes à l’aide de tableaux comparatifs.

Résultats : Les normes, 12, 1 et 5 ont été extraites des systèmes ASTM, HL7 et ISO respectivement.

Conclusions : Les données montrent que l’objectif des normes était de créer des systèmes de DME qui permettent d’identifier non seulement le niveau d’accès des utilisateurs, mais aussi d’exiger l’accord des personnes pour divulguer des informations personnelles et également d’approuver les données par les personnes autorisées dans un cadre sécurisé. À cet égard, ASTM semble offrir une solution exhaustive sur les questions de protection de la sphère privée, tandis que la norme ISO18308 met l’accent sur les questions de sécurité et d’interopérabilité des données simultanément et que HL7 privilégie l’accès.

المسائل الرئيسية المتعلقة بالأمن والخصوصية في تنفيذ السجل الصحي الإلكتروني الوطني في جمهورية إيران الإسلامية

سيدي صديق سيد فرج الله، رضا صفدري، مرجان غازي سعيدي، ليلى كيخا

الخلاصة

الخلفية: في البلدان التي لم تُطبق السجل الصحي الإلكتروني تطبيقاً شاملاً، تُعتبر معايير المنظمات الدولية خطوات مهمة في سبيل تطوير سجل صحي إلكتروني.

الأهداف: تقارن هذه الدراسة بين شتَّى أبعاد الخصوصية في أنظمة التسجيل الصحي الإلكتروني وفقًا لمعايير المنظمات التالية: الجمعية الأمريكية للاختبار والمواد (ASTM)، والمستوى الصحي السابع (HL7)، والمنظمة الدولية للتوحيد القياسي (ISO)، من أجل وضع نموذجٍ يمتاز بالأمان والخصوصية للتسجيل الصحي الإلكتروني.

طرق البحث: أُجريت هذه الدراسة في خطوتين: الأولي: لمسح معايير المنظمات؛ والثانية: للمقارنة بين المعايير في جداول مقارنة.

النتائج: استُخلصت المعايير 12 و1 و5 من معايير ASTM و HL7و ISOعلى التوالي.

الاستنتاجات: تشير الأدلة إلى أن الهدف من المعايير يتمثَّل في إنشاء أنظمة سجل صحي إلكتروني لا تحدد مستوى قدرة المستخدمين على الوصول إلى البيانات وحسب، بل تتناول أيضاً الحصول على موافقة للكشف عن معلومات الأشخاص، وكذلك البيانات المعتمدة من قِبَل أشخاص مصرَّح لهم في إطار عمل آمن. ويبدو، في هذا الصدد، أن نظام ASTM يشمل مسائل الخصوصية، بينما يركز نظام ISO 18308 على مسائل الأمان وقابلية التشغيل البيني للبيانات في وقت واحد، ويشدد نظام Hl7 على مستوى الوصول للبيانات.

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