Advantages for improving healthcare delivery for patients
My Health Record is an Australian government initiative that has been commenced in the year 2012 in order to improve healthcare services across the country. It is an online secure summary or database of individuals health information that can be accessed by the approved healthcare professionals, i.e., General Practitioners (GP), patients, and a number of different government and non-health-related-agencies. It enables the healthcare professionals and individuals to access a variety of health-related information of people which include shared health summary, hospital discharge summary, diagnostic imaging reports, dispense and prescription information, event summaries, and specialist letters. Hospital administrators and staff employees can view the medications, shared health summaries, and hospital discharge summaries of patients whereas Australian citizens can view the Medicare or PBS claims, add emergency contact details and advance care plan, and set access control in their individual Health Records (AGDH, 2016).
The key advantages of My Health Record (MHR) System include improvement in healthcare service delivery as it facilitates sharing and access of patients’ clinical & treatment information by medical professionals with other healthcare service providers and individuals on a national level (AGDH, 2016). In terms of patient care, the application of My Health Record System has helped the healthcare administrators to provide quality clinical care services to individuals more efficiently and effectively along with improving the continuity of care. It has also minimised the unnecessary repeat tests and exorbitant medical expenses for patients. Apart from these, it also enables healthcare service providers, government agencies, and individuals to access the stored patient clinical information securely from anywhere using internet service.
For effective healthcare administration, the application of My Health Record (MHR) has made the Australian national health care system better connected as it allows the medical service providers and individuals to access the clinical information easily without any major difficulty. The adoption of My Health Record on state and national level will also result in better management and effective administration of healthcare services. The utilisation of My Health Record is equally important to improve medication safety by reducing the medication errors that lead to harmful medical safety incidents and Adverse Drug Events (ADE). The better access to medical information can save the clinicians necessary time to perform other medical duties, and also reduces the unnecessary test duplication. (ADHA 2018). Furthermore, the availability of rich amount of patient medical information in MHR can also be used for improving medical research outcomes to generate enormous benefit for the society. However, medical research is required to be carried out under strict ethical guidelines, and lack of robustness of the consent process and risk of re-identification of patient personal information is a major issue in MHR, which needs to be handled effectively.
Security and privacy of My Health Record
According to Walsh et al., (2018), privacy and security provisions in the application lead to higher uptake of personal electronic health records. Concerns about privacy and lack of security decrease the reliance of the users and these factors are among the major barriers in the uptake of the personal electronic health record. In relation to My Health Record, the information particularly linked to privacy and security is available in details.
My Health Record provides numerous security-related options for keeping the personal information safe and secure. Firstly, an individual is provided with various access control settings, with which the user can control the information sharing. The user can adjust settings and can provide access to viewing and managing health information to their trusted individuals such as family members, friends, and carers. In addition to this, an individual can also control access to information for healthcare providers. My Health Record offers security settings with which the user can apply restriction for to the information that the medical professionals can access. Similarly, the individual can also control the access to specified documents in their My Health Record account (My Health Record 2018).
There are three types of code, which can be used for changing the level of access to the information. The first code is ‘Record Access Code’ (or RAC), which is used for controlling the access for healthcare providers and healthcare organisations. A customer can modify the settings of RAC to control which healthcare organisation can see the personal record. In the line of codes, the second code is ‘Limited document access code’ (or LDAC), with which the individual can control the access of healthcare organisations to specific documents. Lastly, ‘Personal Access Code’ (or PAC) allows the user to nominate other people to access the My Health Record (My Health Record 2018). For enabling these security features, the individual must log in to the My Health Record and select the ‘Privacy & Access’ menu . The user can then select the preferred option from the list to enhance the security of the account.
Additionally, the users can also remove the clinical and medical documents from the account permanently if they deem necessary. Besides, an individual can also choose to share the data to improve the health outcomes for other patients. Considering the types of access to the nominated representatives, My Health Record offers three types of access, which are general access, restricted access, and full access. The security and privacy provision for an individual reflect that My Health Record is secure, and an individual can increase or decrease the level of security as per the convenience (My Health Record 20181).
Security and privacy of My Health Record using (1) People (2) Process (3) Technology and (4) Legislation
MHR will be beneficial in transforming the Australian healthcare system as it provides a digital summary of individuals medical information that can be accessed by authorised healthcare professionals in order to provide necessary care (Margo 2018). However, it is important the Australian government and ADHA apply specific security control in MHR system to protect and secure the individuals’ health data available on these systems. In order to exert complete security control for MHR system, the following measures need to be undertaken by the Australian government and ADHA
- ADHA should recruit and appoint skilled cybersecurity personnel that are capable of ensuring adequate safety for MHR system by applying necessary cybersecurity and data protection techniques which include utilisation of encryption techniques, firewalls, and secure log-in using role-based access control model
- ADHA and Australian government should also establish an independent audit and review committee that regularly monitor the data safety measures, encryption standards, and data sharing functionality of MHR system
- The Australian government should also appoint the individuals that will work as volunteers for promoting the MHR system in order to increase awareness and knowledge among the local citizens in Australia.
Considering the poor legislation and safeguards adopted by ADHA for MHR, it is important to make the entire registration and data sharing process transparent for the individuals so that they can have a robust control on the stored information. ADHA should provide necessary information to the individuals concerning the privacy control and opt-out option available for them. In the recent past, ADHA has made significant efforts to make the registration process transparent and secure the user data available on MHR. The restriction on third-party health applications to sell patient data to unauthorised entities, i.e., insurance and law firms is a prime example of the ADHA initiative to protect user data (ADA 2018). Furthermore, ADHA has also formulated strict policies concerning the sharing of patient data with government agencies, police, and other non-health-related organisations. However, the lack of clarity and transparency related to data accessibility among the individuals is a major issue that needs to be addressed by both ADHA and the Australian government. For instance, once an individual upload or shares his /her medical summary on the MHR system, he or she will be unable to obtain information regarding the individuals who have seen their data online, which is a major problem. In order to make the entire process clear and transparent following measures are required to undertaken by the Australian government and ADHA
- ADHA should include the functionality of profile visit in the MHR system so that users can have a precise idea about the individuals who have viewed their medical summary or data recently. It can be attained by providing regular alert mails through mail and SMS.
- ADHA should made efforts to make the entire MHR registration and opt-out process lucid for individuals by making them aware about the privacy policies and security measures that are undertaken to ensure complete safety of medical data that will be available on MHR.
The data breach or loss of individuals personal and health-related information is one of the major issues in the MHR system. ADHA is responsible for the proper functioning and storage of individuals medical summary in MHR system. In the past several years, no data breach event has been found for the MHR system, but it is highly vulnerable to external cyber attacks considering the poor safety measures. In order to secure the stored patient medical information, a national cybersecurity centre has also been established by digital health agency for constant and multilayer surveillance of the MHR system since its inception (Margo 2018).
However, the current security and privacy measures related to MHR system are not satisfactory and require significant improvement through utilisation of modern security techniques. Furthermore, there is no standard way that is available to share the medical summary of patients for the clinical service providers. For instance, it is evident that MHR systems are equipped with military-level security considering the safeguards which include encryption, firewalls, secure logins, and regular surveillance. Still, the accidental leave of a secure portal and download of patient medical information on an unsecured computer by hospital staff and doctor can lead to a clinical data breach.
In order to implement strict security control, the following technology-related measures can be implemented by the ADHA to safeguard the individual personal and medical information
- Considering the future usability of EHR system in transforming the healthcare sector of Australia, the implementation of 256-bit SSL encryption technology must be processed by ADHA considering the fact that it provides an extra layer of security. It will also be helpful in protecting the individuals user-id and password more effectively. For instance, the utilisation of 256-bit SSL encryption technique will also ensure authorised access and minimise the external cyber attacks due to increased safety (Dhru 2018).
- ADHA should also continually support and implement a Role-Based Access Control (RBAC) as a preferred access control model for MHR systems. ADHA should also regularly review and organise independent audit to assess the asymmetric and symmetric key encryption methods used in MHR system (Aleman et al. 2013).
In order to exert specific control for addressing the issue related to security and privacy of patient data stored in MHR, the government should make necessary legislative changes in the 2012 My Health Record legislation. For instance, it is important that if any individual decides to opt-out or cancel their MHR, the record should be immediately deleted from the MHR databases unlike storage of this clinical information for the next 30 years. There is an urgent need to amend the poor legislation and policies related to MHR designed by the Australian government (Mclean, 2018). In order to ensure privacy and security of individual medical data stored in MHR, the MHR legislation needs to strengthen and matched with the ADHA policy. The amendment in the 2012 MHR legislation should fulfil these requirements
- No MHR data will be released or made available to police, non-health-related organisations, and any other government agencies. In order to obtain such data, an individual will be required to produce a court order or permission.
- The MHR legislation should be amended or modified as per the ADHA policies to ensure that no medical documents of individuals are release for more than six years (Duckett, 2018).
- The Australian government should made necessary national legislation of privacy tort ensuring the right to compensation for the individuals that have experienced data breach events
- MHR legislation should also include the provision of strict punishment and legal penalties on healthcare service providers that collect, use or disclose a healthcare identifier without permission, and as result access the patients MHR for insurance and employment purposes.
- MHR legislation should also need to ensure that the patient medical information made available to third-party agencies and private organisations will only be used for the research and public health purpose. These private organisations that have access to public health data will also report any data breach or loss incident to the Office of the Australian Information Commission(Mclean, 2018).
- MHR legislation should also include the strict provision that the secondary data related to MHR will only be authorised to use in Australia, and the data will become unavailable once the user chose to opt-out for the MHR (Duckett, 2018).
Improve security of Australian My Health Record system in terms of prevention, detection and recovery of a data breach
Cybersecurity is increasingly becoming crucial in the digitalised world. There are chances that the highly-secured infrastructure can be breached and hacked. One such incident of a data breach is witnessed in Singapore, where the personal information of more than 1.5 million patients was compromised. SingHealth, which is the largest group of healthcare institutions in the country, was attacked by the hackers and personal data was compromised. Between May 1, 2015, and July 4, 2018, the hackers gained access to the data of more than 1.5 million patients, which include name, national identification number, date of birth, race, gender, and most importantly outpatient medical data of 160,000 patients among them (Yu 2018).
Integrated Health Information Systems (IHiS) and Cybersecurity agency of Singapore (CSA) stated that the attack on the SingHealth was deliberate, well-planned, and targeted. The attackers specifically targeted Prime Minister Lee Hsien Loong’s particulars and data. According to information provided CSA, Yu (2018) cited that hackers gained access to a frontend workstation, from where they obtained login credentials to gain access to a database of SingHealth. This was the worst cyber attack in the country, which led to a severe data breach. The pattern of the attack suggests that it has an association with an advanced adversary operation. The tactics, techniques, and procedures in the attack suggested that the cyber attack had links with Advanced Persistent Threat (APT), which is an organisation that commit premeditated cyber crimes (Tauwhare, Matthews & Kelley 2018). However, the exact reason behind the attack is not known. The healthcare data is deemed important for the hackers because, with the personal information, the hackers can blackmail people in position and meet their illegitimate demands. Moreover, the non-public health information can also be used for extortion. The hackers may also sell the information to the terrorist organisations or the spy agencies of enemy nations, which can lead to internal disturbances in the country.
As mentioned above, a particular front-end workstation was attacked by the hackers, with which they gained access to the complete IT health system. The steps of attack include establishing a foothold in the system without being detected. The hackers compromised the first device after some reconnaissance to acquire access to the network. After further reconnaissance, the hackers escalate the privileges, use the access to compromise the target organisation and finally exfiltrate the data. The government of Singapore released that hackers used advanced tools that were capable of evading the anti-virus software and security tools employed in SingHealth (Gov.sg 2018). The hackers infected the system with the malware and accessed the database (BBC 2018).
The data breach in Singapore reveals that there is a requirement of tightening up security measures. The control on the servers, main workstations, and system account must be increased in My Health Record System to prevent it from similar attacks. In order to prevent the attacks, firstly it is imperative to enhance the security of My Health Record System. As observed in the IT system data breach of Singapore, the hackers had advanced tools as compared to the government, due to which they were able to evade the security. Therefore, the government must use the latest software and tools and update them from time to time to enhance the security of the system. Additionally, the security attacks on the system can be further prevented by forming a cyber cell specially dedicated to spying the unusual, unauthorised, harmful, and suspicious activities in the system. In case of detection of any such activities, the cyber experts must take immediate actions to forestall the attack. Furthermore, it is essential that the businesses and the government work together to improve the collective security of the system so that the consequences can be minimised in the case of a data breach, as they are inevitable. Along with this, My Health Record system can be equipped with an Intrusion Detection System (IDP). IDPs have the ability to detect the breach or intrusion, which is crucial for minimising the damage.
To minimise the consequences after an attack on the system is detected, the administrators and the in-charge of the system must inform the security agency of My Health Record to take necessary and immediate actions. According to the magnitude and scale of the attack, the security agencies must deceive the strategy to break the communication links so that further attack can be stalled. Along with this, it is essential to increase the monitoring across all other information systems to detect the unusual activities. Several applications such as Healthi and Health Engine can connect to My Health Record; therefore, it is essential to increase their monitoring and restrict their access (Bogle 2018). Once the attack is detected, the systems must be seized. Apart from this, it is essential to spread the information among the administrators and users as soon as possible so that they can reset the password. Furthermore, after the incident of a data breach, it is essential to recover the data that is compromised and prevent further breaches. My Health Record can use the assets that are available to recover the lost data and protect the remaining data.