Hospitals Struggle With Access Control

Despite increased awareness of access control issues, healthcare providers continue to struggle with security and compliance related to user access, according to the results of a survey conducted at the Health Information Management and Systems Society 2008 conference in February.

The survey, conducted by enterprise provisioning and access control software vendor Courion at the show Feb. 24-28, revealed that 64 percent of respondents cited controlling user access to clinical systems as their top IT security concern.

The survey, which was conducted among 136 pre-screened HIMSS attendee respondents, found that 60 percent reported issues with users sharing passwords, 52 percent found that orphaned user accounts were not properly disabled after employment was terminated and 38 percent of respondents said there had been instances of inappropriate access.

Todd Chambers, chief marketing officer at Courion, said that while many hospitals are taking a more strategic view of security and privacy issues related to access, these issues were complicated by the fact that many organizations were relying on remote work forces, as well as mobile and wireless technology, which made it difficult to secure a hospital's IT environment.

Chambers said outside contractors, nurses or physicians who weren't part of the permanent staff, as well as third-party vendors, all needed access to systems and information to do their jobs, but that access could create vulnerabilities if they affected a caregiver's ability to deliver patient care. 

"These guys are worried about getting their job done and caring for patients," Chambers said.  "A security or compliance requirement is going to be ignored in favor of getting that job done—especially if those requirements stand in the way—if it's easy for [caregivers] to bypass and if they're not enforced by hospitals.”

Access issues are a major concern not only because they can leave hospital systems vulnerable to viruses and hackers, but because of the need to meet HIPAA audit requirements that require knowledge of who is accessing specific systems at what time and whether that access is authorized.

Chambers said one surprising statistic showed that the threat of a HIPAA compliance audit was the strongest incentive for increasing security initiatives, with 60 percent of survey respondents saying that was a major driver of security and compliance decisions, and 75 percent of respondents reporting they were concerned or very concerned about facing a HIPAA audit. Chambers said that while HIPAA audits were performed in the past, they have become more frequent recently.

"Until recently, the idea of a HIPAA audit was not that threatening. But now more HIPAA audits are taking place in hospitals that may not have even had any violations, and as the government enforces HIPAA, they are being more punitive," he said.

Typically, hospitals perform internal audits to test for security and compliance, but these usually are time-consuming and often don't prevent a breach from happening, since they can only report what has already happened. 

The survey included a cross-section of healthcare providers ranging from community hospitals to multi-hospital systems, and was developed to augment a focus group Courion conducts that gathers insight into security and compliance in the healthcare industry.