I-Corps: Explanation-Based Auditing: Improving the Security of Electronic Medical Records

研究人员开发了一个基于验证的审计系统，通过从审计日志中过滤适当的访问，使合规人员可以集中精力在可疑行为，以提高电子病历审计效率。该团队的审计日志分析方法基于挖掘的逻辑解释消除了非可疑访问，并通过常见类型的缺失数据增强了这些解释。关键的见解是，电子病历（EMR）数据库已经存储了描述患者治疗过程的信息（例如，预约、药物医嘱、诊断等），这可以用来解释为什么会发生访问。此外，审计系统自动发现这些解释并将其提交给合规官员以供批准，而不是要求合规官员手动指定为什么应该发生访问的所有原因。以往的研究证实，该系统可以减轻医院的审计负担，基于审计的审计系统有可能减轻医院的审计和合规负担。首先，大型医院的合规办公室目前雇用了数十名员工，每周手动处理和审查数十起投诉。有了拟议的技术，合规官员只需要审查一小部分访问，大大减少了人工工作。先前的研究表明，超过94%的访问可以出于临床或操作原因进行过滤。第二，医院的病人可以要求对他们的医疗记录的所有访问进行统计，这被称为访问报告。目前，这些访问报告对患者来说是不可解释的，因为它们只是列出了访问医疗记录的员工，而不是他们是谁以及为什么会发生访问。基于验证的审计系统通过附加描述访问的临床或操作原因的可解释文本描述来增强这些访问报告。第三，为了验证基于审计的审计系统的效率和有效性，已在2010年设立了一个试点，让合规干事测试审计工具，并利用已知的滥用情况衡量其准确性。

Researchers have developed an explanation-based auditing system to improve electronic medical record auditing efficiency by filtering appropriate accesses from the audit log so compliance officers can focus their efforts on suspicious behavior. The team's approach to audit log analysis eliminates non-suspicious accesses based on mined logical explanations and enhances these explanations with common types of missing data. The key insight is that electronic medical record (EMR) databases already store information describing the process by which a patient is treated (e.g., appointments, medication orders, diagnoses, etc.), which can be used to explain why accesses occur. Moreover, instead of requiring compliance officers to manually specify all reasons for why accesses should occur, the auditing system automatically discovers these explanations and presents them to compliance officers for approval. Previous research has confirmed that the system reduces the auditing burden.The explanation-based auditing system has the potential to reduce the auditing and compliance burden for hospitals. First, compliance offices at large hospital currently employ tens of individuals to manually process and review tens of complaints a week. With the proposed technology, compliance officers will only need to review a small subset of the accesses, significantly reducing the manual effort. Previous research has shown that over 94% of all accesses can be filtered for clinical or operational reasons. Second, hospital patients can request an accounting of all accesses to their medical record, which are known as access reports. Currently, these access reports are un-interpretable for patients because they simply list the employees who accessed the medical record instead of who they are and why the access occurred. The explanation-based auditing system enhances these access reports by attaching interpretable text descriptions describing the clinical or operational reason for access. Third, to verify the efficiency and effectiveness of the explanation-based auditing system, a pilot trial has been set up at to allow compliance officers to test the auditing tool and measure its accuracy using known instances of misuse.