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

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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.