How to use your iPhone to keep a patient list

this will be cool.
imagine integrated patient management systems on the iphone. pull up lab results, XRs, CTs.
see it on the iPhone by accessing direct to the hospital system.

How does this handle the security and privacy requirements of HIPAA?

An iPhone has essentially no security and is easily lost. It scares me when doctors talk about keeping records on them.

As you said, HIPPA doesn’t apply to you, because you’re in Australia, but I think the privacy and security of medical records on an iPhone is still an issue, particularly in the US.

My problem is that an iPhone is too easily lost or stolen. If you go out to lunch, and leave it behind or have it stolen, what patient information is released? You can’t count on the iPhone password really keeping anyone out.

You’re storing their name, patient number, and what surgical operations you’re doing, but that’s enough to be a problem. I might not want the public to know that I’m having elbow reduction surgery. You mentioned iChart and pulling up XRays or CTs. That’s even more information that really shouldn’t be leaving the medial building.

There’s always a trade off between security and access… The question isn’t so much should you carry information with you, but what is a reasonably secure way to do it?

The trick is to find a happy medium and think thru possibilities. For example, it sounds like you have a good idea of how you’re going to avoid losing your phone. For example, I *know* where my phone is at all times — if I put it on a table, I don’t let it get covered up. At home and at my desk, there are only a few places I leave it, and it’s never far from me. You can’t do this perfectly, but “perfect” is not attainable.

You can also think about risk of theft and how to prevent that. That involves being aware of people around you, especially when it’s sitting on a table or something. If you’re in a crowded place or in a dangerous neighborhood, you could keep it in an inside pocket and avoid using those white ear buds, so people don’t know you have an iPhone. Again, you can’t do this perfectly!

We did once have a scare in Washington DC because some government employee lost his laptop, and it had records for a lot of veterans on it. In that case, the police were able to find the laptop and found the thief had not cared or noticed the information on the computer. So, there was a lot of concern about this, but the information was never used for identity theft. Of course, you can’t depend on thieves not hacking your phone, but you can factor into a risk analysis that most thieves are not interested in the information in the iPhone.

On the software side, just the fact that you have a passcode on the phone helps since that means it will take longer for someone to hack it, especially since the iPhone requires the pin if the phone is simply turned off and moved. To increase the chance the pin is required, keep the “auto-lock” time set to one minute and require the passcode after a relatively short time. This only buys time, but buying time is worth it when it comes to security.

If you do misplace your phone, borrowing someone else’s and quickly dialing your number might help you locate it. It might not, but it would be worth doing.

So do you see where I’m going with this? Think things thru and plan. Talk to Apple and the software company that wrote iChart, if you decide to use that and see what else can be done. The newer iPhones have GPS built in — if you have one of those, that could be used to locate the iPhone fairly quickly. Talk to the police to find out what they could or would do if it was stolen.

I think you can make a plan that would keep the data reasonably safe.

While you’re thinking this thru, you might want to consider the advantages to your patients, as well. You will probably have more information on hand and you might spend less time doing paperwork — that all sounds good to me if that means you can spend more time with patients. And you’re probably more likely to lose papers or two here and there as you go.

If you were my doctor, I think the risk would be worth it.

Yes, I’m definitely guilty of being an IT professional.

I spent some of my years working for the agency that defined, implemented, and tested the security of US DoD computers and facilities. That has led me to pay attention to issues of security and privacy.

Your comments on the insecurity of a hospital are also noted. I was sitting in an examining room at my doctors office. Security there is probably better than a hospital, because of the limited number of people who require access. In the room is a terminal so the nurse and doctor can record data and the doctor can pull up old records. Of course, that’s password protected so patients can’t access it. But as I sat there I noticed two immediate problems. First, the staff wasn’t particularly good at hiding their passwords. They were too short and I could shoulder surf fairly easily. Second, the terminal they used was located in the room. I easily could have attached a key logger, and grabbed the passwords.

There are always trade offs between security and usability. Also, there is no such thing as secure, it’s always a matter of deciding how long you want it to take for a given attacker to break the security. The more computing power you have the faster you can break an encryption system. You have to decide how much risk you can tolerate depending on the content your protecting and who might be trying to acquire that data.

My concern is that the PIN code on an iPhone is a really weak security measure. Apple never intended it to stop someone who had access to the phone. The iPhone really should be considered a computer, not a phone. With 16GB of storage it can store a significant amount of data, and with all the services it runs it can be attacked in a variety of ways.

What I’d suggest is strong encryption with good authentication, and a policy that you lock and unlock the application between each use.

The reality is that the iPhone isn’t going to be very amenable to typing a good password. If a procedure is too inconvenient it’ll be avoided. For example, users would likely pick really short passwords.

There are three ways you can authenticate someone, by having them present something they know (as password), something they are (biometrics), or something they have (a physical key).

With an iPhone, your best answer might be a something like a blue tooth finger print reader. Something small enough you could carry it in your pocket. Just stick your hand in your pocket and press your thumb in to the reader. It would have a unique id and it check your finger print, then do a challenge response with the phone or any other computer for that matter.

As far as I know such a thing doesn’t exist. So as a practical matter, you’re more limited. The last couple posts by Liz and yourself are in the right direction. It’s easy to let convenience trump privacy, but if you take the time to think about the trade offs you’re making and whether they are beneficial to the patient, that’s the best you can do.

[...] Keep patient demographics, in a pinch. Although you probably have another system for keeping track of patient information, sometimes it breaks down. A test note, or a photograph of a patient label will support your main system. [...]