Usability and Security: Two Key Ingredients in a Healthy Solution Recipe

When security technologies are introduced together with usability improvements in healthcare solutions they have a much greater chance of being approved and winning acceptance by healthcare workers. This is in contrast to introducing security technologies into healthcare organizations without usability improvements which at best have no usability impact, and may in fact have negative usability impact.

In my last blog, Improving Healthcare Solution Usability with Single Sign-On, I describe how too many layers of login is one of the most cumbersome usability challenges that compels healthcare workers to do risky workarounds out of compliance with privacy and security policy. Single Sign On (SSO) solutions provide a solution that can greatly reduce the number of sets of credentials as well as the number of actual logins required by healthcare workers during their day, providing major usability benefits. When such a solution is combined with more usable forms of multi-factor authentication such as wireless proximity cards (RFID, NFC or other) it can greatly improve both security and usability. In this type of solution once the healthcare worker has logged into a device they can start up multiple apps within their session without having to re-authenticate to each app. As more healthcare apps are integrated with such a SSO solution the number of separate credentials needed for the healthcare worker can be reduced, eventually to a single set of credentials required to login to the SSO solution.

Many SSO solutions also enable healthcare organizations to implement policy where the first login of the day requires 2 factors, perhaps the proximity card and a password, but thereafter as long as the clinician authenticates at another point in the network with their proximity card within a configurable amount of time defined by policy, eg 2 hours, then the proximity card alone is sufficient to authenticate and no password is required. This effectively enables the clinician to move between devices throughout the day with a simple tap of their proximity card.

SSO may also provide patient context sharing where different healthcare apps running in the same session track the same patient automatically so a clinician that searches and finds a patient in the Electronic Health Record (EHR) system can then switch over to a Picture Archiving and Communication System (PACS) and it has already automatically found the same patient, freeing the clinician from having to search for the patient again in each application. Such patient context capability may be based on the Clinical Context Object Workgroup (CCOW) standard. Clearly another major usability benefit that also mitigates risk of a clinician accidentally looking at different patients across different apps.

Just as important as easy login is minimizing risk of a live session being hijacked once the authenticated healthcare worker moves away from the device with the open live session. This can be done by setting an inactivity timeout to a low number of minutes, which in practice is workable from a usability standpoint since a simple tap of the wireless proximity card gets the healthcare worker back into their session. In the future technologies such as facial recognition may also enable the device to detect when the healthcare worker moves away, closing the session automatically and further reducing the window of opportunity for session hijacking.

Biometrics holds promise in further freeing the healthcare worker from having a wireless proximity card. This is especially compelling in healthcare where not having to touch anything can be a significant healthcare improvement since healthcare workers need to keep sterile hands. To achieve this improvement biometrics need to be both highly reliable and resilient to spoofing. For example viable facial recognition would need to have negligibly low false accept and false reject rates, and would have to be able to detect if a face in front of a device was a picture or a real person. Several strategies are emerging for this including multiple cameras able to detect depth, and facial recognition strategies that require some motion such as blinking to ensure the subject is not a static picture. The reality in healthcare is many healthcare workers, such as doctors working in multiple healthcare organizations, need separate credentials for each organization, and in a worst case a separate proximity card for each facility. As more healthcare organizations implement biometrics this has potential to reduce the number of tokens such as proximity cards required by a given healthcare worker. Furthermore, strategic initiatives such as National Strategy for Trusted Identities in Cyberspace (NSTIC) have the potential to separate Identity Providers from Service Providers where healthcare workers have one set of credentials to authenticate with the Identity Provider and could then access multiple Service Providers such as healthcare organizations without having to be issued a separate set of credentials from each healthcare organization.

Another technology that holds major promise is virtualization with “follow me session” where a healthcare worker that has logged into a given device to start up a secure session, started up healthcare apps within their session, and located a given patient medical record, may then move to another device, login and get access to the same session without having to start the apps and search for that patient again. This becomes particularly compelling as the number and types of devices healthcare workers use increases and their use cases require them to move between the devices seamlessly. This capability can also be especially beneficial where healthcare workers must use many shared workstations throughout their day and switching of devices is frequent even within a given patient encounter. Along with this type of compute model one can do centralized patching and management, leading to major security, manageability and operational efficiency benefits. Where virtualized healthcare clients running on mobile devices have the ability for secure local storage of limited healthcare data, for example just records for the patients a healthcare worker will see that day, they enable healthcare workers to be productive even in areas lacking network coverage or performance, such as rural areas or patient homes. This improved availability is particularly important has healthcare becomes more decentralized.

What kinds of solutions that combine usability and security improvements are you seeing in your healthcare organization?