TRUST Retreat, October 8-9, 2006

EMR Project

Vanderbilt (Sztipanovits, Karsai, Xue)

Stanford (Mitchell, Datta, Barth, Sundaram)

Berkeley (Bajcsy, Sastry)

Cornell (Wicker, Gerkhe, Machanavajjhala)

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Preamble

EMR is an integrative project for motivating, testing, evaluating core TRUST research areas in:

– Model-based design for security– Formal modeling, verifying and enforcing policies– Sensor networks – Investigate “best practices” for interfacing public policy to

technology We are fully aware of the fact that EMR is a huge area

of research and EMR-TRUST is just one relatively small subproject in TRUST. We leverage our partnership with the Vanderbilt Medical Center to have a broader impact.

One related effort in the US is Microsoft’s Software Factory for HL7 compliant EMR transfer among providers.

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The Problem

Rise in mature population– Population of age 65 and older with – Medicare was 35 million for 2003 and – 35.4 million for 2004

New types of technology– Electronic Patient Records– Telemedicine– Remote Patient Monitoring

Empower patients: – Access to own medical records– Control the information – Monitor access to medical data

Regulatory compliance

Table compiled by the U.S. Administration on

Aging based on data from the U.S. Census Bureau.

United Nations ▪ “Population Aging ▪ 2002”

2050

Percentage of Population over 60 years oldGlobal Average = 21%

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Challenges

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

– HIPAA Privacy Rule (2003): gives US citizens Right to access their medical records Right to request amendments, accounting of disclosures, etc.

– HIPAA Security Rule (2005): requires healthcare organizations to

Protect for person-identifiable health data that is in electronic format

Complexity of privacy– Variable levels of sensitivity; “sensitive” in the eye of multiple

beholders– No bright line between person-identifiable and “anonymous”

data Complexity of access rights and policies

– Simple role-based access control is insufficient– Governing principles: “need-to-know” and “minimum

disclosure”

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Research Platform: Patient Portal

MyHealthAtVanderbilt is a web portal for an increasing number of services for patients.

Current capabilities include – appointment management, – secure messaging, – access to EMR and– billing

Future services will/may include medication management,patient data uploads, real-time datalinks and others..

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Overall Research Objective

Satisfying high-level requirements stated for– privacy, confidentiality,– integrity,– non-repudiation and– access control

properties of information flows in the PP system.

Focus on system architecture and policy issues - leveraging existing security technology components.

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TRUST Research Effort in EMR

Architecture modeling and analysis Policy modeling and analysis Interfacing real-time patient data

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Architecture Modeling and Analysis Sub-Project

Architecture analysis is conducted based on the SOA architecture framework – natural fit to the problem and to the existing implementation of MyHealthAtVanderbilt

In SOA– Workflow modeling– Policy modeling– Data modeling– Service modeling

is used to restrict and automate information flow in complex, dynamic environment.

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Research Approach

• System Analysis• Risks and Threats Analysis • Policy Analysis

Domain analysis• VU Medical School• TRUST research groups (Vanderbilt, Stanford)

• Domain Specific Modeling Languages• Domain Specific Policy Languages• Privacy preservation

Modeling• VU Medical School• TRUST research groups (Vanderbilt, Stanford, Cornell)

• Mapping to target architecture -> recommendations

Fast prototyping• BPEL4WS tools• TRUST research groups (Vanderbilt, Stanford, Berkeley)

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Domain Analysis

Regular meetings with Medical School– Physicians– Medical Informatics Researchers– Software engineering staff– Privacy Officer– Information Security Officer

Architecture and policy discussions Case studies Brain storming sessions

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“Target” Architecture for Experimentation

Internal Policy Enforcement Point

S1 S2 Sn

BPEL Process Manager

External Policy Enforcement Point

PolicyRepos.

PolicyDecision Pt.

PolicyDecision Pt.

ConfigurationEngine

Partners Standards:

• BPEL• XACML• SAML• WS-Sec• …

Target ArchitectureLimitations:

• Modeling lngs?• Policy lngs?• Openness of architecture?• Tractability of analysis?

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Modeling For Patient Portal

Workflow Models• Activities• Coordination

Service Models• Component Interface • Data Models

Policy Models• Access models• Privacy models

ModelTransformation

ModelTransformation

ModelTransformation

BPEL Process Manager PolicyRepos.

BPEL Infrastructure

PP Domain

Research Tasks: • Specification of modeling/policy languages

• Model analysis/verification methods

• Model translator specification

• Case studies

Modeling Tools

Analysis Tools

Model Translators

Technology infrastructure:

WSDLBPEL4WS XACML

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Modeling Challenges

Development of ”correct” abstractions– How to establish clear relationship among

workflow, data and policy related abstractions?

Examples:“ A patient is allowed to make appointment only for regular hours.”

“ Physicians can access and modify medical records for those patients where they are the designated primary care physician.”

“ A nurse can read medical records only in her specialization except when the illness is marked confidential.”

Research approach:

Formal specification, experimental evaluation and evolution of modeling languages.

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Modeling Tool

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Architecture Challenges

Privacy/security in open, dynamic architectures– Workflows are added and modified in the system. – Structure of information flows are dynamic, data

dependent and complex. How can we guarantee and maintain privacy/security

properties? Example:A new service added to the PP to provide relevant information

for patients. Are there privacy leaks?

Research approach:Data mining of audit files and discovering leaks, not-

modeled information flows.

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Deliverables

Suite of modeling languages and tools In-depth modeling of part of the PP and

detailed analysis of security and privacy properties

Integration with Policy Languages component Exploring privacy issues related to the

research project (e.g. privacy leaks through access to audit logs.)

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Policy Modeling Subproject

Privacy and Utility in Patient Portals

Adam Barth*John C. Mitchell*

Anupam Datta*Sharada Sundaram*+

*+

Stanford UniversityTCS

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Interfacing Real-time Patient Data

(See Professor Bajcsy’s Talk)

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Impact and technology transfer

Direct connection to a major Patient Portalresearch and deployment project

Results can be generalized to a wide range of SOA applications

MyHealthAtVanderbilt; ….

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How is TRUST making a difference here?

Vanderbilt, Stanford, Berkeley, Cornell This project would be impossible without

TRUST in every sense

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Education and Outreach

Immediate result of the unprecedented collaboration with the Medical School are:- consideration of a CS pre-med - joint projects- co-advising students- “TRUST Fellowship” for medical informatics Ph.D.

candidates