There is currently a strong focus worldwide on the potential of large-scale Electronic Health Record systems to cut costs and improve patient outcomes through increased efficiency. A number of countries are developing nationwide EHR systems to aggregate services currently provided by isolated Electronic Medical Record databases. However, such aggregation introduces new risks for patient privacy and data security, both by linking previously-separate pieces of information about an individual, and by creating single access points to a wide range of personal data. It is thus essential that new access control policies and mechanisms are devised for federated Electronic Health Record systems, to ensure not only that sensitive patient data is accessible by authorized personnel only, but also that it is available when needed in life-critical situations. Here we review the traditional security models for access control, Discretionary Access Control, Mandatory Access Control and Role-Based Access Control, and use a case study to demonstrate that no single one of them is sufficient in a federated healthcare environment. We then show how the required level of data security can be achieved through a judicious combination of all three mechanisms.
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