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Cookbook for Security Considerations

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Healthcare today has some of the most diverse needs with regard to sharing of data and the need to securely move patient information among systems. Within Health Level Seven (HL7) there are multiple verticals that consider messaging, structures, data models, coding and the like. Security is the common thread that connects all of them. Increasingly, healthcare organizations and technology vendors are performing assessments (threat risk assessments, privacy impact assessments, business impact assessments, etc.) to ensure installed healthcare technology will have a positive impact on healthcare delivery. These assessments, often called risk assessments, are even mandated for healthcare delivery organizations in some countries. Unfortunately, key decision makers often have difficulty understanding the relevance of the risks identified, and often overlook them when writing standards.

The Goal

This Security Risk Assessment Cookbook is intended to enable HL7 domain committees and working groups to publish standards that have taken privacy and security considerations into account. This guide introduces security risk assessments and a process to facilitate completing a security risk assessment for a specific standard. Using this process will facilitate the identification of gaps in a standard’s baseline security and privacy, allowing the working group to either update the standard on their own or to send a request to the Security Working Group for assistance in filling the gap. This will lead to standards that include privacy and security as part of their base, reducing the need to “bolt” security on later. As a result, the HL7 standards will better support patient safety and improved patient outcomes.

The Process

The formal cookbook is documented and training is available in the Resources section below. This text comes from section 2 of the cookbook document

When considering security and privacy issues associated with a standard, one must:

  1. Identify (See section 2.2)
    1. And clearly define the scope of the standard, including the baseline assumptions
    2. New threat scenarios and describe the type of impact that scenario implies
  2. Analyze (See section 2.3)
    1. The level of impact and likelihood of occurrence for each threat scenario to determine risk
    2. Prioritize these risks in order to focus on the most important ones
  3. Plan (See section 2.4)
    1. Determine mitigation strategies that should be implemented for all medium to high risk threat scenarios
  4. Track (See section 2.5)
    1. Assess the effect of the application of the mitigation strategies
    2. Reassess the risks by going through steps 2 and 3 until all medium and high risk threat scenarios have been addressed
  5. Document all security considerations (See section 2.6)

Resources

Do NOT use this tool :-)

Examples of Risk Assessment Spreadsheets

  • SAML use in CCOW -- spreadsheet not yet published
  • CDA-Consent -- spreadsheet not yet published
  • PASS - Accounting of Disclosures Service -- spreadsheet not yet published