Cataloging and Comparing Logging Mechanism Specifications for Electronic Health Record Systems

Electronic health record (EHR) systems must log all transactions with protected health information (PHI) to deter unauthorized behavior and prevent users from denying that they created, read, updated, or deleted PHI. However, a plethora of standardization and governing organizations publish documentation (such as standards, suggestions, and requirements) to outline transactions that should be logged and the data that should be captured for each log entry. The objective of this research is to guide the design of electronic health record systems by cataloging suggested information that should be captured by logging mechanisms from both healthcare and non-healthcare documentation. In this paper, we focus on three types of information: data transactions, security events, and log entry content. We collect a set of ten healthcare-related and six nonhealthcare related documents that contain specifications for logging mechanisms. From these 16 sources, we catalog 11 data transactions, 77 security events, and 22 data elements for log entry content. Overall, we identify 14 security events and 2 data elements for log entry content that are not explicitly addressed by healthcare documents. We found that developers must consider 13 of the 16 documents to extract 100% of the security events and log entry content cataloged.