Risk Assessment of Electronic Health Records

Risk management plays an important role in theimpact need to be estimated and the vulnerability
implementation of information security, and is oneof an asset towards a threat has to be evaluated
of the requirements that the ISO/IEC 27001[1]as well.
security standard sets for certification. Moreover,The following is an example of threats identified
parties involved in the handling of personalfor a couple of assets:
information are legally required to prepare risk· Reputation of EHR
assessments and to review such assessments on· Careless communication of information to
a regular basis.unauthorized recipient
Health care computer systems and Electronic· Adverse publicity in media
Health Records (EHRs) can contain highly critical· Loss of availability to authorized users
information, including personal and sensitive· Physical and logical components of the system
information that fall under the act and regulations· Traffic overloading
on the protection and processing of personal data.· Technical failure of network components
At the same time there is a great demand on· Malicious software (e.g. viruses)
having EHRs easily accessible for health care· Illegal use of software
providers. Privacy concerns need to be addressed· Network access by unauthorized users
with adequate controls to minimize risk of misuse1.1.4. Risk Evaluation and Risk Treatment
and accidental disclosure.From the evaluated assets and threats it is
When preparing a risk assessment, it is importantpossible to calculate the estimated risk which is
to use a systematic method to assess the risk,here called base security risk. The base security
i.e. a method that ensures that another personrisk represents the risk before any mitigating
performing the same risk assessment reachescontrols have been implemented. At this point it is
the same conclusions.important to evaluate the risk and compare it
The following subparagraphs describe awith the risk criteria decided upon establishing the
methodology that is standardized and incontext. The risk criteria decision and the context
accordance with the ISO/IEC 27005:2008[2]may be revisited and given more detail since at
guidelines for information security riskthis point there is more knowledge about the
management. This methodology helps theidentified risks. It should be determined whether
assessor to take into account all aspects of thethe risks are acceptable or require treatment.
risk assessment requirements of the ISO/IECOnce the risks have been evaluated it should be
27001 security standard.identified and evaluated which risk treatment
1.1. Methodologyoptions to use for those risks that stand out of
Risk assessment is performed in a methodologicalthe risk criteria. The possible actions include
way, according to the ISO/IEC 27001 standard.reducing risks by implementing appropriate
1.1.1. Define the Scope and Criteriacontrols, accepting risks providing they clearly
The first step when performing a risksatisfy the policy and criteria for accepting risks,
assessment is context establishment, whichavoiding risks and transferring risks to other
involves setting the basic risk criteria, defining theparties such as insurers.
scope and boundaries and establishing theFor risks where the treatment option selected is
appropriate organization operating the informationreducing risk then the appropriate and justified
security risk management. The scope can be thecontrols should be selected as mitigating controls.
whole business or a part of it. In the case of theThe selection should take account of the risk
EHRs the scope should cover the whole operation,acceptance criteria as well as legal, regulatory and
but could be handled in more manageable parts ifcontractual requirements. In general, controls may
it is ensured that nothing is left out. The basic riskprovide one or more of the following types of
criteria should state the minimum level of risk, i.e.protection: correction, elimination, prevention,
what is the acceptable risk level.impact minimization, deterrence, detection,
1.1.2. Identify Assets and Their Valuerecovery, monitoring and awareness. The
The next step is to identify the informationimplementation status of each control is then
assets within the scope. An information asset isdetermined and a justification for the status
any information of value to an organization and itsrecorded.
operation. Information assets, like other assets ofThe following is an example of selected controls
a company, must be protected to ensure thatfor a couple of the risks previously identified as
the company's operation meets expectations, andan example:
to ensure that there is no discontinuity in· Reputation of EHR
operations. All the information assets of the· Careless communication of information to
operation must be registered when informationunauthorized recipient
security is implemented. These assets can be· A.5.1.1 Information security policy documented
either intangible, or tangible. Tangible assets are· A.6.1.5 Confidentiality agreements
such as housing, computer equipment and· A.8.2.2 Information security awareness,
furniture. Intangible assets include businesseducation, and training
connections, reputation, procedures, services,· Physical and logical components of the system
knowledge and human resources. The asset value· Malicious software (e.g. viruses)
to the operation has to be assessed and as· A.10.4.1 Controls against malicious code
according to ISO/IEC 27001 the confidentiality,· A.10.6.1 Network security management
integrity and availability must be assessed as well.· Illegal use of software
For each asset it is important and a requirement· A.8.1.1 Roles and responsibilities
from the ISO/IEC 27001 standard to identify an· A.8.2.3 Disciplinary process
owner of all assets. According to the standard the1.2. Results
term owner identifies an individual or entity thatAfter completing the risk treatment it is important
has approved management responsibility forto obtain management approval of the proposed
controlling the production, development,residual risks and to obtain auhorization to
maintenance, use and security of the assets. Theimplement and operate the Information Security
term owner does not mean that the personManagment System.
actually has any property rights to the asset.The result of the risk management process
The following list is an example of few identifiedappears in a Statement of Applicability (SOA)
information assets for an EHR: Reputation of EHR,report that is presented as a confirmation of the
the EHR data, contracts with hosting servicestate of information security in the operation. This
providers, physical and logical components of theis important for managers, clients and regulatory
system, health care professionals, public users andbodies, e.g. the Data Protection Authority, which
the procedures of EHR usage.request information on the security matters of
1.1.3. Identify and Evaluate Threatsthe organisation or company in question. The SOA
For each asset all possible threats and theirreport shall include the following:
sources should be identified. Threats may be1. The control objectives and controls selected in
different origin or nature and may arise within orthe risk treatment process and the reasons for
from outside of the organization. Some threatstheir selection.
may affect more than one asset and the resulting2. The control objectives and controls currently
impact may differ depending on the asset. Forimplemented.
each threat the probability of occurrence and3.