Governments around the world are
promoting and standardizing the digitization of patient information in the
health care sector – developers need to find an easy solution to implement
these new standards and ensure that this information stays private and secure.
Specifically, we will look at how
the United States has implemented certain regulations that obligate health care
actors to add new features to their applications within a certain time frame; this
requires a solution that meets standards across the board and is easy to
implement even in existing applications
Important features required by
these regulations include:
- Securing data
- Auditing features
- Restricting permissions to a need to know basis
Visual Guard is a
comprehensive solution for access control in .NET applications from Novalys. It combines
authentication, permissions and auditing features in the same tool. A number of
Visual Guard clients are public and private health care actors.
This article demonstrates how Visual Guard has been able to help
meet the strict criteria of health regulations in the United States. It will
look at why two major health care actors have integrated Visual Guard into
A system developed for the
health care industry needs to be flexible, modular and scalable to meet the
security policy of multiple public and private actors. It needs to filter patient
information into a need to know basis and protect it from any extraneous forces.
A custom in-house access control system can be implemented into a health
care application; but, such a solution is
usually very complex, time consuming and costly to build, maintain and update. With
the strict timelines set by government agencies for the implementation of
health care regulations, these deadlines can impose heavy constraints on development
and testing time.
"I'm not writing an additional user management system. I'm tired of it."
A U.S. State Health Care Department developer now using Visual Guard.
"I'm not writing an additional user management system. I'm
tired of it." is something heard often by developers who have gone on to choose
Visual Guard as a solution. Visual Guard is an access control system that
combines user account management, permissions and audit for one or multiple
applications. It is easily integrated into most
application architectures (.NET 2.0 and above, C#, vb.net, asp.net, Winforms,
WCF, WPF, Silverlight, MVC3, MVC4) and can be implemented in four easy steps
(see below) with no need to do a full development cycle each time the
application needs to be maintained. Repetitive actions such as administering
permissions throughout the application can be done quickly and easily by
Visual Guard has a number of clients in the health care
industry in the United States and Europe, including Federal and State Departments
of Health and private actors such as labs and hospitals that specifically chose
Visual Guard as their solution because of the flexibility and ease of
implementing and using it within their application.
American Health Care Regulations (HIPAA, HITECH,
There are a number of regulations that need to be met by
public and private actors in the health care industry. In this article we will
focus on the U.S. Health Insurance
Portability and Accountability Act of 1996, (HIPAA). It provides advice and guidelines
for patient health data, including its encoding, privacy, security, integrity,
and availability. It offers a set of principles to be met by any health care industry
actor, public or private, that transmits electronic billing or related
information to insurance companies (most notably Medicaid and Medicare) no
matter how minimal the services provided are. All
the data, processes, and systems throughout the organization are subject to
Starting in 2015, hospitals and doctors will be subject to
financial penalties under Medicare if they are not using electronic health
records. Recently, HIPAA guidelines have been additionally reinforced through
the Health Information Technology for Economic and Clinical Health Act
(HITECH). This is meant to promote and expand the adoption of health
information technology. HITECH extends the penalties for HIPAA security breaches
to private associates of covered entities and has newly updated civil and
criminal penalties to business associates.
There are a number of other standards that regulate
applications related to health care data. Both federal and state standards
exist. Generally, the most stringent standard, whether it is state or federal
supersedes less strict security and privacy standards. For HIPPA, state laws
take effect where there are no HIPPA provisions or if there is an exception
Health care application
standards are regularly updated to meet with changing technological
environments. MITA 3.0 (Medicaid Information Technology Architecture) was
recently released. It takes into account enacted legislation such as HITECH,
the Children’s Health Insurance Program Reauthorization Act (CHIPRA), and the
Affordable Care Act (ACA); emerging technologies such as cloud computing are
A list of
regulations from the Centers for Medicare and Medicaid Services can be found here.
complies with a number of federal and state health care regulations.
"Losing an accreditation is worse than receiving a fine."
New Century Health Director of Systems Development
Fines are far from the only reason meeting these standards
is important. It can take months even years to meet the standards required and
get accredited by a recognized institution.
Receiving full accreditation
status provides assurance to patients, physicians, payers, health plans,
employers and regulatory agencies that an organization’s practices are
consistent with national standards.
Visual Guard in the Health Care Industry
The State Health Department application that Visual Guard
secures is a project that ensures citizens are eligible for health care
programs and helps them to enroll. It allows citizens to fill in an
application, for that information to be verified and to see whether they are
eligible or not. The data is then sent on to the appropriate services. It also
allows users to renew/update their Medicaid application. The project deadline
is set by Medicaid and CHIP (Children's Health Insurance Program).
Another customer, New Century Health, has a provider portal
– a custom online portal that provides mainly pre-authorization for oncology
treatment requests through various clinical review and approval processes. It
is a collaboration platform that is used by physicians, health insurance organizations
and employees within NCH.
We will see in the rest of
this article how Visual Guard’s modularity allows for simple changes to permission
and security structures in applications. Visual Guard helps organizations to
easily meet changing standards such as securing applications deployed to the
Protect sensitive data
requires that data be securely guarded. Systems need to:
- "Protect against any reasonably anticipated threats or hazards to
the security of such information. This specification is a reasonable and
appropriate safeguard in its environment, when analyzed with reference to the
likely contribution to protecting the entity's electronic protected health
- "Protect against any reasonably anticipated uses or disclosures
of such information that are not permitted or required under subpart E of this
Stopping unauthorized access to private data
Visual Guard has created a system that provides
safeguards against the most common types of attacks, some examples are:
- Encrypts sensitive data like passwords. A sophisticated Password
Policy can be implemented to protect against password cracking
- Protects against DNS attacks.
- Blocks illegally giving supplementary access rights to user
- Supports SSL/HTTPS protocols and encryption of communications
between the browser and the web server…)
- Protects against the capture of data packets to find passwords or
security tokens in transit over the network.
- Pre-arms the administration console against SQL injections
- Security data is unreadable by direct SQL access. Visual Guard
requires a secured connection via the SaaS application or via the
administration interface to read and modify this data.
To read more about Visual Guard security:
How Visual Guard protects against security breaches
Manage Administrative Permissions
HIPPA requires organizations
to define what level of access each employee has to the organization's
software, based on the role the employee holds within the organization. This is
also applied to any third parties that have been given access to the
For example, someone in the accounting department may
require information like address and billing procedures for every
client the organization charges. But this person does not need, and should not
be able to access patient’s case information. Therefore, a system that can
define very specific roles and access levels in your software package and that
allows customization is needed. This can be tedious to develop, and to
maintain. As an access control system, Visual Guard allows for easy management of
permission sets. Employees can easily and securely be given, edited or have
taken away specific access rights to patient information.
"A physician’s primary goal is to give treatment not to remember their passwords" New Century Health Director of Systems Development
Health care actors need to
centralize permissions, as they usually use an in-house application that will
be accessed by several entities of a large organization, or various
organizations/companies. Such is the case of Visual Guard’s client, New Century
Health – whose online portal allows insurance companies, doctors and patients
to only access pertinent information.
Breaking the development cycle
The majority of projects write
application code to define how to apply user permissions. For example,
according to the role of the user, this code will deactivate a menu, hide a
control, filter a list of data…
As a result, to change the application
security (adding new restrictions, for example), there is no need to perform a
full development cycle (design, coding, test, deployment).
Visual Guard has developed an innovative
technology to eliminate these inconveniences and completely separate security
from business logic:
- Visual Guard defines permissions and stores them in
its security database.
- When the application is in production, Visual Guard
loads the user's permissions from the security database and dynamically applies
them. So, there is no security code in the application.
This solution has the following benefits:
- Agility: Update security rules in minutes, even when the
application is in production.
- Maintenance costs: No need for changes in the code when security
is updated. Avoid a complete development cycle and have a code easier to
- Implementation: Integration is simple – no need to adapt your
application. This technology supports all existing .NET applications.
- Flexibility: This system supports all types of
permissions/restrictions in the application.
Each client can be assigned to a
group, and their internal structure is replicated through the creation of
sub-groups. The same security system is used for all clients, but each client
will have administration rights for their users only.
Have someone non-technical administer permissions
Visual Guard allows the giving of
privileges to an administrator so that they can manage users and give roles for
Administration privileges can
also be limited to a group of users. In this case, the administrator can only
see and manage the users in their group.
When working with a multi-tenant
application, it is recommended to name at least one administrator per tenant,
and to limit their administration rights to that tenant.
Example 1: you can name an
administrator for each tenant
However, Visual Guard can do much more: it can limit administration
permissions to any level of the group hierarchy. This system offers a great
deal of flexibility for the distribution of administration rights in any
entities within each tenant.
Example 2: you can limit
administration to a sub-group inside a tenant
Combine multiple criteria to limit administration permissions:
- As shown above, these permissions can be limited to certain
groups of users
- These permissions can also be limited to certain applications
- Limit them to certain administration operations (for example, the
administrator can create users and give them Roles, but cannot define Roles)
application is being accessed by several entities whether inside the
organization or outside, such as insurance companies, it is important to be
able to see who has accessed what and to ensure that these rights are not being
abused. New Century Health has a portal designed to be accessed by employees,
patients and insurance related personnel - each group has access to their
Example 3: you can define
several administration levels in each tenant
Audit Access to Sensitive Data
HIPAA requires that
organizations keep an audit log of who did what in the software package. An
organization must be able to track when a user accessed each record and if they
edited anything within the record. It also specifies that users are only able
to access the information that is required for them to do their job.
HITECH requires HIPAA covered entities to report data breaches
affecting 500 or more individuals to the Department of Health and Human
Services (HHS) and the media, in addition to notifying the affected
As most companies that fall under HIPAA standards are using
self-hired external auditors, it is important that they are able to access all
the information necessary to ensure that the regulations are being met and that
the application is HIPAA certified.
Easily seeing who has accessed what part of a patient’s
information is therefore essential for any application in the health care
- Generate Access Control Reports: Visual Guard administrators and
auditors can generate reports based on the current security data (users,
groups, roles, permissions...)
- Logging and Auditing of End-user operations: Save all sensitive
operations users have performed in applications secured by Visual Guard. You
can then generate reports on these operations (who has done what, when, etc...)
- Logging and Auditing of Administrator operations: Save all
operations Visual Guard administrators have performed (create accounts, give
Improve Team Efficiency
"I think I’m saving 50% of time" said
one of NCH’s developers, as with Visual Guard he has reduced such menial tasks
like resetting passwords.
"I think I’m saving 50% of time" New Century Health Director of Systems Development
The administration interface is as easily deployable as the
application itself, enabling one to distribute administration rights in a way
that is very flexible. Each administrator is able to access the administration
features, no matter where they are or their technical skill.
Visual Guard will
provide you with a user administration console in both winform and webform. As
an alternative Visual Guard also offers a Custom Administration User Interface:
- A custom ASP.NET or WCF/Silverlight administration interface can
be developed and deployed as a separate administration console.
- You can integrate admin control directly into an application. Visual
Guard APIs allow all necessary administration operations. These APIs are
secured as described above. They allow, in particular, managing the tenants and
delegating the administration restrictions to each tenant.
See more information on the APIs here.
experience by providing Single Sign-On features (SSO)
A user-friendly access control system ensures that the
technical team can concentrate on development.
With Visual Guard:
Simplifying security implementation –Visual Guard
in 4 steps
"Simple, robust, full featured client" New Century Health Director of Systems Development
The time factor is critical for a number of Visual Guard’s
clients. They have strict deadlines to put an application into production. The
State Department of Health using Visual Guard has less than a year to develop
the app and implement the corresponding security.
Integrating Visual Guard is a simple process. Below is an
example of how easy it can be to integrate Visual Guard in a .NET application
in just 4 steps:
- Adding the Visual Guard runtime to the Visual
Studio project of your application.
- Inserting the few lines of code which will identify the user and activate the
- Creating a Visual Guard repository and
declaring your application through the administration console.
- Generating Visual Guard configuration
These steps are just an example for a .NET application, as
Visual Guard can be integrated into any application that can make HTTP
HIPAA requires that
organizations ensure patient data is available to only those who need to see
it, including the patients themselves. This availability requirement implies
that your system is functional on an ongoing basis and that
your data is backed up. It is therefore important to have not only a system
that is reliable, but also technical support that is there from inception to
implementation of the project.
and post-sales can be two very different things"…. " I had a very uniform
experience thanks to Anne" - New Century Health Director of Systems Development
As one of
Visual Guard’s users mentioned: ‘it’s better to work with a ready-to-use
solution as we are not security experts and prefer to focus on our business and
core developments, especially when a company has
already done the work for us.’
An all-in-one solution that is very modular and flexible can
fit requirements, evolve with the technology and easily adapt to regulations
changes or corporate policy updates. See for yourself how Visual Guard helps
meet health care requirements; get a trial version of Visual Guard here.