How should hospitals handle the use of sharing credentials to access sensitive information, especially in critical situations?

Question

Most organizations today hold individuals accountable for their actions on systems and networks by unique user IDs and passwords. However, imagine working in a hospital environment where access to sensitive information is done frequently by many individuals and also used in emergency/extraordinary circumstances. For users that share credentials, how does one enforce accountability while also being able to retrieve patient information without having to log on and off, especially in critical scenarios?

Answer 1

The ER model:

• Everybody gets a proximity card (preferably the active kind that can't be passively copied).
• The nurses' desk has a number of active but unissued cards in envelopes.
• Authentication is single factor; a valid card is valid access.
• Sessions log-off from inactivity or manual action. Card logons should be fast enough that nobody feels bothered.

Security comes from control of cards. A nursing manager can be in charge of associating a card with a new cardholder and deactivating their old or broken card. Availability comes from the fact that any employee can quickly get a new card. Accountability comes from ensuring that cards are quickly associated with employees.

---

See also: http://healthcareit.stackexchange.com/q/254/37

Answer 2

This is really quite a bad idea. One of the fundamental methods of auditing access we have is by means of what we like to call "User Attribution". Meaning, being able to attribute actions to a specific user. While this is by no means perfect, since accounts can be compromised, logs can be falsified, or account credentials can be shared, it is still one of the best tools we have. Intentionally using shared accounts prevents us from having any trust in the audit logs.