Internet Draft                                              G. Marshall
Document: draft-marshall-security-audit-02.doc                  Siemens
Expires: September 2003                                      March 2003

              Security Audit and Access Accountability Message
                Data Definitions for Healthcare Applications


Status of this Memo

   This document is an Internet-Draft and is in full conformance with
   all provisions of Section 10 of RFC2026[1].

   Internet-Drafts are working documents of the Internet Engineering
   Task Force (IETF), its areas, and its working groups.  Note that
   other groups may also distribute working documents as Internet-
   Drafts.

   Internet-Drafts are draft documents valid for a maximum of six months
   and may be updated, replaced, or obsoleted by other documents at any
   time.  It is inappropriate to use Internet-Drafts as reference
   material or to cite them other than as "work in progress."

   The list of current Internet-Drafts can be accessed at
        http://www.ietf.org/ietf/1id-abstracts.txt
   The list of Internet-Draft Shadow Directories can be accessed at
        http://www.ietf.org/shadow.html.

Abstract

   To help assure healthcare privacy and security in automated systems,
   usage data need to be collected.  These data will be reviewed by
   administrative staff to verify that healthcare data is being used in
   accordance with the healthcare provider's data security requirements
   and to establish accountability for data use.  This review process is
   called security auditing.

   This document defines the format of the data to be collected and
   minimum set of attributes that need to be captured by healthcare
   application systems for subsequent use by an automation-assisted
   review application.  The data includes records of who accessed
   healthcare data, when, for what action, from where, and which
   patients' records were involved.  The data definition is an XML
   schema to be used as a reference by healthcare standards developers
   and application designers.

Conventions used in this document

   The key words "MUST", "MUST NOT", "REQUIRED", "SHALL", "SHALL NOT",
   "SHOULD", "SHOULD NOT", "RECOMMENDED",  "MAY", and "OPTIONAL" in this
   document are to be interpreted as described in RFC-2119[2].


Marshall               Expires - September 2003               [Page 1]


Security Audit and Access Accountability Message             March 2003

Table of Contents

   1. Purpose.......................................................2
   2. Scope.........................................................3
      2.1 Data Collection...........................................3
      2.2 Anticipated Data End-uses.................................4
      2.3 Conformance...............................................5
   3. Goals.........................................................5
      3.1 Effective Data Gathering..................................5
      3.2 Efficiency................................................6
   4. Trigger Events................................................7
      4.1 Security Administration...................................7
      4.2 Audit Administration and Data Access......................8
      4.3 User Access...............................................9
   5. Data Definitions.............................................11
      5.1 Event Identification.....................................11
      5.2 Active Participant Identification........................14
      5.3 Network Access Point Identification......................17
      5.4 Audit Source Identification..............................18
      5.5 Participant Object Identification........................20
   6. XML Schema Definition........................................27
   7. Security Considerations......................................36
   References......................................................36
   Draft Change History............................................37
   Acknowledgments.................................................38
   Author's Addresses..............................................38


1. Purpose

   The purposes the document fulfills are to:

   1) Define data to be communicated for evidence of compliance with,
      and violations of, a healthcare enterpriseÆs security and privacy
      policies and objectives.

      The focus of auditing in this document is to retrospectively
      detect and report security/privacy breaches, versus directly
      inhibiting access.  This includes capturing data that supports
      individual accountability for patient record creation, access,
      updates, and deletions.  It does not include real-time access
      alarm actions since there is a perception in the healthcare
      community that security measures that inhibit access may also
      inhibit effective patient care, under some circumstances.

      This document does not define healthcare security and privacy
      policies or objectives.





Marshall               Expires - September 2003               [Page 2]


Security Audit and Access Accountability Message             March 2003

   2) Depict the data that would potentially reside in a common audit
      engine or database.

      Privacy and security audit data is to be collected on each
      hardware system, and there are likely to be separate local data
      stores for system-level and application-level audits.  Collating
      these records and providing a common view û transcending hardware
      system boundaries û is seen as necessary for cost-effective
      security and privacy policy administration.

      The data definitions support such a collation, but the technical
      implementation alternatives are not covered in this document.

   3) Depict data that allows useful queries against audited events.

      Audit data, in its raw form, reflects a sequential view of system
      activity.  Useful inquiries for security and privacy
      administration need workflow, business process, organizational,
      role, and person-oriented views.  Data definitions in this
      document anticipate and support creating those views and queries,
      but do not define them.

   4) Provide a common reference standard for healthcare IT standards
      development organizations.

      This document consolidates previously disjoint viewpoints from
      Health Level 7 (HL7)[3], Digital Imaging and Communications in
      Medicine (DICOM) Working Group 14, Integrating the Healthcare
      Enterprise (IHE)[4], the ASTM International Healthcare Informatics
      Technical Committee (ASTM E31)[5], and the Joint NEMA/COCIR/JIRA
      Security and Privacy Committee[6].  It is intended as a reference
      for these four groups and other healthcare standards developers.

      By specifying an XML schema, this document anticipates extensions
      to the base schema to meet requirements of healthcare standards
      bodies and application developers.

2. Scope

2.1  Data Collection

   This document specifies audit data to be collected and communicated
   from automated systems.  It does not include non-automated processes.

   Data for events in the above categories may be selectively collected,
   based on healthcare organization policy.  This document does not
   specify any baseline or minimal policies.





Marshall               Expires - September 2003               [Page 3]


Security Audit and Access Accountability Message             March 2003

   For each audited event, this document specifies the minimal data
   requirements plus optional data for the following event categories:

   1) Security administrative events û establishing and maintaining
      security policy definitions, secured object definitions, role
      definitions, user definitions, and the relationships among them.
      In general, these events are specific to the administrative
      applications.

   2) Audit access events û reflecting special protections implemented
      for the audit trail itself.

   3) Security-mediated events û recording entity identification and
      authentication, data access, function access, nonrepudiation,
      cryptographic operations, and data import/export for messages and
      reports.  In general, these events are generic to all protected
      resources, without regard to the application data content.

   4) Patient care data events û documenting what was done, by whom,
      using which resources, from what access points, and to whose
      medical data.  In general, these audits are application-specific
      since they require knowledge of the application data content.

   Security subsystems found in most system infrastructures include a
   capability to capture system-level security relevant events like
   logon and security object accesses.  This document does not preclude
   such functions being enabled to record and supply the data defined in
   this document, but transformation to conform to the common XML schema
   definition will be required.

   Application-level events, such as patient record access, are not
   captured by system-level security audits.  The defined data support
   applicationsÆ record access auditing for healthcare institutional
   security and privacy assurance plus related policy administration
   functions.

   System-local data definitions for collection and storage of audit
   data, prior to transformation to a common schema and transmission to
   a common repository, are not included in this document.

2.2  Anticipated Data End-uses

   This document anticipates, but does not define, end-uses for the data
   collected.

   The typical healthcare IT environment contains many systems from
   various vendors and developers who have not implemented common or
   interoperable security administrative functions.  This document
   anticipates a requirement to transmit data from several unrelated



Marshall               Expires - September 2003               [Page 4]


Security Audit and Access Accountability Message             March 2003

   systems to a common repository.  It also anticipates the aggregated
   data may then be queried and viewed an a variety of ways.

   There are distinctions of detail granularity, specificity, and
   frequency between audit data required for surveillance versus
   forensic purposes.  While some surveillance data may useful for
   forensics, the scope of this document is limited to surveillance.

   This document does not address access real-time policy violation
   alarm actions.  There is a perception in the healthcare community
   that security measures that inhibit access may also inhibit effective
   patient care, under some circumstances.

   This document does not define any data for patient care consents or
   patients' permissions for data disclosure.  It is conceivable that
   the proposed audit data could be input to such applications, however,
   assuming strict access controls for audit data have been established.

   This document does not define system-specific or application-specific
   data that may be collected and reported in addition to the defined
   elements.  For example, it is conceivable that audit mechanisms may
   be useful for tracking financial or payroll transactions.  At the
   same time, this document does not preclude extending the XML schema
   to incorporate additional data.

   There is a potential requirement for a set of administrative messages
   to be sent from a central source to each participating system to
   uniformly specify, control, enable, or disable audit data collection.
   Such messages are not included in this document.

2.3  Conformance

   This document does not include any definitions of conformance
   practices.  Instead, it anticipates that standards development
   organizations that reference this document may specify their own
   conformance requirements.

3. Goals

3.1  Effective Data Gathering

   The process of assuring that security policies are implemented
   correctly is essential to information security administration.  It is
   a set of interrelated tasks all aimed at maintaining an acceptable
   level of confidence that security protections are, in fact, working
   as intended.  These tasks are assisted by data from automated
   instrumentation of system and application functions.

   Data gathered from a secured environment is used to accumulate
   evidence that security systems are working as intended and to detect


Marshall               Expires - September 2003               [Page 5]


Security Audit and Access Accountability Message             March 2003

   incidents and patterns of misuse for further actions.  Once messages
   have been collected, various reports may be created in support of
   security assurance and administration information requirements.

   When a site runs multiple heterogeneous applications, each
   application system may have its own security mechanisms - user logon,
   roles, access right permissions and restrictions, etc.  Each
   application system also has its own security log file that records
   security relevant events, e.g., login, data access, and updates to
   the security policy databases.  A system administrator or security
   auditor must examine each of these log files to find security
   relevant incidents.  Not only is it difficult to examine each of
   these files separately, the format and contents of each file may be
   confusingly different.

   Resolving these issues requires a framework to:

   -  Maximize interoperability and the meaningfulness of data across
      applications and sites
   -  Minimize ambiguity among heterogeneous systems
   -  Simplify and limits costs for administrative audit tasks.

3.2  Efficiency

   One of the leading concerns about auditing is the potential volume of
   data gathering and its impact on application system performance.
   Although this document does not prescribe specific implementations or
   strategies, the following are meant as informative guidance for
   development.

   1) Audits should be created for transactions or record-access, not
      for individual attribute-level changes to data.

   2) This document does not discourage locally optimized gathering of
      audit data on each application system.  Instead, it anticipates
      periodic gathering and transmission of data to a common
      repository.  This common repository would be optimized for after-
      the-fact audit queries and reporting, thus unburdening each
      application system of those responsibilities.  It is also
      important to keep the message size compact so that audit data will
      not penalize normal network operation.

   3) On each application system, a variety of policy-based methods
      could be employed to optimize data gathering and storage, e.g.,
      selective auditing of only events defined as important plus
      workload buffering and balancing.  Data gathering itself should be
      stateless to avoid the overhead of transactional semantics.  In
      addition, prior to transmission, some summarization of repeated
      events would reduce the number of messages.  Audit data storage



Marshall               Expires - September 2003               [Page 6]


Security Audit and Access Accountability Message             March 2003

      and integrity on each application system need only be scaled for
      relatively low-volume and short-duration requirements.

   4) Leveraging existing data collection should be considered.  For
      example, it is common is some systemsÆ designs to provide a
      transaction log for data reconstruction in event of database loss.
      Collecting audit data within this subsystem could reduce impact on
      system performance.

   5) A security audit repository would gather all audit message data
      from the different applications in one database with one standard
      structure.  This would allow easier evaluation and querying.  Once
      a suspicious pattern has been found in the audit log repository,
      investigation might proceed with more detail in the application
      specific audit log.  The presence of a common repository also
      simplifies and streamlines the implementation of policies for
      audit data storage, integrity, retention, and destruction.

4. Trigger Events

   The following identifies trigger events for generating audit
   messages.  These should be viewed as application-level events.  For
   those events arising in the security infrastructure the "minimal" and
   "basic" level of auditing as outlined in the Common Criteria[7]
   should be used as a reference standard.

4.1  Security Administration

   This group includes all actions that create and maintain definitions
   for securing data, functions, and the associated access policies.
   For each trigger type, the creation, update or amendment, and
   activation or deactivation are auditable.

4.1.1 Data Definition

   This includes data definitions for data sets, data groups, or classes
   plus the atomic data elements or attributes.

4.1.2 Function Definition

   This includes, for example, application function definitions for
   patient management and clinical processes, registry of business
   objects and methods, program creation and maintenance, etc.

4.1.3 Domain Definition

   This includes all activities that create or modify security domains
   according to various organizational categories such as entity-wide,
   institutional, departmental, etc.:



Marshall               Expires - September 2003               [Page 7]


Security Audit and Access Accountability Message             March 2003

4.1.4 Classification Definition

   This includes all activities that create or modify security
   categories or groupings for functions and data such as patient
   management, nursing, clinical, etc.

4.1.5 Permission Definition

   This includes all activities that create or modify the allowable
   access permissions associated with functions and data, such as
   create, read, update, delete, and execution of specific functional
   units or object access or manipulation methods.

4.1.6 Role Definition

   This includes all activities that create or modify security roles
   according to various task-grouping categories such as security
   administration, admissions desk, nurses, physicians, clinical
   specialists, etc.  It also includes the association of permissions
   with roles for role-based access control.

4.1.7 User Definition

   This includes all activities that create or modify user accounts.  It
   also includes the association of roles with users for role-based
   access control, or permissions with users for user-based access
   control.

4.2  Audit Administration and Data Access

   This category includes all actions that determine the collection and
   availability of audit data.

4.2.1 Audit Enable or Disable

   This reflects a basic policy decision that an event should or should
   not be audited.  Some, but not necessarily all, triggers or use cases
   must create an audit record.  The selection of what to audit depends
   on administrative policy decisions.  Note that, for integrity, this
   event should always be audited.

4.2.2 Audit Data Access

   This includes instances where audit data is viewed or reported for
   any purpose.  Since the audit data itself may include data protected
   by institutional privacy policies and expose the implementation of
   those policies, access to the data is highly sensitive.  This event
   should therefore always be audited.




Marshall               Expires - September 2003               [Page 8]


Security Audit and Access Accountability Message             March 2003

4.2.3 Audit Data Modify or Delete

   This includes instance where audit data is modified or deleted.  This
   is a signature event for unauthorized hostile systems access.  This
   event should therefore always be audited.

4.3  User Access

   This category includes events of access to secured data and functions
   for which audit data might be collected.

4.3.1 Sign-On

   This includes successful and unsuccessful attempts from human users
   and automated systems.

4.3.2 Sign-Off

   This includes explicit sign-off events and session abandonment
   timeouts from human users and automated systems.

4.3.3 Function Access

   This includes user invocation of application or system functions that
   have permission definitions associated with them.  Note that in a
   Discretionary Access Control environment not all functions require
   permissions, especially if their impact is benign in relation to
   policies.

   The following items enumerate audit triggers that are relevant to
   patient privacy.  Additional triggers for institutional data access,
   policies for non-care functions, and support regulatory requirements
   will need to be identified by system implementers.

4.3.3.1 Subject of Care Record Access

   This includes all functions which manipulate basic patient data:

   -  Create, e.g., demographics or patient profile
   -  Assign identifier, e.g., medical record number
   -  Update, amend
   -  Merge/unmerge, e.g., combine multiple medical records for one
      patient
   -  Import/export of data  from/to an external source, including
      printing and creation of portable media copies.







Marshall               Expires - September 2003               [Page 9]


Security Audit and Access Accountability Message             March 2003

4.3.3.2 Encounter or Visit

   This includes all functions which associate a subject of care with an
   instance of care:

   -  Create, e.g., demographics or patient profile
   -  Assign encounter identifier
   -  Per-admit
   -  Admit
   -  Update, amend

4.3.3.3 Care Protocols

   This includes all functions which associate care plans or similar
   protocols with an instance or subject of care:

   -  Schedule, initiate
   -  Update, amend
   -  Complete
   -  Cancel

4.3.3.4 Episodes or Problems

   This includes specific clinical episodes within an instance of care.
   Initiate

   -  Update, amend
   -  Resolve, complete
   -  Cancel

4.3.3.5 Orders and Order Sets

   This includes clinical or supplies orders within an instance or
   episode of care.

   -  Initiate
   -  Update, amend
   -  Complete
   -  Cancel

4.3.3.6 Health Service Event or Act

   This includes various health services scheduled and performed within
   an instance or episode of care

   -  Schedule, initiate
   -  Perform, complete
   -  Cancel




Marshall               Expires - September 2003              [Page 10]


Security Audit and Access Accountability Message             March 2003

4.3.3.7 Medications

   This includes all medication orders and administration within an
   instance or episode of care.  These are distinct from orders and
   events in the need to check for adverse interactions and to verify
   the medications prior to delivery.

   -  Order
   -  Check
   -  Cancel interactions
   -  Verify
   -  Dispense/deliver û including administration instructions
   -  Administer

4.3.3.8 Staff Assignment

   This includes staffing actions relevant to an instance or episode of
   care.

   -  Assignment of healthcare professionals, caregivers attending
      physician, residents, medical students, consultants, etc.
   -  Change in assigned role or authorization, e.g., relative to
      healthcare status change.
   -  De-assignment

5. Data Definitions

   This section defines and describes the data in the XML schema.  The
   actual XML schema definition is in section 6.

   The proposed data elements are grouped into these categories:

   1) Event Identification û what was done
   2) Active Participant Identification û by whom
   3) Network Access Point Identification û initiated from where
   4) Audit Source Identification û using which server
   5) Participant Object Identification û to what record

5.1  Event Identification

   The following data identify the name, action type, time, and
   disposition of the audited event.  There is only one set of event
   identification data per audited event.

5.1.1 Event ID

   Description

      Required



Marshall               Expires - September 2003              [Page 11]


Security Audit and Access Accountability Message             March 2003

      Identifier for a specific audited event, e.g., a menu item,
      program, rule, policy, function code, or application name, or URL.
      It identifies the performed function.

   Format / Values

      Identifier string for the function.  This should be an unambiguous
      code, unique, at least within Audit Source ID.  Examples of Event
      IDs are program name, method name, or function name.

   Rationale

      This field identifies the audited function.  For analyzing
      ôExecuteö Event Action Code audit records, this identifies the
      application function performed.

5.1.2 Event Action Code

   Description

      Optional.  Default value is "E".

      Indicator for type of action performed during the event that
      generated the audit.

   Format / Values

      Enumeration:

         Value Meaning               Examples
         ----- --------------------- ---------------------------------
           C   Create                Create a new database object such
                                     as Placing an Order.
           R   Read/View/Print/Query Display or print data such as a
                                     Doctor Census
           U   Update                Update information such as Revise
                                     Patient Information
           D   Delete                Delete items from a master file
                                     such as a Doctor Record
           E   Execute               Perform a system or application
                                     function such as logon, program
                                     execution, or use of an objectÆs
                                     method.

   Rationale

      This broadly indicates what kind of action was done on the
      Participant Object.




Marshall               Expires - September 2003              [Page 12]


Security Audit and Access Accountability Message             March 2003

   Notes

      Actions that are not enumerated above are considered an Execute of
      a specific function or object interface method or treated two or
      more distinct events.  An application action, such as an
      authorization, is a function Execute, and the Event ID should
      identify the function.  For compound actions, such as ôMove,ö
      should be audited by creating audit data for each operation û
      read, create, delete û or as an Execute of a function or method.

5.1.3 Event Date/Time

   Description

      Required

      Universal coordinated time (UTC), i.e. a date/time specification
      that is unambiguous as to local time zones.

   Format / Values

      A date/time representation that is unambiguous in conveying
      universal coordinated time (UTC)

   Rationale

      This ties an event to a specific date and time.  Security audits
      typically require a consistent time base, e.g., UTC, to eliminate
      time-zone issues arising from geographical distribution.

   Notes

      In a distributed system, some sort of common time base, e.g., an
      NTP[8]server, is a good implementation tactic.

5.1.4 Event Outcome Indicator

   Description

      Required

      Indicates whether the event succeeded or failed.

   Format / Values

      Enumeration:

      Value Meaning
       ---- ----------------------------------------------------
        0   Success


Marshall               Expires - September 2003              [Page 13]


Security Audit and Access Accountability Message             March 2003

        4   Minor failure; action restarted, e.g., invalid password
            with first retry
        8   Serious failure; action terminated, e.g., invalid
            password with excess retries
       12   Major failure; action made unavailable, e.g., user
            account disabled due to excessive invalid logon attempts

   Rationale

      Some audit events may be qualified by success or failure
      indicator.  For example, a Logon might have this flag set to a
      non-zero value to indicate why a logon attempt failed.

5.2  Active Participant Identification

   The following data identify a user for the purpose of documenting
   personal accountability for the audited event.  Optionally, the
   userÆs network access location may be specified.  There may be more
   than one user per event, e.g., in cases of actions initiated by one
   user for other users, however only one user may be the
   initiator/requestor for the event.

5.2.1 User ID

   Description

      Required

      Unique identifier for the user performing the event

   Format / Values

      Key from authentication system.  It is a unique value within the
      Audit Source ID.

   Rationale

      This field ties an audit event to a specific user.

   Notes

      For cross-system audits, especially with long retention, this user
      identifier should permanently tie an audit event to a specific
      user via a perpetually unique key.








Marshall               Expires - September 2003              [Page 14]


Security Audit and Access Accountability Message             March 2003

5.2.2 Alternative User ID

   Description

      Optional

      Alternative unique identifier for the user performing the event.

   Format / Values

      Key from authentication system.  This identifier should be one
      known to a common authentication system (e.g., single sign-on), if
      available.

   Rationale

      In some situations a user may authenticate with one identity but,
      to access a specific application system, may use a synonymous
      identify.  For example, some "single sign on" implementations will
      do this.  The alternative identifier would then be the original
      identify used for authentication, and the User ID is the one known
      to and used by the application.

5.2.3 User Name

   Description

      Optional

      The human-meaningful name for the user

   Format / Values

      Text string

   Rationale

      The User ID and Alternative User ID may be internal or otherwise
      obscure values.  This field assists the auditor in identifying the
      actual user.


5.2.4 User Is Requestor

   Description

      Optional

      Indicator that the user is or is not the requestor-actor for the
      audit event.


Marshall               Expires - September 2003              [Page 15]


Security Audit and Access Accountability Message             March 2003


   Format / Values

      Boolean, default/assumed value is "true"

   Rationale

      This value is used to distinguish between requestor-users and
      recipient-users.  For example, one person may request a report-
      output to be sent to a another user.

5.2.5 Role ID Code

   Description

      Optional, multi-valued

      Specification of the role(s) the user plays when performing the
      event, as assigned in role-based access control security

   Format / Values

      Coded value, with attribute "code" valued with the role code or
      text from authorization system.

      This may reference a standard enumeration.  For such cases the XML
      schema defines these optional attribute values:

         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system
         DisplayName    The value to be used in displays and reports
         OriginalText   Input value that was translated to the code

   Rationale

      This value ties an audited event to a userÆs role(s).  It is an
      optional value that might be used to group events for analysis by
      user functional role categories.

   Notes

      Many security systems are unable to produce this data, hence it is
      optional.

      For the common message, this identifier should be the one known to
      a common authorization system, if available.  Otherwise, it is a
      unique value within the Audit Source ID.  Consider using a



Marshall               Expires - September 2003              [Page 16]


Security Audit and Access Accountability Message             March 2003

      globally unique identifier associated with the role to avoid
      ambiguity in auditing heterogeneous systems.

      Role ID is not a substitute for personal accountability.

      Ambiguities arise from composite roles and users with multiple
      roles, i.e., which role within a composite is being used or what
      privilege was a user employing?

5.3  Network Access Point Identification

   The network access point identifies the logical network location for
   application activity.  These data are paired 1:1 with the Active
   Participant Identification data.

5.3.1 Network Access Point Type Code

   Description

      Optional

      An identifier for the type of network access point that originated
      the audit event.

   Format / Values

      Enumeration:

         Value Meaning
         ----- ----------------
           1   Machine Name
           2   IP Address
           3   Telephone Number

   Rationale

      This datum identifies the type of network access point identifier
      of the user device for the audit event.  It is an optional value
      that may be used to group events recorded on separate servers for
      analysis of access according to a network access pointÆs type.

5.3.2 Network Access Point ID

   Description

      Optional





Marshall               Expires - September 2003              [Page 17]


Security Audit and Access Accountability Message             March 2003

      An identifier for the network access point of the user device for
      the audit event.  This could be a device id, IP address, or some
      other identifier associated with a device.

   Format / Values

      Text may be constrained to only valid values for the given Network
      Access Point Type, if specified.  Recommendation is to be as
      specific as possible where multiple options are available.

   Rationale

      This datum identifies the userÆs network access point, distinct
      from the server that performed the action.  It is an optional
      value that may be used to group events recorded on separate
      servers for analysis of a specific network access pointÆs access
      across all servers.

   Note

      Network Access Point ID is not a substitute for personal
      accountability.  Internet IP addresses, in particular, are highly
      volatile and may be assigned to more than one person in a short
      time period.

   Examples

      Network Access Point ID: SMH4WC02
      Network Access Point Type: 1 = Machine Name

      Network Access Point ID: 10.10.203.42
      Network Access Point Type: 2 = IP address

      Network Access Point ID: 610-555-1212
      Network Access Point Type: 3   = Phone Number

5.4  Audit Source Identification

   The following data are required primarily for application systems and
   processes.  Since multi-tier, distributed, or composite applications
   make source identification ambiguous, this collection of fields may
   repeat for each server or process actively involved in the event.
   For example, multiple value-sets can identify participating web
   servers, application processes, and database server threads in an n-
   tier distributed application. Passive event participants, e.g., low-
   level network transports, need not be identified.






Marshall               Expires - September 2003              [Page 18]


Security Audit and Access Accountability Message             March 2003

5.4.1 Audit Enterprise Site ID

   Description

      Optional

      Logical source location within the healthcare enterprise network,
      e.g., a hospital or other provider location within a multi-entity
      provider group.

      This is configurable and defined by the application that generates
      the audit record.  It contains a unique code that identifies a
      business organization (owner of data) that is known to the
      enterprise.  The value further qualifies [disambiguates] the Audit
      Source ID.  Values may vary depending on type of business.  There
      may be levels of differentiation within the organization.

   Format / Values

      Unique identifier within the healthcare enterprise.  Null value
      when the system is uniquely identified by Audit Source ID.

   Rationale

      This value differentiates among the sites in a multi-site
      enterprise health information system.

5.4.2 Audit Source ID

   Description

      Required

      Identifier of the source where the event originated.

   Format / Values

      Unique identifier, at least within the Audit Enterprise Site ID

   Rationale

      This field ties the event to a specific source system.  It may be
      used to group events for analysis according to where the event
      occurred.

   Notes

      In some configurations, a load-balancing function distributes work
      among two or more duplicate servers.  The values defined for this



Marshall               Expires - September 2003              [Page 19]


Security Audit and Access Accountability Message             March 2003

      field thus may be considered as an source identifier for a group
      of servers rather than a specific source system.

5.4.3 Audit Source Type Code

   Description

      Optional

      Code specifying the type of source where event originated.

   Format / Values

      Enumeration:

         Value  Meaning
         -----  ------------------------------------------
           1    End-user device
           2    Web server process
           3    Application server process
           4    Database server process
           5    Security server, e.g., a domain controller
           6    ISO level 1-3 network component
           7    ISO level 4-6 operating software
           8    External source, unknown type

   Rationale

      This field indicates which type of source is identified by the
      Audit Source ID.  It is an optional value that may be used to
      group events for analysis according to the type of source where
      the event occurred.

5.5  Participant Object Identification

   The following data assist the auditing process by indicating specific
   instances of data or objects that have been accessed.

   These data are optional if the values for Event Identification,
   Active Participant Identification, and Audit Source Identification
   are sufficient to documents the entire auditable event.  In addition,
   the production audit records containing these data may be enabled or
   not, as determined by healthcare organization policy and regulatory
   requirements.







Marshall               Expires - September 2003              [Page 20]


Security Audit and Access Accountability Message             March 2003

   Because events may have more than one participant, this group should
   be considered a repeating set of values.  For example, depending on
   institutional policies and implementation choices:

   -  Two participant object value-sets can be used to identify access
      to patient data by medical record number plus the specific health
      care encounter or episode for the patient.
   -  A patient participant and his authorized representative may be
      identified concurrently.
   -  An attending physician and consulting referrals may be identified
      concurrently.
   -  All patients identified on a worklist may be identified.

5.5.1 Participant Object Type Code

   Description

      Optional

      Code for the participant object type being audited.  This value is
      distinct from the userÆs role or any user relationship to the
      participant object.

   Format / Values

      Enumeration:

         Value Meaning
         ----- -------------
           1   Person
           2   System Object
           3   Organization

   Rationale

      To describe the object being acted upon. In addition to queries on
      the subject of the action in an auditable event, it is also
      important to be able to query on the object of that action.


5.5.2 Participant Object Type Code Role

   Description

      Optional

      Code representing the functional application role of Participant
      Object being audited




Marshall               Expires - September 2003              [Page 21]


Security Audit and Access Accountability Message             March 2003

   Format / Values

      Enumeration, specific to Participant Object Type Code:

         Value Meaning              Participant Object Type Codes
         ----- -------------------- -----------------------------
           1   Patient              1 û Person
           2   Location             3 û Organization
           3   Report               2 û System Object
           4   Resource             1 û Person
                                    3 û Organization
           5   Master file          2 - System Object
           6   User                 1 û Person
           7   List                 2 - System Object
           8   Doctor               1 û Person
           9   Subscriber           3 û Organization
          10   Guarantor            1 û Person
                                    3 û Organization
          11   Security User Entity 1 - Person
                                    2 - System Object
          12   Security User Group  2 û System Object
          13   Security Resource    2 û System Object
          14   Security Granularity 2 û System Object
               Definition
          15   Provider             1 û Person
                                    3 û Organization
          16   Report Destination   2 û System Object
          17   Report Library       2 û System Object
          18   Schedule             2 û System Object
          19   Customer             3 û Organization
          20   Job                  2 - System Object
          21   Job Stream           2 - System Object
          22   Table                2 - System Object
          23   Routing Criteria     2 - System Object
          24   Query                2 û System Object

      A "Security Resource" an abstract securable object, e.g., a
      screen, interface, document, program, etc.

   Rationale

      For some audit analysis it may be necessary to indicate a more
      granular type of participant, based on the application role it
      serves.







Marshall               Expires - September 2003              [Page 22]


Security Audit and Access Accountability Message             March 2003

5.5.3 Participant Object Data Life Cycle

   Description

      Optional

      Identifier for the data life-cycle stage for the participant
      object.  This can be used to provide an audit trail for data, over
      time, as it passes through the system

   Format/Values

      Enumeration:

         Value Meaning
         ----- --------------------------------------
           1   Origination
           2   Amendment
           3   Verification
           4   Translation
           5   Access / use
           6   De-identification
           7   Aggregation, summarization, derivation
           8   Report
           9   Disclosure
          10   Receipt
          11   Archiving
          12   Destruction

   Rationale

      Institutional policies for privacy and security may optionally
      fall under different accountability rules based on data life
      cycle.  This provides a differentiating value for those cases.

5.5.4 Participant Object ID Type Code

   Description

      Required

      Describes the identifier that is contained in Participant Object
      ID.









Marshall               Expires - September 2003              [Page 23]


Security Audit and Access Accountability Message             March 2003

   Format / Values

      Coded-value enumeration, specific to Participant Object Type Code,
      using attribute-name "code":

         code Meaning                Participant Object Type Codes
         ---- ---------------------- -----------------------------
          1   Medical record number  1 û Person
          2   Patient number         1 û Person
          3   Enrollee number        1 û Person
          4   Social Security Number 1 û Person
          5   Account number         1 û Person
                                     3 û Organization
          6   Guarantor ID           1 û Person
                                     3 û Organization
          7   Report Name            2 - System Object
          8   Report Number          2 - System Object
          9   Search Criteria        2 - System Object
          10  User Identifier        1 - Person
                                     2 - System Object
          11  URI                    2 - System Object

      User Identifier and URI[9] values are intended to be used for
      security administration trigger events to identify the objects
      being acted-upon.

      This enumeration may be a coded-value reference to a standard
      enumeration, e.g., HL7 version 2 table 207.  For such cases the
      XML schema defines these optional attribute values:

         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system
         DisplayName    The value to be used in displays and reports
         OriginalText   Input value that was translated to the code

   Rationale

      Required to distinguish among various identifiers that may
      synonymously identify a participant object.


5.5.5 Participant Object ID Sensitivity

   Description

      Optional




Marshall               Expires - September 2003              [Page 24]


Security Audit and Access Accountability Message             March 2003

      Denotes policy-defined sensitivities for the Participant Object ID
      such as VIP, HIV status, mental health status, or similar topics.

   Format / Values

      Values are institution and implementation defined text-strings.

5.5.6 Participant Object ID

   Description

      Required

      Identifies a specific instance of the participant object

   Format / Values

      Text.  Value format depends on Participant Object Type Code and
      the Participant Object ID Type Code.

   Rationale

      This field identifies a specific instance of an object, such as a
      patient, to detect/track privacy and security issues.

   Notes

      Consider this to be the primary unique identifier key for the
      object, so it may be a composite data field as implemented.

5.5.7 Participant Object Name

      Description

      Optional

      An instance-specific descriptor of the Participant Object ID
      audited, such as a personÆs name

   Format / Values

      Free text

   Rationale

      This field may be used in a query/report to identify audit events
      for a specific person, especially if multiple synonymous
      Participant Object IDs have been used for that person.




Marshall               Expires - September 2003              [Page 25]


Security Audit and Access Accountability Message             March 2003

5.5.8 Participant Object Query String

   Description

      Optional

      The actual query string for a query-type participant object.

   Format / Values

      Base 64 encoded data

   Rationale

      For query events it may be necessary to capture the actual query
      string input the query process in order to identify the specific
      event.  It is a data blob, relative to auditing, that may be
      decoded and interpreted by downstream audit analysis processing


































Marshall               Expires - September 2003              [Page 26]


Security Audit and Access Accountability Message             March 2003

6. XML Schema Definition

   <xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema"
   elementFormDefault="qualified" attributeFormDefault="unqualified">
    <xs:element name="AuditMessage">
     <xs:complexType>
      <xs:sequence>
       <xs:element name="EventIdentification"
   type="EventIdentificationType"/>
       <xs:element name="AuditSourceIdentification"
   type="AuditSourceIdentificationType" maxOccurs="unbounded"/>
       <xs:element name="ActiveParticipant" maxOccurs="unbounded">
        <xs:complexType>
         <xs:complexContent>
          <xs:extension base="ActiveParticipantType"/>
         </xs:complexContent>
        </xs:complexType>
       </xs:element>
       <xs:element name="ParticipantObjectIdentification"
   type="ParticipantObjectIdentificationType" minOccurs="0"
   maxOccurs="unbounded"/>
      </xs:sequence>
     </xs:complexType>
    </xs:element>
    <xs:complexType name="EventIdentificationType">
     <xs:attribute name="EventID" type="xs:string" use="required"/>
     <xs:attribute name="EventActionCode" use="optional" default="E">
      <xs:simpleType>
       <xs:restriction base="xs:string">
        <xs:enumeration value="C">
         <xs:annotation>
          <xs:appinfo>Create</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="R">
         <xs:annotation>
          <xs:appinfo>Read</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="U">
         <xs:annotation>
          <xs:appinfo>Update</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="D">
         <xs:annotation>
          <xs:appinfo>Delete</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="E">


Marshall               Expires - September 2003              [Page 27]


Security Audit and Access Accountability Message             March 2003

         <xs:annotation>
          <xs:documentation>Execute</xs:documentation>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
     <xs:attribute name="EventDateTime" type="xs:dateTime"
   use="required"/>
     <xs:attribute name="EventOutcomeIndicator" use="required">
      <xs:simpleType>
       <xs:restriction base="xs:integer">
        <xs:enumeration value="0">
         <xs:annotation>
          <xs:appinfo>Success</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="4">
         <xs:annotation>
          <xs:appinfo>Minor failure</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="8">
         <xs:annotation>
          <xs:appinfo>Serious failure</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="12">
         <xs:annotation>
          <xs:appinfo>Major failure; action made unavailable
             </xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
    </xs:complexType>
    <xs:complexType name="AuditSourceIdentificationType">
     <xs:attribute name="AuditEnterpriseSiteID" type="xs:string"
   use="optional"/>
     <xs:attribute name="AuditSourceID" type="xs:string"
   use="required"/>
     <xs:attribute name="AuditSourceTypeCode" use="optional">
      <xs:simpleType>
       <xs:restriction base="xs:unsignedByte">
        <xs:enumeration value="1">
         <xs:annotation>
          <xs:appinfo>End-user device</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>


Marshall               Expires - September 2003              [Page 28]


Security Audit and Access Accountability Message             March 2003

        <xs:enumeration value="2">
         <xs:annotation>
          <xs:appinfo>Web server process</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="3">
         <xs:annotation>
          <xs:appinfo>Application server process</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="4">
         <xs:annotation>
          <xs:appinfo>Database server process</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="5">
         <xs:annotation>
          <xs:appinfo>Security server, e.g., a domain controller
            </xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="6">
         <xs:annotation>
          <xs:documentation>ISO level 1-3 network component
             </xs:documentation>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="7">
         <xs:annotation>
          <xs:appinfo>ISO level 4-6 operating software</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="8">
         <xs:annotation>
          <xs:appinfo>External source, unknown type</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
    </xs:complexType>
    <xs:complexType name="ActiveParticipantType">
     <xs:sequence minOccurs="0">
      <xs:element name="RoleIDCode" minOccurs="0" maxOccurs="unbounded">
       <xs:complexType>
        <xs:complexContent>
         <xs:restriction base="CodedValueType">
          <xs:attribute name="code" use="required"/>
         </xs:restriction>
        </xs:complexContent>


Marshall               Expires - September 2003              [Page 29]


Security Audit and Access Accountability Message             March 2003

       </xs:complexType>
      </xs:element>
     </xs:sequence>
     <xs:attribute name="UserID" type="xs:string" use="required"/>
     <xs:attribute name="AlternativeUserID" type="xs:string"
   use="optional"/>
     <xs:attribute name="UserName" type="xs:string" use="optional"/>
     <xs:attribute name="UserIsRequestor" type="xs:boolean"
   use="optional" default="true"/>
     <xs:attribute name="NetworkAccessPointID" type="xs:string"
   use="optional"/>
     <xs:attribute name="NetworkAccessPointTypeCode" use="optional">
      <xs:simpleType>
       <xs:restriction base="xs:unsignedByte">
        <xs:enumeration value="1">
         <xs:annotation>
          <xs:appinfo>Machine Name</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="2">
         <xs:annotation>
          <xs:appinfo>IP Address</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="3">
         <xs:annotation>
          <xs:appinfo>Telephone Number</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
    </xs:complexType>
    <xs:complexType name="ParticipantObjectIdentificationType">
     <xs:sequence>
      <xs:element name="ParticpantObjectIDTypeCode"
   type="CodedValueType"/>
      <xs:choice minOccurs="0">
       <xs:element name="ParticipantObjectName" type="xs:string"
   minOccurs="0"/>
       <xs:element name="ParticipantObjectQueryString"
   type="xs:base64Binary" minOccurs="0"/>
      </xs:choice>
     </xs:sequence>
     <xs:attribute name="ParticipantObjectID" type="xs:string"
   use="required"/>
     <xs:attribute name="ParticipantObjectTypeCode" use="optional">
      <xs:simpleType>
       <xs:restriction base="xs:unsignedByte">
        <xs:enumeration value="1">


Marshall               Expires - September 2003              [Page 30]


Security Audit and Access Accountability Message             March 2003

         <xs:annotation>
          <xs:appinfo>Person</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="2">
         <xs:annotation>
          <xs:appinfo>System object</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="3">
         <xs:annotation>
          <xs:appinfo>Organization</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
     <xs:attribute name="ParticipantObjectTypeCodeRole" use="optional">
      <xs:simpleType>
       <xs:restriction base="xs:unsignedByte">
        <xs:enumeration value="1">
         <xs:annotation>
          <xs:appinfo>Patient</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="2">
         <xs:annotation>
          <xs:appinfo>Location</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="3">
         <xs:annotation>
          <xs:appinfo> Report</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="4">
         <xs:annotation>
          <xs:appinfo>Resource</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="5">
         <xs:annotation>
          <xs:appinfo>Master file</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="6">
         <xs:annotation>
          <xs:appinfo>User</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>


Marshall               Expires - September 2003              [Page 31]


Security Audit and Access Accountability Message             March 2003

        <xs:enumeration value="7">
         <xs:annotation>
          <xs:appinfo>List</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="8">
         <xs:annotation>
          <xs:appinfo>Doctor</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="9">
         <xs:annotation>
          <xs:appinfo>Subscriber</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="10">
         <xs:annotation>
          <xs:appinfo>Guarantor</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="11">
         <xs:annotation>
          <xs:appinfo>Security User Entity</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="12">
         <xs:annotation>
          <xs:appinfo>Security User Group</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="13">
         <xs:annotation>
          <xs:appinfo>Security Resource</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="14">
         <xs:annotation>
          <xs:appinfo>Security Granualarity Definition</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="15">
         <xs:annotation>
          <xs:appinfo>Provider</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="16">
         <xs:annotation>
          <xs:appinfo>Report Destination</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>


Marshall               Expires - September 2003              [Page 32]


Security Audit and Access Accountability Message             March 2003

        <xs:enumeration value="17">
         <xs:annotation>
          <xs:appinfo>Report Library</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="18">
         <xs:annotation>
          <xs:appinfo>Schedule</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="19">
         <xs:annotation>
          <xs:appinfo>Customer</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="20">
         <xs:annotation>
          <xs:appinfo>Job</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="21">
         <xs:annotation>
          <xs:appinfo>Job Stream</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="22">
         <xs:annotation>
          <xs:appinfo>Table</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="23">
         <xs:annotation>
          <xs:appinfo>Routing Criteria</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="24">
         <xs:annotation>
          <xs:appinfo>Query</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
     <xs:attribute name="ParticipantObjectDataLifeCycle" use="optional">
      <xs:simpleType>
       <xs:restriction base="xs:unsignedByte">
        <xs:enumeration value="1">
         <xs:annotation>
          <xs:appinfo>Origination</xs:appinfo>
         </xs:annotation>


Marshall               Expires - September 2003              [Page 33]


Security Audit and Access Accountability Message             March 2003

        </xs:enumeration>
        <xs:enumeration value="2">
         <xs:annotation>
          <xs:appinfo>Amendment</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="3">
         <xs:annotation>
          <xs:appinfo>Verification</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="4">
         <xs:annotation>
          <xs:appinfo>Translation</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="5">
         <xs:annotation>
          <xs:appinfo>Access / Use</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="6">
         <xs:annotation>
          <xs:appinfo>De-identification</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="7">
         <xs:annotation>
          <xs:appinfo>Aggregation, summarization, derivation
             </xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="8">
         <xs:annotation>
          <xs:appinfo>Report</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="9">
         <xs:annotation>
          <xs:appinfo>Disclosure</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="10">
         <xs:annotation>
          <xs:appinfo>Receipt</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="11">
         <xs:annotation>
          <xs:appinfo>Archiving</xs:appinfo>


Marshall               Expires - September 2003              [Page 34]


Security Audit and Access Accountability Message             March 2003

         </xs:annotation>
        </xs:enumeration>
        <xs:enumeration value="12">
         <xs:annotation>
          <xs:appinfo>Destruction</xs:appinfo>
         </xs:annotation>
        </xs:enumeration>
       </xs:restriction>
      </xs:simpleType>
     </xs:attribute>
     <xs:attribute name="ParticipantObjectIDSensitivity"
   type="xs:string" use="optional"/>
    </xs:complexType>
    <xs:complexType name="CodedValueType">
     <xs:attribute name="code" type="xs:string" use="required"/>
     <xs:attributeGroup ref="CodeSystem"/>
     <xs:attribute name="displayName" type="xs:string" use="optional"/>
     <xs:attribute name="originalText" type="xs:string" use="optional"/>
    </xs:complexType>
    <xs:attributeGroup name="CodeSystem">
     <xs:attribute name="codeSystem" type="OID" use="optional"/>
     <xs:attribute name="codeSystemName" type="xs:string"
   use="optional"/>
    </xs:attributeGroup>
    <xs:simpleType name="OID">
     <xs:restriction base="xs:string">
      <xs:whiteSpace value="collapse"/>
     </xs:restriction>
    </xs:simpleType>
   </xs:schema>






















Marshall               Expires - September 2003              [Page 35]


Security Audit and Access Accountability Message             March 2003

7. Security Considerations

   Audit data must be secured at least to the same extent as the
   underlying data and activities being audited.  This includes access
   controls as well as data integrity and recovery functions.  This
   document acknowledges the need for, but does not specify, the
   policies and technical methods to accomplish this.

   It is conceivable that audit data might have unintended uses, e.g.,
   tracking the frequency and nature of system use for productivity
   measures.  ASTM standard E2147-01[5] states, in paragraph 5.3.10,
   "Prohibit use for other reasons than to enforce security and to
   detect security breaches in record health information systems, for
   example, the audits are not to be used to explore activity profiles
   or movement profiles of employees.ö

References

   1  Bradner, S., "The Internet Standards Process -- Revision 3", BCP
      9, RFC 2026, October 1996.

   2  Bradner, S., "Key words for use in RFCs to Indicate Requirement
      Levels", BCP 14, RFC 2119, March 1997

   3  Marshall, G., and Dickinson, G., "Common Audit Message", HL7
      Security and Accountability Special Interest Group, November 2001

   4  "IHE Technical Framework", Volume III, HIMMS/RSNA, April 2002

   5  "E2147-01 Standard Specification for Audit and Disclosure Logs for
      Use in Health Information Systems", ASTM International, June 2002

   6 ôSecurity and Privacy Auditing in Health Care Information
      Technologyö, Joint NEMA/COCIR/JIRA Security and Privacy Committee,
      26 June 2001

   7  "ISO/IEC 15408:1999 Common Criteria for Information Technology
      Security Evaluation, Part 2: Security Functional Requirements",
      ISO, August 1999

   8  Mills, D., Network Time Protocol (Version 3) Specification,
      Implementation, March 1992.

   9  Berners-Lee, et. al., "Uniform Resource Identifiers (URI): Generic
      Syntax", RFC 2396, August 1998







Marshall               Expires - September 2003              [Page 36]


Security Audit and Access Accountability Message             March 2003

Draft Change History

   Version  Date  Description
     00     12/02 Original draft publication
     01     02/03 1) Reword the Abstract to be more understandable to a
                     wider audience.
                  2) Revise Purpose and Scope and Data definition
                     sections for clarity, in accordance with comments
                     from several reviewers.
                  3) Document default value for Event Action Code.
                  4) Add Alternate User ID and User Name fields.
                  4) Include participant object identifier support for
                     objects of security administration trigger events.
                  5) Update XML schema to agree with data definitions.
     02     03/03 1) Updated schema to make the "code" attribute in
                     CodedValueType a required value.
                  2) Minor wording changes to the Abstract for clarity.
                  3) Added reference to ôSecurity and Privacy Auditing
                     in Health Care Information Technologyö, by the
                     Joint NEMA/COCIR/JIRA Security and Privacy
                     Committee.































Marshall               Expires - September 2003              [Page 37]


Security Audit and Access Accountability Message             March 2003

Acknowledgments

   The author gratefully acknowledges the advice and assistance of the
   following people during the preparation of this document:

   Carmela Couderc, Siemens Medical Solutions Health Services
   Michael Davis, SAIC
   Gary Dickinson, Per-Se Technologies, Inc.
   Robert Horn, Agfa
   James McAvoy, Siemens Medical Solutions Health Services
   Jennifer Puyenbroek, McKesson Information Solutions
   Angela Ray, McKesson Information Solutions
   Larry Tarbox, Siemens Corporate Research


Author's Addresses

   Glen Marshall
   Siemens Medical Solutions Health Services
   51 Valley Stream Parkway
   Malvern, PA 19312
   USA
   Phone: (610) 219-3938
   Email: glen.f.marshall@siemens.com




























Marshall               Expires - September 2003              [Page 38]