Blog | G5 Cyber Security

Healthcare Role-Based Access Control

G5 Cyber Security

TL;DR

This guide explains how to set up role-based access control (RBAC) in healthcare applications, keeping patient data safe and meeting legal requirements. It covers planning roles, setting permissions, implementing the system technically, testing it thoroughly, and ongoing maintenance.

1. Planning Your Roles

  1. Identify Job Functions: List every type of person who needs access to your healthcare application (doctors, nurses, receptionists, administrators, billing staff, etc.).
  2. Define Core Tasks: For each job function, write down the essential tasks they perform daily. This will form the basis of your roles.
  3. Create Role Profiles: Group similar job functions with similar task needs into distinct roles. Examples:
    • Doctor: Full access to patient records, prescribing medications, ordering tests.
    • Nurse: View patient records, administer medication (limited prescribing), record observations.
    • Receptionist: Schedule appointments, update basic patient information, billing details.
    • Billing Administrator: Access financial data, generate invoices, process payments.
  4. Least Privilege Principle: Ensure each role only has the *minimum* access required to do their job. Avoid giving broad permissions “just in case”.

2. Setting Permissions

  1. Granular Permissions: Don’t just allow ‘access to patient records’. Break it down:
    • Read Patient Demographics
    • Write Patient Notes
    • View Lab Results
    • Approve Medication Orders
  2. Data Sensitivity Levels: Categorise data based on sensitivity (e.g., highly sensitive – medical history, moderate – billing information). Permissions should reflect these levels.
  3. Permission Matrix: Create a table mapping roles to specific permissions. This is your central reference point. 
    Role | Read Patient Records | Write Patient Notes | View Lab Results
-------|----------------------|--------------------|-----------------
Doctor | Yes                  | Yes                | Yes
Nurse  | Yes                  | Yes                | Limited
Receptionist | No                   | No                 | No

3. Technical Implementation

  1. Choose an RBAC Framework: Many frameworks exist within programming languages and databases.
    • Database-Level RBAC: Implement permissions directly in your database (e.g., using views, stored procedures).
    • Application-Level RBAC: Handle permissions within your application code. More flexible but requires more development effort.
    • Identity and Access Management (IAM) Solutions: Use a dedicated IAM system (e.g., AWS IAM, Azure Active Directory) for centralised control.
  2. User Authentication: Securely verify user identities before granting access.
    • Multi-Factor Authentication (MFA) is highly recommended.
  3. Code Example (Simplified): This shows a basic check in Python: 
    def check_permission(user, permission):
  if user.role == 'Doctor' and permission in ['read_patient', 'write_notes']:
    return True
  elif user.role == 'Nurse' and permission == 'view_lab_results':
    return True
  else:
    return False
  4. Session Management: Ensure sessions are secure and time-limited.

4. Testing

  1. Unit Tests: Verify individual permission checks work correctly.
  2. Integration Tests: Test how RBAC interacts with different parts of your application.
  3. User Acceptance Testing (UAT): Have real users test the system to ensure it meets their needs and that permissions are appropriate.
  4. Penetration Testing: Hire security experts to try and bypass the RBAC system.

5. Ongoing Maintenance

  1. Regular Audits: Review user roles and permissions periodically (at least annually) to ensure they are still appropriate.
  2. Access Reviews: Confirm that users only have access to the data they need.
  3. Log Monitoring: Track access attempts, especially failed ones, for suspicious activity.
  4. Security Updates: Keep your RBAC framework and related software up-to-date with the latest security patches.
  5. Incident Response Plan: Have a plan in place to deal with potential security breaches or permission issues.
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