path: root/doc/rfc/rfc3881.txt

Network Working Group                                        G. Marshall
Request for Comments: 3881                                       Siemens
Category: Informational                                   September 2004


           Security Audit and Access Accountability Message
           XML Data Definitions for Healthcare Applications

Status of this Memo

   This memo provides information for the Internet community.  It does
   not specify an Internet standard of any kind.  Distribution of this
   memo is unlimited.

Copyright Notice

   Copyright (C) The Internet Society (2004).

IESG Note

   This RFC is not a candidate for any level of Internet Standard.  The
   IETF disclaims any knowledge of the fitness of this RFC for any
   purpose, and notes that it has not had IETF review.  The RFC Editor
   has chosen to publish this document at its discretion.

Abstract

   This document defines the format of data to be collected and minimum
   set of attributes that need to be captured for security auditing in
   healthcare application systems.  The format is defined as an XML
   schema, which is intended as a reference for healthcare standards
   developers and application designers.  It consolidates several
   previous documents on security auditing of healthcare data.


















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Table of Contents

   1. Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2
   2. Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4
      2.1.  Data Collection . . . . . . . . . . . . . . . . . . . . .  4
      2.2.  Anticipated Data End-uses . . . . . . . . . . . . . . . .  5
      2.3.  Conformance . . . . . . . . . . . . . . . . . . . . . . .  6
   3. Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6
      3.1.  Effective Data Gathering. . . . . . . . . . . . . . . . .  6
      3.2.  Efficiency. . . . . . . . . . . . . . . . . . . . . . . .  7
   4. Trigger Events. . . . . . . . . . . . . . . . . . . . . . . . .  8
      4.1.  Security Administration . . . . . . . . . . . . . . . . .  8
      4.2.  Audit Administration and Data Access. . . . . . . . . . .  9
      4.3.  User Access . . . . . . . . . . . . . . . . . . . . . . . 10
   5. Data Definitions. . . . . . . . . . . . . . . . . . . . . . . . 13
      5.1.  Event Identification. . . . . . . . . . . . . . . . . . . 13
      5.2.  Active Participant Identification . . . . . . . . . . . . 17
      5.3.  Network Access Point Identification . . . . . . . . . . . 20
      5.4.  Audit Source Identification . . . . . . . . . . . . . . . 22
      5.5.  Participant Object Identification . . . . . . . . . . . . 24
   6. XML Schema. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
      6.1.  XML Schema Definition . . . . . . . . . . . . . . . . . . 31
      6.2.  XML Schema Localization . . . . . . . . . . . . . . . . . 43
   7. Security Considerations . . . . . . . . . . . . . . . . . . . . 44
   8. References. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
      8.1.  Normative References. . . . . . . . . . . . . . . . . . . 44
      8.2.  Informative References. . . . . . . . . . . . . . . . . . 45
   Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . 45
   Author's Address . . . . . . . . . . . . . . . . . . . . . . . . . 46
   Full Copyright Statement . . . . . . . . . . . . . . . . . . . . . 47

1.  Purpose

   To help assure healthcare privacy and security in automated systems,
   usage data needs to be collected.  This 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 data collection
   and 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






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   patients' records were involved.  The data definition is an XML
   schema to be used as a reference by healthcare standards developers
   and application designers.

   This document consolidates previously disjointed viewpoints of
   security auditing from Health Level 7 (HL7) [HL7SASIG], Digital
   Imaging and Communications in Medicine (DICOM) Working Group 14,
   Integrating the Healthcare Enterprise (IHE) [IHETF-3], the ASTM
   International Healthcare Informatics Technical Committee (ASTM E31)
   [E2147], and the Joint NEMA/COCIR/JIRA Security and Privacy Committee
   [NEMASPC].  It is intended as a reference for these groups and other
   healthcare standards developers.

   The purposes the document fulfills are to:

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

      This document defines the audit message format and content for
      healthcare application systems.  The focus of auditing is to
      retrospectively detect and report security/privacy breaches.  This
      includes capturing data that supports individual accountability
      for patient record creation, access, updates, and deletions.

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

   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 - transcending hardware
      system boundaries - is seen as necessary for cost-effective
      security and privacy policy administration.

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







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   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.

      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.

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

   1) Security administrative events - 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 - reflecting special protections implemented
      for the audit trail itself.

   3) Security-mediated events - 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.







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   4) Patient care data events - 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
   log-on 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 of the collected data to the common
   XML schema definition may be necessary to support requirements
   consolidated auditing views.

   Application-level events, such as patient record access, are not
   captured by system-level security audits.  The defined data support
   applications' 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
   systems to a common repository.  It also anticipates the aggregated
   data which may then be queried and viewed in 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 be 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 which inhibit access may also inhibit
   effective patient care, under some circumstances.







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   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
   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 log-
   on, roles, access right permissions and restrictions, etc.  Each
   application system also has its own security log file that records
   security relevant events, e.g., log-in, 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



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   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 limit the costs of 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-level data
      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
      implementation-defined 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 filtering, aggregation, and
      summarization of repeated events would reduce the number of
      messages.  Audit data storage and integrity on each application
      system need only be scaled for relatively low-volume and short-
      duration requirements, yet be consistent with implementation-
      defined minimums for holding the data for subsequent collection.

   4) Leveraging existing data collection should be considered.  For
      example, most commercial security subsystems record events in a
      local common log file, so the log file data can be extracted for
      communication to a common repository.  Also, it is common in some
      systems' designs to have a transaction log for data reconstruction



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      in event of database loss, so collecting data-update audit data
      within this subsystem could reduce impact on application 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 representative trigger events for generating
   audit messages.  This is not a complete list of trigger events.

   For those events arising in the security infrastructure the "minimal"
   and "basic" level of auditing as outlined in the Common Criteria
   [ISO15408-2] should be used as a reference standard.

4.1.  Security Administration

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

4.1.1.  Data Definition

   This includes creation, modification, deletion, query, and display of
   security attributes for data sets, data groups, or classes plus their
   atomic data elements or attributes.

4.1.2.  Function Definition

   This includes, for example, creation, modification, deletion, query,
   or display of security attributes and auditable events for the
   application functions used for patient management, clinical
   processes, registry of business objects and methods, program creation
   and maintenance, etc.

4.1.3.  Domain Definition

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



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4.1.4.  Classification Definition

   This includes all activities that create, modify, delete, query or
   display 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, modify, delete, query or
   display 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, modify, delete, query or
   display 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, modify, delete, query, or
   display user accounts.  It includes password or other authentication
   data.  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.  Auditable Event 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.










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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.

4.2.3.  Audit Data Modify or Delete

   This includes instances where audit data is modified or deleted.
   While such operations are sometimes permitted by systems policies,
   modification or destruction of audit data may well be the result of
   unauthorized hostile systems access.  Therefore, this type of event
   should 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 system.  It also includes re-authentication actions and
   re-issuing time-sensitive credentials such as Kerberos tickets.

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
   security policies.

   The following are examples of trigger events relevant to healthcare
   privacy.  The actual triggers for institutional data access, policies
   for non-care functions, and support regulatory requirements need to
   be identified by application-domain standards developers and system
   implementers.






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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.
   -  Delete, e.g., invalid creation of care record

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
   -  Delete, e.g., invalid creation of encounter record, breakdown of
      equipment, patient did not arrive as expected

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







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4.3.3.5.  Orders and Order Sets

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

   -  Initiate
   -  Update, amend
   -  Check for contraindications
   -  Verify
   -  Deliver/complete - including instructions
   -  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
   -  Update, amend
   -  Check for contraindications
   -  Verify
   -  Perform/complete - including instructions
   -  Cancel

4.3.3.7.  Medications

   This includes all medication orders and administration within an
   instance or episode of care:

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

4.3.3.8.  Staff/Participant Assignment

   This includes staffing or participant assignment 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




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

5.1.  Event Identification

   The following data identifies 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

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

   Optionality: Required

   Format / Values

      Coded value, either defined by the system implementers or as a
      reference to a standard vocabulary.  The "code" attribute must be
      unambiguous and unique, at least within Audit Source ID (see
      section 5.4).  Examples of Event IDs are program name, method
      name, or function name.

      For implementation defined coded values or references to
      standards, the XML schema defines these optional attributes:

         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system; strongly recommended
                        to be valued for locally-defined code-sets.
         DisplayName    The value to be used in displays and reports
         OriginalText   Input value that was translated to the code




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      To support the requirement for unambiguous event identification,
      multiple values may not be specified.

   Rationale

      This identifies the audited function.  For "Execute" Event Action
      Code audit records, this identifies the application function
      performed.

5.1.2.  Event Action Code

   Description

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

   Optionality: Optional

   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 data, such as Revise
                                     Patient Information
           D   Delete                Delete items, such as a doctor
                                     master file record
           E   Execute               Perform a system or application
                                     function such as log-on, program
                                     execution, or use of an object's
                                     method

   Rationale

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










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   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 would
      identify the function.

      For some applications, such as radiological imaging, a Query
      action may only determine the presence of data but not access the
      data itself.  Auditing need not make as fine a distinction.

      Compound actions, such as "Move," would be audited by creating
      audit data for each operation - read, create, delete - or as an
      Execute of a function or method.

5.1.3.  Event Date/Time

   Description

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

   Optionality: Required

   Format / Values

      A date/time representation that is unambiguous in conveying
      universal coordinated time (UTC), formatted according to the ISO
      8601 standard [ISO8601]

   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 [RFC1305] server, is a good implementation tactic.

5.1.4.  Event Outcome Indicator

   Description

      Indicates whether the event succeeded or failed.




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   Optionality: Required

   Format / Values

      Enumeration:

      Value Meaning
       ---- ----------------------------------------------------
        0   Success
        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 log-on attempts

   Rationale

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

   Notes

      In some cases a "success" may be partial, for example, an
      incomplete or interrupted transfer of a radiological study.  For
      the purpose of establishing accountability, these distinctions are
      not relevant.

5.1.5.  Event Type Code

   Description

      Identifier for the category of event.

   Optionality: Optional

   Format / Values

      Coded value enumeration, either defined by the system implementers
      or as a reference to a standard vocabulary.  For implementation
      defined codes or references to standards, the XML schema defines
      these optional attributes:








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         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system; strongly recommended
                        to be valued for locally-defined code-sets.
         DisplayName    The value to be used in displays and reports
         OriginalText   Input value that was translated to the code

      Since events may be categorized in more than one way, there may be
      multiple values specified.

   Rationale

      This field enables queries of messages by implementation-defined
      event categories.

5.2.  Active Participant Identification

   The following data identify a user for the purpose of documenting
   accountability for the audited event.  A user may be a person, or a
   hardware device or software process for events that are not initiated
   by a person.

   Optionally, the user's network access location may be specified.

   There may be more than one user per event, for example, in cases of
   actions initiated by one user for other users, or in events that
   involve more than one user, hardware device, or system process.
   However, only one user may be the initiator/requestor for the event.

5.2.1.  User ID

   Description

      Unique identifier for the user actively participating in the event

   Optionality: Required

   Format / Values

      User identifier text string from the authentication system.  It is
      a unique value within the Audit Source ID (see section 5.4).

   Rationale

      This field ties an audit event to a specific user.





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   Notes

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

      For node-based authentication -- where only the system hardware or
      process, but not a human user, is identified -- User ID would be
      the node name.

5.2.2.  Alternative User ID

   Description

      Alternative unique identifier for the user

   Optionality: Optional

   Format / Values

      User identifier text string from authentication system.  This
      identifier would 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

      The human-meaningful name for the user

   Optionality: Optional

   Format / Values

      Text string







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   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

      Indicator that the user is or is not the requestor, or initiator,
      for the event being audited.

   Optionality: Optional

   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 initiate a report-
      output to be sent to a another user.

5.2.5.  Role ID Code

   Description

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

   Optionality: Optional; multi-valued

   Format / Values

      Coded value, with attribute "code" valued with the role code or
      text from authorization system.  More than one value may be
      specified.

      The codes may be implementation-defined or reference a standard
      vocabulary enumeration.  For implementation defined codes or
      references to standards, the XML schema defines these optional
      attributes:







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         Attribute      Value description
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system; strongly recommended
                        to be valued for locally-defined code-sets.
         Display Name   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 user's 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 would be the one known to
      a common authorization system, if available.  Otherwise, it is a
      unique value within the Audit Source ID (see section 5.4).
      Consider using a globally unique identifier associated with the
      role to avoid ambiguity in auditing data collected from multiple
      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

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

   Optionality: Optional

   Format / Values



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      Enumeration:

         Value Meaning
         ----- --------------------------------
           1   Machine Name, including DNS 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 point's type.

5.3.2.  Network Access Point ID

   Description

      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.

   Optionality: Optional

   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 user's network access point, which may
      be 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 point's
      data 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.






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   Examples

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

      Network Access Point ID: 192.0.2.2
      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 application 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.

   Depending on implementation strategies, it is possible that the
   components in a multi-tier, distributed, or composite applications
   may generate more than one audit message for a single application
   event.  Various data in the audit message may be used to identify
   such cases, supporting subsequent data reduction.  This document
   anticipates that the repository and reporting mechanisms will perform
   data reduction when required, but does not specify those mechanism.

5.4.1.  Audit Enterprise Site ID

   Description

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

   Optionality: Optional

   Format / Values

      Unique identifier text string within the healthcare enterprise.
      May be unvalued when the audit-generating application is uniquely
      identified by Audit Source ID.






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   Rationale

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

   Notes

      This is 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 and disambiguates the Audit Source ID.
      Values may vary depending on type of business.  There may be
      levels of differentiation within the organization.

5.4.2.  Audit Source ID

   Description

      Identifier of the source where the event originated.

   Optionality: Required

   Format / Values

      Unique identifier text string, 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
      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

      Code specifying the type of source where event originated.

   Optionality: Optional




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   Format / Values

      Coded-value enumeration, optionally defined by system implementers
      or a as a reference to a standard vocabulary.  Unless defined or
      referenced, the default values for the "code" attribute are:

         Value  Meaning
         -----  ------------------------------------------------------
           1    End-user interface
           2    Data acquisition device or instrument
           3    Web server process tier in a multi-tier system
           4    Application server process tier in a multi-tier system
           5    Database server process tier in a multi-tier system
           6    Security server, e.g., a domain controller
           7    ISO level 1-3 network component
           8    ISO level 4-6 operating software
           9    External source, other or unknown type

      For implementation defined codes or references to standards, the
      XML schema defines these optional attributes:

         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system; strongly recommended
                        to be valued for locally-defined code-sets.
         DisplayName    The value to be used in displays and reports
         OriginalText   Input value that was translated to the code

      Since audit sources may be categorized in more than one way, there
      may be multiple values specified.

   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 required unless the values for Event Identification,
   Active Participant Identification, and Audit Source Identification
   are sufficient to document the entire auditable event.  Production of




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   audit records containing these data may be enabled or suppressed, as
   determined by healthcare organization policy and regulatory
   requirements.

   Because events may have more than one participant object, this group
   can be 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.
   -  For radiological studies, a set of related participant objects
      identified by accession number or study number, may be identified.

   Note, though, that each audit message documents only a single usage
   instance of such participant object relationships and does not serve
   to document all relationships that may be present or possible.

5.5.1.  Participant Object Type Code

   Description

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

   Optionality: Optional

   Format / Values

      Enumeration:

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








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   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 type for the action.

5.5.2.  Participant Object Type Code Role

   Description

      Code representing the functional application role of Participant
      Object being audited

   Optionality: Optional

   Format / Values

      Enumeration, specific to Participant Object Type Code:

         Value Meaning              Participant Object Type Codes
         ----- -------------------- ----------------------------------
           1   Patient              1 - Person
           2   Location             3 - Organization
           3   Report               2 - System Object
           4   Resource             1 - Person
                                    3 - Organization
           5   Master file          2 - System Object
           6   User                 1 - Person
                                    2 - System Object (non-human user)
           7   List                 2 - System Object
           8   Doctor               1 - Person
           9   Subscriber           3 - Organization
          10   Guarantor            1 - Person
                                    3 - Organization
          11   Security User Entity 1 - Person
                                    2 - System Object
          12   Security User Group  2 - System Object
          13   Security Resource    2 - System Object
          14   Security Granularity 2 - System Object
               Definition
          15   Provider             1 - Person
                                    3 - Organization
          16   Data Destination     2 - System Object
          17   Data Repository      2 - System Object
          18   Schedule             2 - System Object
          19   Customer             3 - Organization
          20   Job                  2 - System Object
          21   Job Stream           2 - System Object



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          22   Table                2 - System Object
          23   Routing Criteria     2 - System Object
          24   Query                2 - System Object

      A "Security Resource" is an abstract securable object, e.g., a
      screen, interface, document, program, etc. -- or even an audit
      data set or repository.

   Rationale

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

5.5.3.  Participant Object Data Life Cycle

   Description

      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.

   Optionality: Optional

   Format/Values

      Enumeration:

         Value Meaning
         ----- --------------------------------------
           1   Origination / Creation
           2   Import / Copy from original
           3   Amendment
           4   Verification
           5   Translation
           6   Access / Use
           7   De-identification
           8   Aggregation, summarization, derivation
           9   Report
          10   Export / Copy to target
          11   Disclosure
          12   Receipt of disclosure
          13   Archiving
          14   Logical deletion
          15   Permanent erasure / Physical destruction






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   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

      Describes the identifier that is contained in Participant Object
      ID.

   Optionality: Required

   Format / Values

      Coded-value enumeration, specific to Participant Object Type Code,
      using attribute-name "code".  The codes below are the default set.

         Value Meaning                Participant Object Type Codes
         ----- ---------------------- -----------------------------
           1   Medical Record Number  1 - Person
           2   Patient Number         1 - Person
           3   Encounter Number       1 - Person
           4   Enrollee Number        1 - Person
           5   Social Security Number 1 - Person
           6   Account Number         1 - Person
                                      3 - Organization
           7   Guarantor Number       1 - Person
                                      3 - Organization
           8   Report Name            2 - System Object
           9   Report Number          2 - System Object
           10  Search Criteria        2 - System Object
           11  User Identifier        1 - Person
                                      2 - System Object
           12  URI                    2 - System Object

      User Identifier and URI [RFC2396] text strings are intended to be
      used for security administration trigger events to identify the
      objects being acted-upon.

      The codes may be the default set stated above, implementation-
      defined, or reference a standard vocabulary enumeration, such as
      HL7 version 2.4 table 207 or DICOM defined media types.  For
      implementation defined codes or references to standards, the XML
      schema defines these optional attributes:




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         Attribute      Value
         -------------- --------------------------------------------
         CodeSystem     OID reference
         CodeSystemName Name of the coding system; strongly recommended
                        to be valued for locally-defined code-sets.
         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 Sensitivity

   Description

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

   Optionality: Optional

   Format / Values

      Values are institution- and implementation-defined text strings.

5.5.6.  Participant Object ID

   Description

      Identifies a specific instance of the participant object.

   Optionality: Required

   Format / Values

      Text string.  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.



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5.5.7.  Participant Object Name

   Description

      An instance-specific descriptor of the Participant Object ID
      audited, such as a person's name.

   Optionality: Optional

   Format / Values

      Text string

   Rationale

      This field may be used in a query/report to identify audit events
      for a specific person, e.g., where multiple synonymous Participant
      Object IDs (patient number, medical record number, encounter
      number, etc.) have been used.

5.5.8.  Participant Object Query

      Description

      The actual query for a query-type participant object.

   Optionality: Optional

   Format / Values

      Base 64 encoded data

   Rationale

      For query events it may be necessary to capture the actual query
      input to the query process in order to identify the specific
      event.  Because of differences among query implementations and
      data encoding for them, this is a base 64 encoded data blob.  It
      may be subsequently decoded or interpreted by downstream audit
      analysis processing.

5.5.9.  Participant Object Detail

   Description

      Implementation-defined data about specific details of the object
      accessed or used.




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   Optionality: Optional

   Format

      Type-value pair.  The "type" attribute is an implementation-
      defined text string.  The "value" attribute is a base 64 encoded
      data.

   Rationale

      Specific details or values from the object accessed may be desired
      in specific auditing implementations.  The type-value pair enables
      the use of implementation-defined and locally-extensible object
      type identifiers and values.  For example, a clinical diagnostic
      object may contain multiple test results, and this element could
      document the type and number and type of results.

      Many possible data encodings are possible for this elements, so
      the value is a base 64 encoded data blob.  It may be subsequently
      decoded or interpreted by downstream audit analysis processing.

6.  XML Schema

   This section contains the actual XML schema definition for the data
   defined in section 5.  It also provides brief guidance for specifying
   schema localizations for implementation purposes.

   The XML schema specified in section 6.1 conforms with the W3C
   Recommendations for XML Schema structure [W3CXML-1] and data types
   [W3CXML-2].

6.1.  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="ActiveParticipant" maxOccurs="unbounded">
     <xs:complexType>
      <xs:complexContent>
       <xs:extension base="ActiveParticipantType"/>
      </xs:complexContent>
     </xs:complexType>
    </xs:element>
    <xs:element name="AuditSourceIdentification"



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     type="AuditSourceIdentificationType" maxOccurs="unbounded"/>
    <xs:element name="ParticipantObjectIdentification"
     type="ParticipantObjectIdentificationType" minOccurs="0"
     maxOccurs="unbounded"/>
   </xs:sequence>
  </xs:complexType>
 </xs:element>
 <xs:complexType name="EventIdentificationType">
  <xs:sequence>
   <xs:element name="EventID" type="CodedValueType"/>
   <xs:element name="EventTypeCode" type="CodedValueType"
    minOccurs="0" maxOccurs="unbounded"/>
  </xs:sequence>
  <xs:attribute name="EventActionCode" use="optional">
   <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">
      <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>



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    <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:sequence>
   <xs:element name="AuditSourceTypeCode" minOccurs="0"
    maxOccurs="unbounded">
    <xs:complexType>
     <xs:complexContent>
      <xs:restriction base="CodedValueType">
       <xs:attribute name="code" use="required">
        <xs:simpleType>
         <xs:restriction base="xs:string">
          <xs:enumeration value="1">
           <xs:annotation>
            <xs:appinfo>End-user display device, diagnostic
             display</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="2">
           <xs:annotation>
            <xs:appinfo>Data acquisition device or
             instrument</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>



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          <xs:enumeration value="3">
           <xs:annotation>
            <xs:appinfo>Web server process</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="4">
           <xs:annotation>
            <xs:appinfo>Application server process</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="5">
           <xs:annotation>
            <xs:appinfo>Database server process</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="6">
           <xs:annotation>
            <xs:appinfo>Security server, e.g., a domain
             controller</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="7">
           <xs:annotation>
            <xs:documentation>ISO level 1-3 network
             component</xs:documentation>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="8">
           <xs:annotation>
            <xs:appinfo>ISO level 4-6 operating software</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="9">
           <xs:annotation>
            <xs:appinfo>External source, other or unknown
             type</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
         </xs:restriction>
        </xs:simpleType>
       </xs:attribute>
      </xs:restriction>
     </xs:complexContent>
    </xs:complexType>
   </xs:element>
  </xs:sequence>
  <xs:attribute name="AuditEnterpriseSiteID" type="xs:string"
   use="optional"/>



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  <xs:attribute name="AuditSourceID" type="xs:string"
   use="required"/>
 </xs:complexType>
 <xs:complexType name="ActiveParticipantType">
  <xs:sequence minOccurs="0">
   <xs:element name="RoleIDCode" type="CodedValueType" minOccurs="0"
    maxOccurs="unbounded"/>
  </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, including DNS 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="ParticipantObjectIDTypeCode">
    <xs:complexType>
     <xs:complexContent>
      <xs:restriction base="CodedValueType">
       <xs:attribute name="code" use="required">
        <xs:simpleType>
         <xs:restriction base="xs:string">
          <xs:enumeration value="1">



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           <xs:annotation>
            <xs:appinfo>Medical Record Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="2">
           <xs:annotation>
            <xs:appinfo>Patient Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="3">
           <xs:annotation>
            <xs:appinfo>Encounter Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="4">
           <xs:annotation>
            <xs:appinfo>Enrollee Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="5">
           <xs:annotation>
            <xs:appinfo>Social Security Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="6">
           <xs:annotation>
            <xs:appinfo>Account Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="7">
           <xs:annotation>
            <xs:appinfo>Guarantor Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="8">
           <xs:annotation>
            <xs:appinfo>Report Name</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="9">
           <xs:annotation>
            <xs:appinfo>Report Number</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="10">
           <xs:annotation>
            <xs:appinfo>Search Criteria</xs:appinfo>
           </xs:annotation>



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          </xs:enumeration>
          <xs:enumeration value="11">
           <xs:annotation>
            <xs:appinfo>User Identifier</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value="12">
           <xs:annotation>
            <xs:appinfo>URI</xs:appinfo>
           </xs:annotation>
          </xs:enumeration>
          <xs:enumeration value=""/>
         </xs:restriction>
        </xs:simpleType>
       </xs:attribute>
      </xs:restriction>
     </xs:complexContent>
    </xs:complexType>
   </xs:element>
   <xs:choice minOccurs="0">
    <xs:element name="ParticipantObjectName" type="xs:string"
     minOccurs="0"/>
    <xs:element name="ParticipantObjectQuery" type="xs:base64Binary"
     minOccurs="0"/>
   </xs:choice>
   <xs:element name="ParticipantObjectDetail"
    type="TypeValuePairType" minOccurs="0" maxOccurs="unbounded"/>
  </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">
      <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>



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     <xs:enumeration value="4">
      <xs:annotation>
       <xs:appinfo>Other</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>
     <xs:enumeration value="7">
      <xs:annotation>
       <xs:appinfo>List</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="8">
      <xs:annotation>



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       <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>
     <xs:enumeration value="17">
      <xs:annotation>
       <xs:appinfo>Report Library</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>



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     <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 / Creation</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="2">
      <xs:annotation>



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       <xs:appinfo>Import / Copy from original </xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="3">
      <xs:annotation>
       <xs:appinfo>Amendment</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="4">
      <xs:annotation>
       <xs:appinfo>Verification</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="5">
      <xs:annotation>
       <xs:appinfo>Translation</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="6">
      <xs:annotation>
       <xs:appinfo>Access / Use</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="7">
      <xs:annotation>
       <xs:appinfo>De-identification</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="8">
      <xs:annotation>
       <xs:appinfo>Aggregation, summarization,
        derivation</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="9">
      <xs:annotation>
       <xs:appinfo>Report</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="10">
      <xs:annotation>
       <xs:appinfo>Export / Copy to target</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="11">
      <xs:annotation>
       <xs:appinfo>Disclosure</xs:appinfo>
      </xs:annotation>



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     </xs:enumeration>
     <xs:enumeration value="12">
      <xs:annotation>
       <xs:appinfo>Receipt of disclosure</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="13">
      <xs:annotation>
       <xs:appinfo>Archiving</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="14">
      <xs:annotation>
       <xs:appinfo>Logical deletion</xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
     <xs:enumeration value="15">
      <xs:annotation>
       <xs:appinfo>Permanent erasure / Physical destruction
       </xs:appinfo>
      </xs:annotation>
     </xs:enumeration>
    </xs:restriction>
   </xs:simpleType>
  </xs:attribute>
  <xs:attribute name="ParticipantObjectSensitivity" 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:complexType name="TypeValuePairType">
  <xs:attribute name="type" type="xs:string" use="required"/>
  <xs:attribute name="value" type="xs:base64Binary" use="required"/>
 </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>



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</xs:schema>

6.2.  XML Schema Localization

   The schema specified in section 6.1 may be extended and restricted to
   meet local implementation-specific requirements.  W3C Recommendation
   for XML Schema structure [W3CXML-1], section 4, is the governing
   standard for accomplishing this.

   As of the current version of this document, a public reference URI
   for the base schema has not been established.

   Local definitions reference the common audit message base schema.
   For example, here is a schema with a local vocabulary restriction for
   "Audit Enterprise Site ID" plus an extension adding a new "Audit
   Source Asset Number" element.

   The URI used to identify this schema (http://audit-message-uri) is a
   syntactically valid example that does not represent an actual schema.
   Schema validators might report an error when attempting to import a
   schema using this URI.

<xs:schema xmlns:audit="http://audit-message-URI"
 xmlns:xs="http://www.w3.org/2001/XMLSchema"
 elementFormDefault="qualified" attributeFormDefault="unqualified">
 <xs:import schemaLocation="http://audit-message-URI"/>
 <xs:complexType name="LocaAuditSourceIdentificationType">
  <xs:complexContent>
   <xs:restriction base="AuditSourceIdentificationType">
    <xs:attribute name="AuditEnterpriseSiteID" use="required">
     <xs:simpleType>
      <xs:restriction base="xs:string">
       <xs:enumeration value="Main"/>
       <xs:enumeration value="Clinic1"/>
       <xs:enumeration value="Clinic2"/>
       <xs:enumeration value="Radiology"/>
       <xs:enumeration value="Lab"/>
      </xs:restriction>
     </xs:simpleType>
    </xs:attribute>
   </xs:restriction>
  </xs:complexContent>
 </xs:complexType>
 <xs:element name="LocalAuditSourceIdentification">
  <xs:complexType>
   <xs:complexContent>
    <xs:extension base="LocaAuditSourceIdentificationType">
      <xs:attribute name="AuditSourceAssetNumber" type="xs:string"



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       use="required"/>
    </xs:extension>
   </xs:complexContent>
  </xs:complexType>
 </xs:element>
</xs:schema>

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 [E2147] 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."

   Some audit data arises from security-relevant processes other than
   data access.  These are the trigger events listed in section 4.1 and
   4.2 of this document.  Audit data, defined in this document, can
   record the accountabilities for the results of these processes, as
   part of a complete security implementation.  A discussion of the
   associated authorities, reference standards, and implementation
   technology choices for the processes is outside the scope of this
   document.

8.  References

8.1.  Normative References

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

   [ISO15408-2] "ISO/IEC 15408:1999 Common Criteria for Information
                Technology Security Evaluation, Part 2: Security
                Functional Requirements", ISO, August 1999.

   [ISO8601]    "ISO 8601:2000 Data elements and interchange formats --
                Information interchange -- Representation of dates and
                times", ISO, December 2000.




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   [RFC1305]    Mills, D., "Network Time Protocol (Version 3)
                Specification, Implementation", RFC 1305, March 1992.

   [RFC2396]    Berners-Lee, T., Fielding, R. and L. Masinter, "Uniform
                Resource Identifiers (URI): Generic Syntax", RFC 2396,
                August 1998.

   [W3CXML-1]   W3C Recommendation "XML Schema Part 1: Structures",
                version 1.0, May 2001.

   [W3CXML-2]   W3C Recommendation "XML Schema Part 2: Datatypes,"
                version 1.0, May 2001.

8.2.  Informative References

   [HL7SASIG]   Marshall, G. and G. Dickinson, "Common Audit Message",
                HL7 Security and Accountability Special Interest Group,
                November 2001.

   [IHETF-3]    "IHE Technical Framework", Volume III, HIMMS/RSNA, April
                2002.

   [NEMASPC]    "Security and Privacy Auditing in Health Care
                Information Technology", Joint NEMA/COCIR/JIRA Security
                and Privacy Committee, 26 June 2001.

Acknowledgments

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

      Carmela Couderc, Siemens Medical Solutions
      Michael Davis, SAIC
      Gary Dickinson
      Christoph Dickmann, Siemens Medical Solutions
      Daniel Hannum, Siemens Medical Solutions
      Robert Horn, Agfa
      James McAvoy, Siemens Medical Solutions
      John Moehrke, General Electric Medical Systems
      Jennifer Puyenbroek, McKesson Information Solutions
      Angela Ray, McKesson Information Solutions
      Lawrence Tarbox, Siemens Corporate Research









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Author's Address

   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









































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Full Copyright Statement

   Copyright (C) The Internet Society (2004).

   This document is subject to the rights, licenses and restrictions
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Acknowledgement

   Funding for the RFC Editor function is currently provided by the
   Internet Society.







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