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Related Experiment Video

Updated: May 5, 2026

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Authentication systems for securing clinical documentation workflows. A systematic literature review.

J Schwartze1, B Haarbrandt, D Fortmeier

  • 1Jonas Schwartze, M.Sc., Peter L. Reichertz Institute for Medical Informatics, Technische Universität Braunschweig and Hannover Medical School, Mühlenpfordtstraße 23, 38106 Braunschweig, Germany,

Methods of Information in Medicine
|November 20, 2013
PubMed
Summary

Implementing electronic signatures in healthcare is challenging. Few user authentication systems are suitable for clinical workflows, with biometric systems showing high error rates and graphical passwords offering no advantage over traditional ones.

Keywords:
Securityauthentication systemdigital signatureelectronic signature

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Area of Science:

  • Health Informatics
  • Information Security

Background:

  • Integrating electronic signatures in German healthcare presents challenges for service and supply facilities.
  • While the suitability of electronic signatures for clinical documents is recognized, practical implementation details remain unclear.

Purpose of the Study:

  • To summarize user authentication systems applicable to clinical workflows.

Main Methods:

  • A systematic literature review of nine databases (September 2011) and conference proceedings (February 2013) was conducted.
  • Included were publications describing usable authentication systems, excluding purely theoretical concepts.
  • Systems were assessed for security, legal compliance, and clinical workflow applicability.

Main Results:

  • 55 publications described 48 authentication systems (39 biometric, 9 graphical passwords).
  • Biometric systems exhibited high error rates exceeding European standards and lacked clinical applicability.
  • Graphical passwords provided no significant advantage over conventional passwords; continuous authentication offers enhanced safety.

Conclusions:

  • Authentication system suitability is contingent on specific national or institutional requirements.
  • Four systems show potential for clinical workflow authentication.
  • Further research into continuous authentication using biometric methods is recommended, emphasizing a multi-factor approach for robust security.