Poor quality of Hospital Information Systems audit trails.

Although IT governance practices (like ITIL, which recommends on the use of Audit Trails (AT) for proper service level management) are being introduced in many Hospitals to cope with increasing levels of information quality and safety requirements, the standard maturity levels of hospital IT departments is still not enough to reach the level of frequent use of AT. This paper aims to address the issues related to the existence and quality of AT in Hospital Information Systems (HIS). A total of 5 hospitals participated in the study (4 CIO interviews and 7 AT from 4 hospitals). Very few AT are known to exist in these hospitals (about 1 per hospital in an estimate of 21 existing IS). The existing AT has poor quality (garbled, incomplete and misformatted information). CIOs should be much more concerned with the existence, quality and maintenance of AT. Recommendations include server clock synchronization, using advanced AT visualization tools, using also real-time auditing tools, and periodically audit the access to all data of a random patient.