Accessing Patient Electronic Health Record Portals Safely Using Social Credentials: A Demonstration Pilot Study (Preprint)

BACKGROUND Patient portals allow communication with clinicians, access to test results, schedule appointments, etc. Their use requires another set of logins and passwords and can become increasingly cumbersome as patients often have records at multiple institutions. Social credentials (e.g., Google, Facebook) are increasingly used as a federated identity to reduce the password burden. Single-FILE (Single Federated Identity Login for EHR) is a real-world pilot to identify barriers to allowing patients to safely use a social credential to access their electronic health records (EHR) at multiple organizations with a single sign-on. OBJECTIVE Deploy a federated identity system for healthcare in a real-world environment to allow patients to safely use a social identity to access their EHR data at multiple organizations and identify barriers to inform development of guidance for deployment of such systems. METHODS Single-FILE allowed patients to pick a social identity as a federated identity to access to multiple EHR patient portals with a single sign-on. Binding the identity to the patient's EHR records was performed by confirming the patient had a valid EHR portal login and sending a one-time passcode to a telephone (text or voice) retrieved from the EHR. This reduced the risk due to stolen EHR portal credentials. Since this was a real-world test, we recruited patients and/or their caregivers who had EHR data at two independent healthcare facilities, enrolled them into Single-FILE, and connected their patient records. RESULTS We enrolled 8 patients and/or their caregivers into the study, to demonstrate that in a real-world environment that they could use a federated identity to access their EHR data. We interviewed the patients and/or their caregivers to assess their comfort level with using a social identity to access their EHR data. Patients noted that they appreciated only having to remember one login as part of Single-FILE and being able to sign up through Facebook. CONCLUSIONS Testing the feasibility of a federated identity for EHR access by implementing it in a web-based patient portal was undertaken, although the concept can be readily implemented on a variety of mobile platforms. Our results indicate that from a technical and operational perspective, a social identity can be bound to a patient's EHR data. A one-time passcode sent to the patient's EHR phone number provides assurance the binding is valid. The patients enrolled in the study indicated that they are comfortable with using a social identity and associated credentials to safely ease the friction associated with access to EHR data since they do not have to remember the login credentials for their EHR portal. Our experience will be used by the study sponsor to inform the implementation of federated identity systems in healthcare in the United States. CLINICALTRIAL