Break glass access

Why it matters

Strict access rules protect privacy, but they can block care when a clinician needs a record outside their usual assignment, for example on a night shift or during an emergency transfer. Break glass access resolves that conflict without removing control: access is possible, but never anonymous. NIST guidance on the HIPAA Security Rule includes an emergency access procedure among the access controls an organisation must have [1].

Key points

• The user sees a warning, records a reason and proceeds; the system logs who opened which record and when.
• In a hospital study of restricted genetic reports, 45 per cent of attempts were abandoned at the break glass warning [2].
• The same study found empty justifications and a few users accounting for many overrides, and recommended mandatory reasons and ongoing log review [2].
• Review works when it is visible: in one trial, staff warned by email after unauthorised access rarely repeated it [3].

In Moana

When a doctor opens a patient assigned to another doctor, Moana shows a break glass prompt before the record opens, and the access is written to the audit log for review, as described on the trust page.

Sources

1. NIST SP 800 66 Revision 2: Implementing the HIPAA Security Rule, a cybersecurity resource guide, National Institute of Standards and Technology, 2024
2. Log analysis of human computer interactions regarding break the glass accesses to genetic reports, ICEIS 2013, SCITEPRESS, 2013
3. On the spot email interventions reduce repeat medical record snooping incidents by 95%, HIPAA Journal, reporting a JAMA Network Open study, 2022