Increased efficiency often comes at a price. Just ask Lutheran Medical Center, which had to move to a single sign-on system after installing a new electronic order-entry application that required it, and exacerbated its existing password confusion and access management problems.

The New York City-based health care provider, which sees 600,000 patients each year and has 4,000 employees, last year switched from a paper-based to an electronic order-entry system for better accuracy and timeliness of data entry as well as for improving the productivity of its physicians. "Few hospitals have electronic order-entry systems installed now, but many are moving in that direction because of the potential benefits they offer," says Steve Art, senior vice president and chief information officer for the health care provider.

But the tradeoff was that it opened up more security challenges for the IT staff, which is charged with ensuring that proper security checks are in place for all new applications. The new order-entry system required the use of a single sign-on system, which could address problems stemming from the sharing of central workstations as well as password confusion -- a move the hospital was planning to make but had not yet begun.

Hospitals, unlike other industries, often require users to share a central workstation: "No one walks into my office and starts using the computer, but it is quite common for many nurses, doctors, and administrators to share a central workstation on a hospital floor," Art says.

In the past, these health care users shared a common password to access a central workstation. "They were all caregivers, so if there was a lab test or something showing, they could all look at it," Art says. But the new order-entry system changed things: A doctor could not sign an order if a nurse was using the central workstation, for instance, and tracking doctors' signatures on their orders became tough to follow.

"When our orders were on paper, it was easy for us to follow the rules requiring doctors' signatures," Art says. "As the orders were automated, they were more difficult to track."

The switch to electronic order entry underscored another problem the hospital had struggled with for some time: password confusion. Once a health care administrator accessed a central workstation, he or she then had to enter a password and ID to access each individual application. A health care provider would work with a lab system, pharmacy system, and an order entry system, so many had at least five different passwords and IDs.

Not only did employees access a handful of different applications, but also, the passwords were routinely changed -- typically every 60- to 90 days. Many employees were frustrated with having to remember their multiple passwords, so the IT department had to find a way to consolidate the number of IDs while still keeping the systems secure.

So at the end of last year, Lutheran Medical Center began searching for an access and identity management system to address its access and password management problems. The company talked to a handful of vendors, including ActivIdentity, Encentuate, Imprivata, Passlogix, and IBM. The hospital selected Encentuate because of its shared-workstation features that let users customize their screens on the central workstations, as well as for its low price, Art says.

The Encentuate end-point identity and access management (IAM) suite was installed in the spring, first in the hospital's IT department. After that, a trial followed in a nursing station on one floor. "When we pulled the [trial] system out, the nurses complained, so we knew we were on the right track," said Art.

Now the IAM system is running in four departments, and it works with all of the hospital's applications. There was a problem, however, getting it to run when Encentuate moved the system to a new release, but Art says the problem was fixed quickly. Lutheran Medical Center expects the new system to be in place for all of its users by the end of the second quarter at the latest.

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