[Paper Review] Usability and Security of Different Authentication Methods for an Electronic Health Records System

Saptarshi Purkayastha, Shreya Goyal+4 more|arXiv (Cornell University)|Feb 23, 2021

User Authentication and Security Systems16 references4 citations

TL;DR

This study evaluates the usability and security of three electronic health records (EHR) authentication methods—username/password, CAS single sign-on, and bio-capsule facial recognition—among 67 graduate students. Using PLS-SEM modeling, it finds that perceived security positively influences usability, with facial authentication emerging as the most secure and usable method due to high confidence and satisfaction scores.

ABSTRACT

We conducted a survey of 67 graduate students enrolled in the Privacy and Security in Healthcare course at Indiana University Purdue University Indianapolis. This was done to measure user preference and their understanding of usability and security of three different Electronic Health Records authentication methods: single authentication method (username and password), Single sign-on with Central Authentication Service (CAS) authentication method, and a bio-capsule facial authentication method. This research aims to explore the relationship between security and usability, and measure the effect of perceived security on usability in these three aforementioned authentication methods. We developed a formative-formative Partial Least Square Structural Equation Modeling (PLS-SEM) model to measure the relationship between the latent variables of Usability, and Security. The measurement model was developed using five observed variables (measures). - Efficiency and Effectiveness, Satisfaction, Preference, Concerns, and Confidence. The results obtained highlight the importance and impact of these measures on the latent variables and the relationship among the latent variables. From the PLS-SEM analysis, it was found that security has a positive impact on usability for Single sign-on and bio-capsule facial authentication methods. We conclude that the facial authentication method was the most secure and usable among the three authentication methods. Further, descriptive analysis was done to draw out the interesting findings from the survey regarding the observed variables.

Motivation & Objective

• To assess user preferences and perceptions of usability and security across three EHR authentication methods.
• To investigate the relationship between perceived security and usability in EHR systems.
• To identify which authentication method offers the optimal balance between security and usability for healthcare applications.
• To examine how user confidence, satisfaction, and concerns influence the adoption of different authentication mechanisms.

Proposed method

• Conducted a survey with 67 graduate students from a Privacy and Security in Healthcare course at Indiana University Purdue University Indianapolis.
• Evaluated three authentication methods: username/password, CAS single sign-on, and bio-capsule facial authentication.
• Developed a formative-formative Partial Least Square Structural Equation Modeling (PLS-SEM) framework to analyze latent variables: Usability and Security.
• Measured usability and security through five observed variables: Efficiency and Effectiveness, Satisfaction, Preference, Concerns, and Confidence.
• Used PLS-SEM to assess the causal relationship between perceived security and usability across the three methods.
• Performed descriptive analysis to extract insights on user behavior and perception trends.

Experimental results

Research questions

• RQ1 How do users perceive the usability and security of username/password, CAS single sign-on, and facial authentication in EHR systems?
• RQ2 What is the relationship between perceived security and perceived usability across different authentication methods?
• RQ3 Which authentication method is preferred by users and why, based on usability and security perceptions?
• RQ4 To what extent do user concerns and confidence levels influence the choice of authentication method?
• RQ5 How do efficiency, effectiveness, and satisfaction vary across the three authentication methods?

Key findings

• Facial authentication was perceived as the most secure and usable method among the three, with the highest user confidence and satisfaction scores.
• Perceived security had a positive and significant impact on perceived usability for both CAS single sign-on and facial authentication methods.
• The PLS-SEM model confirmed a statistically significant relationship between security and usability, particularly in biometric and SSO methods.
• Users expressed greater concerns about the username/password method, citing lower confidence and higher perceived vulnerability.
• Preference and satisfaction were highest for facial authentication, indicating strong user acceptance of biometric solutions in EHR contexts.
• Efficiency and effectiveness were rated most highly for facial authentication, suggesting faster and more reliable access compared to traditional credentials.