Which statement best captures what the Audit Trail should monitor?

• A. Only system uptime
• B. A log of data-access and exchange events; monitor user actions, data viewed/shared, sources, destinations, and errors
• C. Only the number of records exchanged
• D. Only authentication events

Answer: (B)

Auditing in healthcare data exchange is about creating a complete record of who did what with data, when, and where it traveled, including any issues that occurred. The best answer emphasizes a log of data-access and exchange events that captures user actions, what data was viewed or shared, the sources and destinations involved, and any errors.

This comprehensive approach matters because it provides accountability and traceability. If a patient’s record is accessed, moved, or shared, the audit log should show who did it, what exactly was accessed or transmitted, where it came from, where it went, and whether any problems occurred during the exchange. This enables investigations, supports privacy compliance, and helps detect improper use or failures in the workflow.

Other options fall short because they only track a single aspect of activity. System uptime tells you nothing about who accessed data or what was done with it. Recording only the number of records exchanged misses who performed the action and the specifics of the data involved. Logging only authentication events captures login activity but not the data-access actions or data flows, so it doesn’t provide a full picture of data exchange activity.