Privacy, confidentiality, security and patient safety concerns about electronic health records

The electronic health record: does it enhance or distract from patient safety?

PURPOSE OF REVIEW

The electronic health record (EHR) is an invaluable tool that may be used to improve patient safety. With a variety of different features, such as clinical decision support and computerized physician order entry, it has enabled improvement of patient care throughout medicine. EHR allows for built-in reminders for such items as antibiotic dosing and venous thromboembolism prophylaxis.

RECENT FINDINGS

In anesthesiology, EHR often improves patient safety by eliminating the need for reliance on manual documentation, by facilitating information transfer and incorporating predictive models for such items as postoperative nausea and vomiting. The use of EHR has been shown to improve patient safety in specific metrics such as using checklists or information transfer amongst clinicians; however, limited data supports that it reduces morbidity and mortality.

SUMMARY

There are numerous potential pitfalls associated with EHR use to improve patient safety, as well as great potential for future improvement.

Implementation of digital chest radiography for childhood tuberculosis diagnosis at district hospital level in six high tuberculosis burden and resources limited countries

OBJECTIVES

Chest x-ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource-limited settings. Digital CXR (d-CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d-CXR in 12 district hospitals (DHs) in 2021-2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB-speed decentralisation study on childhood TB diagnosis.

METHODS

For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d-CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d-CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d-CXRs and site support supervision reports.

RESULTS

Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d-CXR, including 1505, 136 and 1 children with one, two and three d-CXRs, respectively, resulting in a total of 1780 d-CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty-four children had no d-CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d-CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d-CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d-CXRs due to limited internet access.

CONCLUSION

d-CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges.

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks

BACKGROUND

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Ethical predicaments and countermeasures in nursing informatics

With the increasing use of technology in nursing, how nurses perform practice care has changed, inevitably leading to ethical concerns that differ from original ethical norms in nursing. Studies have focused on ethical issues in health informatics from clinicians' or patients' perspectives, while nurses' perspective is needed. This paper conducts a theoretical study on ethical predicaments that arise in nursing informatics from nurses' perspectives. Why and how these predicaments emerge are elaborated. Also, this paper offers countermeasures in realistic contexts from technique, education, and leadership aspects. Collaborations between governments, administrators, educators, technicians, and nurses are needed to step out of these predicaments.

Medical Image sharing: What do the public see when reviewing radiographs? A pilot study

INTRODUCTION

Policymakers wish to extend access to medical records, including medical imaging. Appreciating how patients might review radiographs could be key to establishing future training needs for healthcare professionals and how image sharing could be integrated into practice.

METHOD

A pilot study in the UK using a survey was distributed to adult participants via the online research platform Prolific. All subjects were without prior professional healthcare experience. Participants reviewed ten radiographs (single projection only) and were asked a two-stage question. Firstly, if the radiograph was 'normal' or 'abnormal' and secondly, if they had answered 'abnormal', to identify the abnormality from a pre-determined list featuring generic terms for pathologies.

RESULTS

Fifty participants completed the survey. A mean of 65.8 % of participants were able to correctly identify if radiographs were normal or abnormal. Results in relation to the identification of a pathology were not as positive, but still notable with a mean of 46.4 % correctly identifying abnormalities. Qualitative data demonstrated that members of the public are enthralled with reviewing radiographs and intrigued to understand their performance in identifying abnormalities.

CONCLUSION

In the pilot, members of the public could identify if a radiograph is normal or abnormal to a reasonable standard. Further detailed interpretation of images requires supportive intervention. This pilot study suggests that patients can participate in image sharing as part of their care. Image sharing may be beneficial to the therapeutic relationship, aiding patient understanding and enhancing consultations between healthcare professional and patient. Further research is indicated.

Reliability and validity of the Chinese version of the Information Security Attitude Questionnaire for nurses

AIM

Nurses play a crucial role within medical institutions, maintaining direct interaction with patient data. Despite this, there is a scarcity of tools for evaluating nurses' perspectives on patient information security. This study aimed to translate the Information Security Attitude Questionnaire into Chinese and validate its reliability and validity among clinical nurses.

DESIGN

A cross-sectional design.

METHODS

A total of 728 clinical nurses from three hospitals in China participated in this study. The Information Security Attitude Questionnaire (ISA-Q) was translated into Chinese utilizing the Brislin two-way translation method. The reliability was assessed through internal consistency coefficient and test-retest reliability. The validity was determined through the Delphi expert consultation method and factor analysis.

RESULTS

The Chinese version of ISA-Q consists of 30 items. Cronbach's α coefficient of the questionnaire was 0.930, and Cronbach's α coefficient of the six dimensions ranged from 0.781 to 0.938. The split-half reliability and test-retest reliability were 0.797 and 0.848, respectively. The content validity index (S-CVI) was 0.962. Exploratory factor analysis revealed a 6-factor structure supported by eigenvalues, total variance interpretation, and scree plots, accounting for a cumulative variance contribution rate of 69.436%. Confirmatory factor analysis further validated the 6-factor structure, demonstrating an appropriate model fit.

CONCLUSION

The robust reliability and validity exhibited by the Chinese version of ISA-Q establish it as a dependable tool for evaluating the information security attitudes of clinical nurses.

IMPLICATIONS FOR NURSING PRACTICE

The Chinese iteration of the ISA-Q questionnaire offers a profound insight into the information security attitudes held by clinical nurses. This understanding serves as a foundation for nursing managers to develop targeted intervention strategies aimed at fortifying nurses' information security attitudes, thereby enhancing patient safety.

Patients' Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review

BACKGROUND

Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients' confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter.

OBJECTIVE

This systematic review aims to investigate patients' perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps.

METHODS

Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022.

RESULTS

A total of 33 articles exploring mHealth patients' perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients' awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive.

CONCLUSIONS

Patients expressed diverse views on mHealth apps' privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients' awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use.

TRIAL REGISTRATION

PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca.

Post-quantum healthcare: A roadmap for cybersecurity resilience in medical data

As healthcare systems transition into an era dominated by quantum technologies, the need to fortify cybersecurity measures to protect sensitive medical data becomes increasingly imperative. This paper navigates the intricate landscape of post-quantum cryptographic approaches and emerging threats specific to the healthcare sector. Delving into encryption protocols such as lattice-based, code-based, hash-based, and multivariate polynomial cryptography, the paper addresses challenges in adoption and compatibility within healthcare systems. The exploration of potential threats posed by quantum attacks and vulnerabilities in existing encryption standards underscores the urgency of a change in basic assumptions in healthcare data security. The paper provides a detailed roadmap for implementing post-quantum cybersecurity solutions, considering the unique challenges faced by healthcare organizations, including integration issues, budget constraints, and the need for specialized training. Finally, the abstract concludes with an emphasis on the importance of timely adoption of post-quantum strategies to ensure the resilience of healthcare data in the face of evolving threats. This roadmap not only offers practical insights into securing medical data but also serves as a guide for future directions in the dynamic landscape of post-quantum healthcare cybersecurity.

Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future

Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.

Privacy concerns among the users of a national patient portal: A cross-sectional population survey study

INTRODUCTION

Seeking and receiving care requires disclosure of personal information which is recorded as health data in electronic health records. Thereafter, restricting the flow of information is dependent on data protection, information security, ethical conduct, and law. Privacy concerns may arise as patients' options concerning privacy have been balanced to cater both the privacy of patients and the needs of healthcare, as well as secondary use of data.

METHODS

This study examined privacy concerns among the users of a national patient portal in a representative sample of Finnish adults aged 20 to 99 years old (n = 3,731). We used logistic regression analysis with population weights to seek answers to which factors are associated with privacy concerns. The cross-sectional survey data was collected in 2020.

RESULTS

Every third patient portal user had privacy concerns. Those who were 50 to 59 years old (p = 0.030) had privacy concerns more often than 20 to 49-year-olds. Those who had financial difficulties (p = 0.003) also had privacy concerns more often while those, who had good digital skills (p=<0.026), did not need guidance on telehealth service use (p=<0.001) and found telehealth service use to be beneficial (p = 0.008), had privacy concerns less often.

CONCLUSION

The usefulness of telehealth seems to play an important role in privacy concerns. Another important factor is the skills required to use telehealth services. We encourage providing guidance to those who lack the necessary skills for telehealth service use. We also encourage putting effort not only into data protection and information security measures of telehealth services, but also into providing transparent and comprehensible privacy information for the service users as privacy concerns are common.

Preferences for onward health data use in the electronic age among maternity patients and providers in South Africa: a qualitative study

Despite the expanding digitisation of individual health data, informed consent for the collection and use of health data is seldom explicitly sought in public sector clinics in South Africa. This study aims to identify perceptions of informed consent practices for health data capture, access, and use in Gauteng and the Western Cape provinces of South Africa. Data collection from September to December 2021 included in-depth interviews with healthcare providers (n = 12) and women (n = 62) attending maternity services. Study findings suggest that most patients were not aware that their data were being used for purposes beyond the individualised provision of medical care. Understanding the concept of anonymised use of electronic health data was at times challenging for patients who understood their data in the limited context of paper-based folders and booklets. When asked about preferences for electronic data, patients overwhelmingly were in favour of digitisation. They viewed electronic access to their health data as facilitating rapid and continuous access to health information. Patients were additionally asked about preferences, including delivery of health information, onward health data use, and recontacting. Understanding of these use cases varied and was often challenging to convey to participants who understood their health data in the context of information inputted into their paper folders. Future systems need to be established to collect informed consent for onward health data use. In light of perceived ties to the care received, these systems need to ensure that patient preferences do not impede the content nor quality of care received.

Saudi Health System and Health Security Structure: A Scope Review Study Addressing the National Need for Governing the Health Security

Health security has gained significant attention at the national and global levels, "security" is not a simple term; instead, it is "essentially contested" - that is, it induces debates about what it means and how to use it. This study aimed to define three terms frequently used in health security discussions. These terms are national health security, Global Health Security, and public health. The research method was a scoping review performed in three stages. The first stage was electronic searching based on selection criteria among multiple sources at various time points during the year 2023. These sources included online literature searches, websites of non-governmental organizations (NGOs), and other governmental health agencies. The second stage involved determining the relevance of the selected papers to the study's objectives; the selected papers had moderate to high relevance to the study's objectives. The third stage was to evaluate the methodological quality of a study; we selected peer-reviewed published papers and websites recognized as trustworthy sources of information. The search yielded 143 articles; five met the inclusion criteria and were subjected to the definition of health security. Despite proposed definitions, agreement has yet to be reached on the content and scope of health security. Another main finding is that health security requires more state and international collaboration efforts to reach Global Health Security. To the best of our knowledge, no known government body or organization is responsible for governing health security in Saudi Arabia. However, the current study presents a definition of health security and differentiates it from the public health approach, in addition to emphasizing the importance of governing the related health sectors within each country in order to improve health security and have a positive impact on overall Global Health Security.

Challenges and Solutions in Implementing eSource Technology for Real-World Studies in China: Qualitative Study Among Different Stakeholders

BACKGROUND

eSources consist of data that were initially documented in an electronic structure. Typically, an eSource encompasses the direct acquisition, compilation, and retention of electronic information (such as electronic health records [EHRs] or wearable devices), which serves to streamline clinical research. eSources have the potential to enhance the accuracy of data, promote patient safety, and minimize expenses associated with clinical trials. An opinion study published in September 2020 by TransCelerate outlined a road map for the future application of eSource technology and identified 5 key areas of challenges. The background of this study concerns the use of eSource technology in clinical research.

OBJECTIVE

The aim of this study was to present challenges and possible solutions for the implementation of eSource technology in real-world studies by summarizing team experiences and lessons learned from an eSource record (ESR) project.

METHODS

After initially developing a simple prototype of the ESR software that can be demonstrated systematically, the researchers conducted in-depth interviews and interacted with different stakeholders to obtain guidance and suggestions. The researchers selected 5 different roles for interviewees: regulatory authorities, pharmaceutical company representatives, hospital information department employees, medical system providers, and clinicians.

RESULTS

After screening all consultants, the researchers concluded that there were 25 representative consultants. The hospital information department needs to implement many demands from various stakeholders, which makes the existing EHR system unable to meet all the demands of eSources. The emergence of an ESR is intended to divert the burden of the hospital information department from the enormous functional requirements of the outdated EHR system. The entire research process emphasizes multidisciplinary and multibackground expert opinions and considers the complexity of the knowledge backgrounds of personnel involved in the chain of clinical source data collection, processing, quality control, and application in real-world scenarios. To increase the readability of the results, the researchers classified the main results in accordance with the paragraph titles in "Use of Electronic Health Record Data in Clinical Investigations," a guide released by the US Food and Drug Administration.

CONCLUSIONS

This study introduces the requirement dependencies of different stakeholders and the challenges and recommendations for designing ESR software when implementing eSource technology in China. Experiences based on ESR projects will provide new insights into the disciplines that advance the eSource research field. Future studies should engage patients directly to understand their experiences, concerns, and preferences regarding the implementation of eSource technology. Moreover, involving additional stakeholders, including community health care providers and social workers, will provide valuable insights into the challenges and potential solutions across various health care settings.

Security, confidentiality, privacy and patient safety in the hospital information systems from the users' perspective: A cross-sectional study

INTRODUCTION

Patient safety maintenance and improvement is an expected core function of Hospital Information Systems (HISs). Patient safety can be affected by the privacy, confidentiality, and security of patient information. This study aimed to evaluate the security, confidentiality, privacy, and patient safety in the HISs from the users' perspective.

METHODS

A descriptive, analytical, cross-sectional study was conducted in five teaching hospitals affiliated with Zahedan University of Medical Sciences in 2022. The research population consisted of users of HISs in the nursing, medical records, radiology, laboratory, and pharmacy departments. The sample included 397 participants. The data were collected using a researcher-made questionnaire and analyzed with the SPSS software using descriptive (mean, standard deviation, frequency, and percentage) and analytical (Pearson, Spearman, and chi-square tests) statistics.

RESULTS

The mean score of patient information privacy, confidentiality, security, and patient safety was 3.19 ± 0.585, 2.48 ± 1.143, 2.53 ± 0.940, and 2.60 ± 0.959, respectively. Patient safety had a strong positive correlation with security and confidentiality, and a moderate positive correlation with patient information privacy (P < 0.05).

CONCLUSION

The given HISs were at a relatively desirable level in terms of information privacy, security, and patient safety and at an undesirable level concerning confidentiality from the users' perspective. Developing guidelines and regulations regarding the privacy, confidentiality, security, and patient safety of HISs, supervising their implementation by responsible agencies and departments, and educating and training healthcare professionals about these concepts are essential to improve the existing situation in HISs of the evaluated hospitals.

Genetic Data Governance in Japanese Hospitals

The storage and access of genetic testing results have unique considerations for medical records. Initially, genetic testing was limited to patients with single gene diseases. Genetic medicine and testing have expanded, as have concerns about appropriately handling genetic information. In this study, we surveyed the management of genetic information in general hospitals in Japan using a questionnaire on access restrictions. Our questions included whether any other medical information was managed in a unique way. We identified 1037 hospitals designated for clinical training located throughout Japan and received responses from 258 hospitals, and 191 reported that they handle genetic information and results of genetic tests. Of the 191 hospitals that handle genetic information, 112 hospitals implement access restrictions to genetic information. Seventy-one hospitals, one of which uses paper medical records rather than electrical medical records, do not enforce access restrictions. For eight hospitals, it was not known whether access restrictions were enforced or not. The responses from these hospitals indicated that access restrictions and storage methods varied across institution type (e.g., general vs. university hospitals), institution size, and the presence of a clinical genetics department. Other information, such as infectious disease diagnosis, psychological counseling records, abuse, and criminal history, was also subject to access restriction in 42 hospitals. The disparity in how medical facilities handle sensitive genetic information demonstrates a need for discussion between medical professionals and the general public on the storage of sensitive records, including genetic information.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41649-023-00242-9.

The Integrated Electronic Health System in Iranian health centers: benefits and challenges

BACKGROUND

Electronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran.

METHODS

This was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis.

RESULTS

Overall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research.

CONCLUSIONS

In the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems.

Promise of Real-World Evidence for Patient Centricity in Gulf Cooperation Council Countries: Call to Action

Presently, Gulf Cooperation Council countries are lagging in the generation of real-world data and use of real-world evidence for patient-centered care compared with the global average. In a collaborative effort, experts from multiple domains of the healthcare environment from the Gulf Cooperation Council countries came together to present their views and recommended key action points for the generation of robust real-world data and leveraging real-world evidence in the countries. The opinions of the experts are presented, along with existing barriers to the effective generation of real-world evidence in the countries. The Gulf Cooperation Council countries are undergoing transformative changes paving the way for improved healthcare measures; however, the challenges in generating reliable, robust, accessible, and secure real-world evidence are persistent. Hence, ongoing public-private engagements, as well as collaborations between regulators, policymakers, healthcare professionals, insurance and pharmaceutical companies, and patients, are warranted. A few notable examples of real-world evidence studies highlighting the benefits of real-world evidence for gaining valuable insights into patient-centric decision making are also discussed. The actionable steps identified for successful real-world evidence generation would provide long-term, real-world evidence-based patient-centric benefits for the countries.

Nurse Information Security Policy Compliance, Information Competence, and Information Security Attitudes Predict Information Security Behavior

Nurses' attitudes toward information security can influence the hospital's information resources management and development. This study investigated the relationships between nurses' information security policy compliance, information competence, and information security attitudes, which are factors that influence information security behavior. Data were collected during September 2020. The participants were 200 clinical nurses from a general hospital in Korea. The self-reported questionnaire included questions on nurses' general characteristics, information security policy compliance, information competence, and information security attitudes. Information security policy compliance (r = 0.554, P < .001) and information competence (r = 0.614, P < .001) were positively associated with information security attitudes. Predictors of nurses' information security attitudes were information competence (β = .439), information security policy compliance (β = .343), prior information security-related education (β = .113), and job position (nurse manager; β = .101). Implications for practice include the need for strategies to develop information security policy compliance and information competence to improve information security behavior, including different approaches tailored to nurses' job positions and previous information security education.

Patient's behavior of selection physician in online health communities: Based on an Elaboration likelihood model

Background

With the rapid development of "Internet + medicine" and the impact of the COVID-19 epidemic, online health communities have become an important way for patients to seek medical treatment. However, the mistrust between physicians and patients in online health communities has long existed and continues to impact the decision-making behavior of patients. The purpose of this article is to explore the influencing factors of patient decision-making in online health communities by identifying the relationship between physicians' online information and patients' selection behavior.

Methods

In this study, we selected China's Good Doctor (www.haodf.com) as the source of data, scrapped 10,446 physician data from December 2020 to June 2021 to construct a logit model of online patients' selection behavior, and used regression analysis to test the hypotheses.

Results

The number of types of services, number of scientific articles, and avatar in physicians' personal information all has a positive effect on patients' selection behavior, while the title and personal introduction hurt patients' selection behavior. Online word-of-mouth positively affected patients' selection behavior and disease risk had a moderating effect.

Conclusion

Focusing on physician-presented information, this article organically combines the Elaboration likelihood model with trust source theory and online word-of-mouth from the perspective of the trusted party-physician, providing new ideas for the study of factors influencing patients' selection behavior in online health communities. The findings provide useful insights for patients, physicians, and community managers about the relationship between physician information and patients' selection behavior.

Using Telemedicine during the COVID-19 Pandemic: How Service Quality Affects Patients' Consultation

The COVID-19 epidemic put pressure on the traditional healthcare system and offline consultation methods. Telemedicine platforms provide a more convenient and safer channel for online health communication. Based on the signaling theory, our study explores the impacts of three dimensions of physicians' service quality (need fulfillment, security, and responsiveness) on online patient consultation on telemedicine platforms. A negative binomial model was used to test cross-sectional data of 2982 physicians obtained from Haodf.com. The results show the following: (1) the need fulfillment dimension variables positively affect online patient consultation; (2) the security dimension variables positively affect online patient consultation; (3) the responsiveness dimension variables positively affect online patient consultation. Our results contribute to the theoretical aspect of signaling theory and service quality in the context of telemedicine platforms and have several practical implications for telemedicine platform physicians and platform operators.

Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors

PURPOSE

To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand.

METHODS

A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics.

RESULTS

Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%).

CONCLUSION

Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.

Electronic patient record and its effects on social aspects of interprofessional collaboration and clinical workflows in hospitals (eCoCo): a mixed methods study protocol

Background

The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records.

Methods

eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows.

Discussion

This study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records.

Trial registration

The study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.

Knowledge and Practice of Patients' Data Sharing and Confidentiality Among Nurses in Jordan

BACKGROUND

The key patient rights entail respecting human decency, receiving healthcare services of high-quality, the right to information, the initial agreement of the patient to medical intervention, respecting privacy and personal life, and sustaining care and treatment. This study aims to survey the knowledge and practice of nurses in various healthcare industries toward sharing and confidentiality of patients' data.

METHODS

A descriptive cross-sectional design was employed through an online survey from May to June 2020. The authors sent a developed tool containing 19 statements reflecting the understanding of nurses' knowledge and practice of privacy and sharing of data required to safeguard patient privacy. A total of 800 nurses agreed to participate in the study out of 1000 nurses.

RESULTS

Roughly, all participants agreed that junior nurses should participate in a data sharing and confidentiality course before engaging in practice. Regarding institution policies for data sharing and protection, many nurses agreed that there are special recommendations and instructions from the institution in which they work to exchange patient information among nurses and the medical staff. The predictors of sharing practices and confidentiality among nurses include age, gender, marriage status, and attending a security course before practice. Young age, female, not attending a data sharing course, and single nurses are less engaging with data sharing and confidentiality of the patients for unauthorized patients.

CONCLUSION

A significant proportion of the staff had appropriate practices that ensured data security. However, practices that ensure patient confidentiality in the aspects of access, sharing, and transferring of patient data need improvement. Training is essential since it will have a beneficial relationship with knowledge, opinions, views, and actions. Thus, planning continuous training on policies and regulations about data safety and privacy may assist in improving healthcare setting practices.