Efficient Ratcheting: Almost-Optimal Guarantees for Secure Messaging

2019 ◽  
pp. 159-188 ◽  
Author(s):  
Daniel Jost ◽  
Ueli Maurer ◽  
Marta Mularczyk
Keyword(s):  
Secure Messaging

Performance and Scalability Assessment for Non-Certificate-Based Public Key Management in VANETs

2012 ◽  
Vol 6 (1) ◽  
pp. 33-56 ◽  
Author(s):  
Pei-Yuan Shen ◽  
Maolin Tang ◽  
Vicky Liu ◽  
William Caelli
Keyword(s):  
Key Management ◽  
Vehicular Ad Hoc Networks ◽  
Ad Hoc ◽  
Comprehensive Evaluation ◽  
Public Key ◽  
Secure Messaging ◽  
Evaluation Of Performance ◽  
Management Regime ◽  
Verification Process ◽  
Hoc Networks

Current research in secure messaging for Vehicular Ad hoc Networks (VANETs) focuses on employing a digital certificate-based Public Key Cryptosystem (PKC) to support security. However, the security overhead of such a scheme creates a transmission delay and introduces a time-consuming verification process to VANET communications. This paper proposes a non-certificate-based public key management for VANETs. A comprehensive evaluation of performance and scalability of the proposed public key management regime is presented, which is compared with a certificate-based PKC by employing a number of quantified analyses and simulations. In this paper, the authors demonstrate that the proposal can maintain security and assert that it can improve overall performance and scalability at a lower cost, compared with certificate-based PKC. The proposed scheme adds a new dimension to key management and verification services for VANETs.

scholarly journals PositiveLinks and the COVID-19 Response: Importance of Low-Barrier Messaging for PLWH in Non-urban Virginia in a Crisis

2021 ◽  
Author(s):  
Breanna R. Campbell ◽  
Sabrina Swoger ◽  
Alexa Tabackman ◽  
Eleanor Hilgart ◽  
Benjamin Elliott ◽  
...  
Keyword(s):  
Poisson Regression ◽  
Social Issues ◽  
Patient Care Team ◽  
People Living With Hiv ◽  
Evidence Based ◽  
Engagement In Care ◽  
Healthcare Resources ◽  
Secure Messaging ◽  
Rapport Building ◽  
Living With Hiv

AbstractPositiveLinks (PL) is an evidence-based mobile health intervention promoting engagement in care for people living with HIV. PL offers secure, in-app patient-provider messaging. We investigated messaging during the early COVID-19 pandemic, comparing messages exchanged between 01/13/2020 and 03/01/2020 (“Pre-COVID”) to messages exchanged between 03/02/2020 and 04/19/2020 (“early COVID”) using Poisson regression. We performed qualitative analysis on a subset of messages exchanged between 02/01/2020 and 03/31/2020. Between “Pre-COVID” and “early COVID” periods, weekly member and provider messaging rates increased significantly. Of the messages analyzed qualitatively, most (53.3%) addressed medical topics, and more than a fifth (21.3%) addressed social issues. COVID-related messages often focused on care coordination and risk information; half of COVID messages contained rapport-building. PL patients (“members”) and providers used in-app secure messaging to reach out to one another, identifying needs, organizing receipt of healthcare resources, and strengthening patient-care team relationships. These findings underscore the importance of low-barrier messaging during a crisis.

scholarly journals Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives (Preprint)

2020 ◽  
Author(s):  
Joseph E Glass ◽  
Theresa E Matson ◽  
Catherine Lim ◽  
Andrea L Hartzler ◽  
Kilian Kimbel ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Opioid Use Disorder ◽  
User Centered Design ◽  
Opioid Use ◽  
Kaiser Permanente ◽  
Secure Messaging ◽  
Phone Calls ◽  
Drug Use Disorders ◽  
User Centered

BACKGROUND Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. OBJECTIVE This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. METHODS The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. RESULTS Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). CONCLUSIONS A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.

scholarly journals A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? (Preprint)

2019 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

BACKGROUND Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. OBJECTIVE This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. METHODS We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). RESULTS Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. CONCLUSIONS Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

scholarly journals Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: A Development Pilot Series

2013 ◽  
Vol 41 (4) ◽  
pp. 383-397 ◽  
Author(s):  
Richard Stott ◽  
Jennifer Wild ◽  
Nick Grey ◽  
Sheena Liness ◽  
Emma Warnock-Parkes ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Randomized Controlled Trials ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Controlled Trials ◽  
Secure Messaging ◽  
Face To Face ◽  
Randomized Controlled ◽  
The Face

Background: Randomized controlled trials have established that individual cognitive therapy based on the Clark and Wells (1995) model is an effective treatment for social anxiety disorder that is superior to a range of alternative psychological and pharmacological interventions. Normally the treatment involves up to 14 weekly face-to-face therapy sessions. Aim: To develop an internet based version of the treatment that requires less therapist time. Method: An internet-delivered version of cognitive therapy (iCT) for social anxiety disorder is described. The internet-version implements all key features of the face-to-face treatment; including video feedback, attention training, behavioural experiments, and memory focused techniques. Therapist support is via a built-in secure messaging system and by brief telephone calls. A cohort of 11 patients meeting DSM-IV criteria for social anxiety disorder worked through the programme and were assessed at pretreatment and posttreatment. Results: No patients dropped out. Improvements in social anxiety and related process variables were within the range of those observed in randomized controlled trials of face-to-face CT. Nine patients (82%) were classified as treatment responders and seven (64%) achieved remission status. Therapist time per patient was only 20% of that in face-to-face CT. Conclusions: iCT shows promise as a way of reducing therapist time without compromising efficacy. Further evaluation of iCT is ongoing.

Evaluation of Secure Mobile and Clinical Communication Solution (SMaCCS) across acute and community practice settings

2020 ◽  
Vol 7 (1) ◽  
pp. 109-116
Author(s):  
Sean P Spina ◽  
Kristin M Atwood ◽  
Peter Loewen
Keyword(s):  
Survey Data ◽  
Secure Communication ◽  
Healthcare Providers ◽  
Community Practice ◽  
Communication Tool ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Clinical Communication ◽  
Study Island ◽  
System Data

AimsClinicians struggle to provide information to each other that supports safe patient transitions, especially across acute and community care jurisdictions. They need flexible communication tools to improve care coordination. Island Health introduced a Secure Mobile and Clinical Communication Solution (SMaCCS) to address these challenges in 2018. In this study we evaluated the SMaCCS system to understand the (1) volume and flow of healthcare communication, (2) degree of adoption and accessibility of the system and (3) user experience.MethodsThis was a prospective, cross-sectional, observational study. Island Health Information Management/Information Technology (IMIT) selected Vocera Collaboration Suite as the secure messaging platform. We invited healthcare providers in various roles in the hospital and community to use SMaCCS for their daily communications and system and survey data were collected between February and August 2018. System data and survey data were used to determine outcomes.ResultsA Sankey diagram represents the volume and flow of communication. A total of 2542 messages were sent and 79% of conversations included more than a single message. Eighty-one per cent of participants agreed that using a secure communication tool made them feel more comfortable sharing patient information. Most users (65%) perceived that the application was a useful method for transmitting simple information.ConclusionHowever, our study showed that different occupational roles require different frequencies and volumes of communication and there are numerous barriers to adoption that must be addressed before secure messaging can be an effective, ubiquitous method of clinical communication.

Novel use of existing technology: A preliminary study of patient portal use for telerehabilitation

2020 ◽  
pp. 1357633X2095017
Author(s):  
Susan S Conroy ◽  
Stacey Harcum ◽  
Linda Keldsen ◽  
Christopher T Bever
Keyword(s):  
Care Delivery ◽  
Health Service Delivery ◽  
Patient Portal ◽  
Significant Other ◽  
Patient Portals ◽  
Secure Messaging ◽  
Exercise Time ◽  
Stroke Population ◽  
Therapist Communication ◽  
Randomised Controlled

Patient portals (PPs) foster engagement and self-management of chronic disease and are emerging as extensions of the care continuum. Utilisation from a health service delivery perspective is growing; however, it is a relatively new model of care in the field of rehabilitation. This pilot, within a larger randomised controlled stroke rehabilitation trial, explored the feasibility and acceptance of secure messaging using an established nationwide PP system for e-visits. Fifteen participants with stroke-related arm disability were randomised to 6 weeks of home arm telerehabilitation. All were over the age of 60 and 73% lived with a spouse or significant other. Mean intervention time was 6.8 weeks, and participants sent 2.3 ± 1.4 messages per week to complete 15.1 h of reported therapy (prescribed therapy = 18 h). Portal use improved therapist efficiency and resulted in a 1:6 therapist to patient exercise time ratio compared with the conventional 1:1 ratio for in-person therapy. Low initial electronic health literacy, self-efficacy or cognitive scores did not prohibit utilisation, and satisfaction with secure messaging for patient–therapist communication was 3.5 ± 1.2 out of 5. Overall, PP-supported e-visits were a feasible and acceptable telerehabilitation care delivery method for this chronic stroke population. ClinicalTrials.gov Identifier NCT02665052. Registered 27 January 2016. https://clinicaltrials.gov/ct2/show/NCT02665052

scholarly journals Secure Messaging, Diabetes Self‐Management, and the Importance of Patient Autonomy: A Mixed Methods Study

2020 ◽  
Vol 55 (S1) ◽  
pp. 41-42
Author(s):  
S. Robinson ◽  
M. Zocchi ◽  
D. Netherton ◽  
A. Ash ◽  
C. Purington ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Autonomy ◽  
Mixed Methods Study ◽  
Self Management ◽  
Secure Messaging

scholarly journals Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037064 ◽  
Author(s):  
Vess Stamenova ◽  
Payal Agarwal ◽  
Leah Kelley ◽  
Jamie Fujioka ◽  
Megan Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secure Messaging ◽  
Communication Modality ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.

scholarly journals AGE- AND ETHNICITY-RELATED DISPARITIES IN TECHNOLOGY USE AMONG HIGH-RISK VETERANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S333-S334
Author(s):  
Kiranmayee Muralidhar ◽  
Willy Marcos Valencia ◽  
Kaicheng Wang ◽  
Diana Ruiz ◽  
Carlos Gomez-Orozco ◽  
...  
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Functional Ability ◽  
Technology Use ◽  
Veterans Affairs ◽  
High School Education ◽  
Secure Messaging ◽  
Black African ◽  
Disabled Veterans ◽  
Higher Functioning

Abstract Using predictive analytic modelling, the Veterans Affairs has identified Veterans considered to be High Need High Risk (HNHR) requiring increased support. This pilot study sent needs assessment questionnaires to 1112 HNHR Veterans to better understand gaps regarding technology use, access, physical function, and mobility. There were 341(30.7%) respondents: 270(80.4%) Non-Hispanic, 64(18.8%) Hispanic/Latino; 210(61.6%) White, 119(34.9%) Black/African Americans; and 310(90.4%) had ≥high school education. Average Barthel(ADL) score was 81.5±22.8 and Lawton(IADL) score was 5.8±2.2. Younger Veterans (age<70) were more likely able to use Internet ((117(65%) vs 74(46%)),(p≤0.01) and email (106(58.9%) vs 67(41.6%),( p≤0.01). They were also more likely enrolled in MyHealtheVet (87(48.3%) vs 58(36%),(p=0.043). Secure messaging was used by 62(34.3%) younger and 37(23%) older Veterans,(p=0.026). More higher functioning Veterans (140(55.1%)) used email than lower functioning (33(37.9%)),(p=0.018). Among higher functioning Veterans, 148(58.3%) were willing to use videoconference for care coordination and 116(45.7%) owned a smartphone or computer with camera for this; more than lower functioning Veterans (33(37.9%) and 28(32.2%)), (p≤0.01 for both). Less dependent Veterans preferred to be contacted via cellphone (88(62.4%)) or Internet (10(7.1%)) compared to the more dependent (96(48%) and 6(3%)) respectively (p=0.01). Only 71(44.1%) of older Veterans were willing to use videoconference (p≤0.01) and 54(33.5%) owned a smartphone or computer with camera,(p≤0.01). There are significant variations in technology use by age and ethnicity. However, although there are differences by functional ability, a significant number of disabled veterans are willing and able to use technology, and this may provide a way to address access barriers in this population.

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