scholarly journals The Hippocratic Bargain and Health Information Technology

2010 ◽  
Vol 38 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Mark A. Rothstein
Keyword(s):  
Information Technology ◽  
Medical Care ◽  
Health Information Technology ◽  
Health Information ◽  
Fourth Century ◽  
Public Places ◽  
Ethical Foundation ◽  
Starting Point ◽  
Wide Range ◽  
Privacy And Confidentiality

Since the fourth century, B.C.E., the Oath of Hippocrates has been the starting point in analyzing the obligations of physicians to protect the privacy and confidentiality interests of their patients. The pertinent provision of the Oath reads as follows: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account must be spread abroad, I will keep to myself, holding such things shameful to be spoken about.”This part of the Oath is subject to more than one interpretation, but its commonly accepted meaning provides the ethical foundation for the physician’s duty of confidentiality. The Oath expressly declares that a physician’s obligation of confidentiality applies beyond matters of medical care. At a time when there were no hospitals or physician offices, patients received medical care in their homes or in public places. Physicians treating patients in their homes could be expected to see and hear a wide range of activities that might be considered embarrassing, immoral, or even illegal.

scholarly journals Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis

2019 ◽  
Vol 26 (1) ◽  
pp. 642-651
Author(s):  
Laura Schubel ◽  
Danielle L Mosby ◽  
Joseph Blumenthal ◽  
Muge Capan ◽  
Ryan Arnold ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Human Factors ◽  
Organ Failure ◽  
Health Information Technology ◽  
Health Information ◽  
Clinical Decision Support ◽  
Clinical Care ◽  
Clinical Decision ◽  
Wide Range

In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance. We developed graphical model displays of two popular sepsis scoring systems, quick Sepsis Related Organ Failure Assessment and Predisposition, Infection, Response, Organ Failure, using human factors principles grounded in user-centered and interaction design. Models will be evaluated in a larger research effort to optimize alert design to improve the collective awareness of high-risk populations and develop a relevant point-of-care clinical decision support system for sepsis.

Usability Methods for Ensuring Health Information Technology Safety: Evidence-Based Approaches Contribution of the IMIA Working Group Health Informatics for Patient Safety

2013 ◽  
Vol 22 (01) ◽  
pp. 20-27 ◽  
Author(s):  
A. Kushniruk ◽  
C. Nohr ◽  
H. Takeda ◽  
S. Kuwata ◽  
C. Carvalho ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Usability Testing ◽  
Evidence Based ◽  
Usability Engineering ◽  
Usability Problems ◽  
Wide Range ◽  
System Usability ◽  
Clinical Simulations

Summary Objectives: Issues related to lack of system usability and potential safety hazards continue to be reported in the health information technology (HIT) literature. Usability engineering methods are increasingly used to ensure improved system usability and they are also beginning to be applied more widely for ensuring the safety of HIT applications. These methods are being used in the design and implementation of many HIT systems. In this paper we describe evidence- based approaches to applying usability engineering methods. Methods: A multi-phased approach to ensuring system usability and safety in healthcare is described. Usability inspection methods are first described including the development of evidence-based safety heuristics for HIT. Laboratory-based usability testing is then conducted under artificial conditions to test if a system has any base level usability problems that need to be corrected. Usability problems that are detected are corrected and then a new phase is initiated where the system is tested under more realistic conditions using clinical simulations. This phase may involve testing the system with simulated patients. Finally, an additional phase may be conducted, involving a naturalistic study of system use under real-world clinical conditions. Results: The methods described have been employed in the analysis of the usability and safety of a wide range of HIT applications, including electronic health record systems, decision support systems and consumer health applications. It has been found that at least usability inspection and usability testing should be applied prior to the widespread release of HIT. However, wherever possible, additional layers of testing involving clinical simulations and a naturalistic evaluation will likely detect usability and safety issues that may not otherwise be detected prior to widespread system release. Conclusion: The framework presented in the paper can be applied in order to develop more usable and safer HIT, based on multiple layers of evidence.

Access and Access Controls

2019 ◽  
pp. 162-169
Author(s):  
Karl E. Misulis ◽  
Mark E. Frisse
Keyword(s):  
Information Technology ◽  
Information Systems ◽  
Health Information Technology ◽  
Health Information ◽  
Healthcare Systems ◽  
Access To Information ◽  
Access Controls ◽  
Privacy And Confidentiality ◽  
Efficient Care ◽  
Regulatory Landscape

Evolution of healthcare systems and the constantly changing regulatory landscape continuously alter all facets of health information technology including access. Access to information systems must be controlled in order to protect privacy and confidentiality. Access systems must be flexible enough to be applicable regardless of device and location. While access must be secure, it cannot obstruct the efficient care of patients. Access controls depend on position because privileges and permissions depend on position. These controls are the method of enforcing authorization through mechanisms and policies. This chapter discusses some of the mechanisms of controlling access. Also discussed are some practical considerations for client and device strategy.

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

2006 ◽  
Vol 144 (10) ◽  
pp. 742 ◽  
Author(s):  
Basit Chaudhry ◽  
Jerome Wang ◽  
Shinyi Wu ◽  
Margaret Maglione ◽  
Walter Mojica ◽  
...  
Keyword(s):  
Systematic Review ◽  
Information Technology ◽  
Medical Care ◽  
Health Information Technology ◽  
Health Information

scholarly journals Current State of Cyber Regulation

2021 ◽  
pp. 148-156
Author(s):  
Eric D. Perakslis ◽  
Martin Stanley
Keyword(s):  
Information Technology ◽  
Adverse Events ◽  
Health Information Technology ◽  
Health Information ◽  
Digital Health ◽  
Quality Measures ◽  
Current State ◽  
Wide Range ◽  
Security Compliance ◽  
Federal Guidelines

The complex interrelationships among privacy, security, compliance, and quality create complementary opportunities to reinforce the objectives of cybersecurity regulation are explored. The risks that result from the involvement of a wide range of authorities with different objectives creates potential pitfalls, oversights, gaps, and delays in attaining these end states. The resulting gaps are threats that contribute to risks of adverse events in digital health. Given an environment where innovations in digital health are near constant, it is essential to keep security, privacy, compliance, and quality measures up to date. Federal guidelines from the National Institute of Standards and Technology (NIST) may be applied to help health information technology and digital health practices safe.

scholarly journals Ten key considerations for the successful optimization of large-scale health information technology

2016 ◽  
Vol 24 (1) ◽  
pp. 182-187 ◽  
Author(s):  
Kathrin M Cresswell ◽  
David W Bates ◽  
Aziz Sheikh
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Large Scale ◽  
Health Care Organizations ◽  
Organization Level ◽  
Leadership Strategy ◽  
Starting Point ◽  
Expensive Process

Implementation and adoption of complex health information technology (HIT) is gaining momentum internationally. This is underpinned by the drive to improve the safety, quality, and efficiency of care. Although most of the benefits associated with HIT will only be realized through optimization of these systems, relatively few health care organizations currently have the expertise or experience needed to undertake this. It is extremely important to have systems working before embarking on HIT optimization, which, much like implementation, is an ongoing, difficult, and often expensive process. We discuss some key organization-level activities that are important in optimizing large-scale HIT systems. These include considerations relating to leadership, strategy, vision, and continuous cycles of improvement. Although these alone are not sufficient to fully optimize complex HIT, they provide a starting point for conceptualizing this important area.

scholarly journals Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do We Go from Here?

2016 ◽  
Vol 25 (01) ◽  
pp. 120-125 ◽  
Author(s):  
C. Nohr ◽  
E. Borycki ◽  
A. Kushniruk
Keyword(s):  
Information Technology ◽  
Human Factors ◽  
Health Information Technology ◽  
Health Information ◽  
System Development ◽  
Unintended Consequences ◽  
Health It ◽  
Healthcare Settings ◽  
It Systems ◽  
Wide Range

SummaryA wide range of human factors approaches have been developed and adapted to healthcare for detecting and mitigating negative unexpected consequences associated with technology in healthcare (i.e. technology-induced errors). However, greater knowledge and wider dissemination of human factors methods is needed to ensure more usable and safer health information technology (IT) systems. Objective: This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development. Results: A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences. Conclusion: Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.

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