Transcription: a strategic approach to the on-line medical record.
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Boston↗
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Results for “secured computing”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Emerging technologies: has their time come?
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Computer Communication Networks↗
Inappropriateness of cataract extraction: an analysis in two Israeli hospital settings.
OBJECTIVE: To assess and compare the appropriateness of cataract extraction in two Israeli regional hospitals. SETTINGS: Two Israeli hospitals located in different geographic areas. DESIGN: A randomized sample of 150 patients was drawn from a list of all patients who underwent cataract surgery at the two study hospitals during 1995. Detailed extraction of hospital medical records was performed. The appropriateness of cataract surgery was assessed using the Medical Review System, an interactive expert system that assesses the appropriateness of selected medical and surgical procedures. RESULTS: The rates of cataract surgery in the two hospitals were 0.54 and 0.59 operations per 1,000 population, respectively, and the age-adjusted rates per 1,000 population were 5.7 and 6.2, respectively. The percentage of patients with only light perception or hand-motion perception in the operated eye before the operation was 62.2%, with no difference in the two hospitals. There was not a significant difference in the distribution of visual acuity before the operation; however, there was a significant difference in the distribution of visual acuity after the surgery. Rates of inappropriate surgeries in the two hospitals were found to be similar to the inappropriate rate in the United States (1.3%). The preoperative visual acuity of patients undergoing cataract surgery in Israel was inferior to the visual acuity of patients undergoing cataract surgery in the United States. CONCLUSION: To increase quality and cost-effectiveness in the Israeli medical system, future studies of this type are warranted in connection with surgical procedures.
Cataract Extraction↗
The challenges of automating a real-time clinical practice guideline.
OBJECTIVE: To elucidate the types of problems encountered during implementation of a World Wide Web-based clinical practice guideline to manage hyperbilirubinemia in newborn infants. DESIGN: Formative assessment of an automated clinical-practice guideline in a large-scale implementation. SETTING: Primary-care clinics and offices, inpatient clinics, and emergency department affiliated with an academic children's hospital. PARTICIPANTS: General pediatricians, neonatologists, pediatric nurses, and computer scientists. RESULTS: Existing guidelines for hyperbilirubinemia management could not be translated directly into web pages. Modifications of the original guidelines were required to represent the clinical intent of the guidelines accurately. In addition, the automated guideline was augmented to incorporate a mechanism for generating clinical encounter forms in order for the system to be accepted into the clinical work flow. Other clinical considerations that influenced the final form of the automated guideline included limitations of computer resources and time constraints during patient encounters. CONCLUSIONS: Many existing guidelines are not amenable to straightforward implementation in automated systems. Strategies to increase the efficacy of the automated guidelines included guideline modifications, as well as careful consideration of the flow of clinical work. Repeated cycles of development and pilot testing are needed to design methods to accommodate the constraints imposed by clinical use.
Boston↗
Going interactive. Once the laggards of interactivity, hospitals are beginning to build Web sites consumers can use.
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Communication↗
Programming secure mobile agents in healthcare environments using role-based permissions.
The healthcare environment consists of vast amounts of dynamic and unstructured information, distributed over a large number of information systems. Mobile agent technology is having an ever-growing impact on the delivery of medical information. It supports acquiring and manipulating information distributed in a large number of information systems. Moreover is suitable for the computer untrained medical stuff. But the introduction of mobile agents generates advanced threads to the sensitive healthcare information, unless the proper countermeasures are taken. By applying the role-based approach to the authorization problem, we ease the sharing of information between hospital information systems and we reduce the administering part. The different initiative of the agent's migration method, results in different methods of assigning roles to the agent.
Access to Information↗
Protection of privacy by third-party encryption in genetic research in Iceland.
As the new human genetics continues its dramatic expansion into many laboratories and medical institutions, the concern for the protection of the personal privacy of individuals who participate increases. It seems that even the smallest of laboratories must confront the issue of how to protect the genetic and phenotypic information of participants in their research. Some have promoted the use of anonymity as a way out of this dilemma. But we are reminded by others that the future cannot be predicted, and that future benefits may be lost when the links to these benevolent volunteers are gone forever. More recently, some ethical bodies have suggested, without specific recommendations, that a reversible third-party encryption system may be a solution to this problem. However, they have not provided a route or even examples of how to proceed. We present here the Icelandic approach to this issue by developing a third-party encryption system in direct collaboration with the Data Protection Commission (DPC) of Iceland. We have incorporated the encryption system within our sample collection and storage software, which minimises inconvenience but enhances security. The strategy assures a barrier between the laboratory and the outside world that can only be crossed by the DPC.
Bioethics↗
[A security protocol for the exchange of personal medical data via Internet: monitoring treatment and drug effects].
We present a security protocol for the exchange of medical data via the Internet, based on the type/domain model. We discuss two applications of the protocol: in a system for the exchange of data for quality assurance, and in an on-line database of adverse reactions to drug use. We state that a type/domain security protocol can successfully comply with the complex requirements for data privacy and accessibility typical of such applications.
Access to Information↗
Canadian experiences in telehealth: equalizing access to quality care.
The Canadian Conference "TExpo'98: Interactive Health" focused on four telehealth themes: community needs, Canadian experiences, industry perspectives, and access/security/interoperability issues. Health and socioeconomic needs have been the driving force behind telehealth initiatives; telelearning is one of the major Canadian initiatives. To encourage Canadian telehealth initiatives, the federal government is building a national health infrastructure. One element in this framework is concerned with empowering the public, strengthening health care services, and ensuring accountability. Technological advancements and innovative partnerships among health communities, government, users, professional bodies, and industry are critical to continued growth. Key issues including access, evaluation, implementation, privacy, confidentiality, security, and interoperability are of universal concern to participants. Research that examines the benefits and costs of telehealth is needed.
Canada↗
Assurance: the power behind PCASSO security.
The need for security protection in Internet-based healthcare applications is generally acknowledged. Most healthcare applications that use the Internet have at least implemented some kind of encryption. Most applications also enforce user authentication and access control policies, and many audit user actions. However, most fall short on providing strong assurances that the security mechanisms are behaving as expected and that they cannot be subverted. While no system can claim to be totally "bulletproof," PCASSO provides assurance of correct operation through formal, disciplined design and development methodologies, as well as through functional and penetration testing. Through its security mechanisms, backed by strong system assurances, PCASSO is demonstrating "safe" use of public data networks for health care.
Computer Security↗
High level security policies for Healthcare Information Systems.
Healthcare Establishments (HCE) have are today highly dependent upon Information and Communications Technologies (ICT). This increasing reliance upon ICT has stressed the need to foster security in Healthcare Information Systems (HIS). Security policies may have a significant contribution to this effort, but they could become the cause of portability and interoperability problems. Moreover, policies that fail to take into account all the aspects of HIS security, the legal and regulatory requirements, and the existence of several stakeholders may lead to ineffective or inefficient security measures. Policies of a special category, named Generic Security Policies (GSPs), should be developed to provide policy-level harmonisation and guidance to policy-makers within HCEs. Five such policies are comparatively reviewed herein.
Computer Security↗
Partitioning knowledge bases between advanced notification and clinical decision support systems.
Due to the varying rates of change of ephemeral administrative and enduring clinical knowledge in decision support systems (DSSs), the functional partition of knowledge base (KB) components can lead to more efficient and cost-effective system implementation and maintenance. Our prototype loosely couples a clinical event monitor developed by Columbia University Medical Center (CUMC) with a secure notification service proxy developed by IBM Research to form a novel and complex clinical event communication service.
Computer Security↗
A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries.
In many developing countries including Turkey, telemedicine systems are not in wide use due to the high cost and complexity of the required technology. Lack of these systems however has serious implications on patients who live in rural areas. The objective of this paper is to present a simple and economically affordable alternative to the current systems that would allow experts to easily access the medical data of their remote patients over the Internet. The system is developed in client-server architecture with a user-friendly graphical interface and various services are implemented as dynamic web pages based on PHP. The other key features of the system are its powerful security features and platform independency. An academic prototype is implemented and presented to the evaluation of a group of physicians. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.
Computer Graphics↗
Approaching safe and secure health information systems in Europe.
Information systems in health care are being utilised in more and more demanding and more clinical situations where security and safety issues become more significant. These issues are explored within the context of the UK National Health Service and the corresponding activities within the European Union.
Computer Security↗
National Committee on Vital and Health Statistics: publication of recommendations relating to HIPAA health data standards--HHS. Notice.
Section 1172 (f), Subtitle F of Pub. L. 104-191, the Health Insurance Portability and Accountability Act of 1996, requires the Secretary of Health and Human Services to publish in the Federal Register any recommendation of the National Committee on Vital and Health Statistics (NCVHS) regarding the adoption of a data standard under that law. On September 9, the NCVHS submitted recommendations to the Secretary relating to the unique identifier for payers, the unique identifier for individuals, and security standards. Accordingly, the full text of the NCVHS recommendations relating to HIPAA data standards is reproduced below. The text of the recommendations is also available on the NCVHS website: http@aspe.os.dhhs.gov/ncvhs/.
Computer Security↗
Methods of responding to healthcare security incidents.
This paper considers the increasing requirement for security in healthcare IT systems and, in particular, identifies the need for appropriate means by which healthcare establishments (HCEs) may respond to incidents. The main discussion focuses upon two significant initiatives that have been established in order to improve understanding and awareness of healthcare security issues. The first is the establishment of a dedicated Incident Reporting Scheme (IRS) for HCEs, enabling the level and types of security incidents faced within the healthcare community to be monitored and advice appropriately targeted. The second aspect presents a description of healthcare security World Wide Web service, which provides a comprehensive source of advice and guidance for establishments when trying to address and prevent IT security breaches. The discussion is based upon work that is currently being undertaken with the ISHTAR (Implementing Secure Healthcare Telematics Applications in Europe) project, as part of the Telematics Applications for Health programme of the European Commission.
Computer Security↗
Internet visits: a new approach to chronic disease management.
First Health has become the first national managed care company to establish reimbursement for Web-based Internet consultations between patients and their physicians. Initially limited to chronic conditions such as diabetes, asthma, and congestive heart failure, the program will reimburse up to 24 consultations per year at a rate of $25 each. Privacy issues have been addressed by utilizing secure network procedures. First Health believes that this initiative will enhance subscribers' well-being and potentially reduce the rates of hospitalization and even lengths of stay.
Chronic Disease↗
Exploring security and privacy issues in hospital information system: an Information Boundary Theory perspective.
A small community hospital (67 beds) in Central New York was undergoing a major technological change within the organization, as they move from the use of several legacy information systems to a hospital-wide information system. The focus of the present research is to explore the privacy and security information issues using a framework called Information Boundary Theory [Stanton, 2002]. IBT explains the motivational factors that lead to the revelation or disclosing of information.
Computer Security↗