Health Information Security and Privacy: A Social Science Exploration of Nurses\u27 Knowledge and Risk Behaviors with Security and Privacy Issues Focusing on Mobile Device Usage

Background. Health information system security and privacy are critical issues that impact the wide use of the Electronic Health Record (EHR) in healthcare including hospitals, providers and health systems (Breaches Affecting 500 or More Individuals, 2017). These issues have been researched from a technology standpoint in this era of accelerated electronic health record adoption, but less has been done related to the EHR users in the United States. Most of the literature related to security and privacy explores research topics, peripheral and direct, regarding policy adherence mechanisms. Yet to be studied is a social science exploration of nurses’ risk knowledge and risk behaviors associated with security and privacy issues. Purpose. This dissertation examines characteristics related to cybersecurity practices of new nurses a year following graduation from nursing school where they may have been prepared to work in environments with EHRs. The study will explore their understanding of cybersecurity as it relates to use and protection of the sources of information in the EHRs, and their own personal risk behaviors with mobile technologies that may put them at risk to outside hacking or misuse of information. The questions that drive the study are the associations with nurses’ knowledge of information system security, risk behaviors specifically with mobile device use, and their threat appraisal that may influence their personal habits and their concern for potential misuse of their own electronic health information. Method. A web-based survey was emailed to a sample of new graduates who completed the National Student Nurses’ Association (NSNA) Annual Survey and gave their permanent email address voluntarily to be contacted again for additional surveys. The survey designed in SurveyMonkey®, the same approach used with this sample in prior studies, was sent to a list of 3,000 addresses. The variables of interest are Knowledge of Information System Security (KISS), ii Risk Behaviors (RB), Personal Technology Practices (PTP), Mobile Device Habits (MDH), Threat Appraisal (Internal and External), Concern for Information Privacy (CFIP), and Information Privacy Protection Response (IPPR). Pilot Testing. Several measures developed for the study were tested on a sample of senior graduating nursing students (n=167) to assess their validity and reliability, including KISS, RB and PTP. Prior to data collection, the new items were assessed for content validity by five judges in preparation to be tested for reliability analysis. A paper-pencil version of the new items was distributed to the nursing students just prior to their graduation. Their responses were entered and analyzed using SPSS, which yielded a final set of items with acceptable reliability (α = .700), These new items were combined with the other variables of previously studied items, slightly modified, for integration on the final tool. Additional demographic questions and mobile device usage were added. Procedures. The final survey was distributed to the list of participants (n=3,000), anticipating a 10 - 20% return rate that would yield 300 - 600 subjects. A reminder was sent every 2 weeks for 6 weeks while the study remained open. Participants were offered an incentive of being eligible for a $250 drawing at the conclusion of the study. Analysis. The first level of analysis included an extensive descriptive analysis of the frequencies and measures of central tendency for subject self-reported mobile device frequency and types of use. The subsequent analysis included a series of correlations calculated on the variables of interest to determine the relationships of predicted relationships. The model did not support the predictions and an adjusted model was proposed for future studies on the measured variables and demographic variables of interest. iii Limitations. The pilot study was distributed in a paper format whereas the proposed format for the national study used an electronic medium. Conclusions. This study provided information about the relationship between the core variables and demographic components. These findings could inform educators and employers about new nurses’ knowledge and risk behaviors related to information system security

Successful Strategies for Implementing EMR Systems in Hospitals

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter\u27s 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles

Considerations for introducing a cloud service in health informatics: user experience monitoring of information systems

This thesis will show concrete examples about how user experience monitoring will improve security of health information systems, patient safety, efficiency, and ease of use. This thesis will prove how the current EMR systems that are stand alone in nature lack the ability of advanced error monitoring capabilities. As part of this research, I will demonstrate with detailed interviews and data collection surveys how automated user monitoring systems improve data record accuracy consistently. Key terminology to Electronic Medical Records (EMR’s) and the usability of cloud computing software solutions will be defined. EMR’s are the primary software used in hospitals for charting patient information and this research focuses on the summarization of key information to the history of healthcare technologies and their functionalities. Usability testing, cloud computing, and how security and trust are affecting the adoption of cloud-based services will also be discussed in more detail. Along with the importance of market research, how to create buyer personas, and what drives their need to buy. The study was conducted in collaboration with Adusso Ltd. in Helsinki, Finland to gain better understanding about what motivates hospital IT departments to buy and the main issues with EMR systems. In collaboration with Adusso we investigated a use case example of their existing customer Apotti leveraging the user error reduction and cost saving benefits they experienced after deploying Adusso’s UX2play system. We sought answers to these topics using semi-structured interviews and analyzing our customer profiles. We found that UI layout, interoperability, and the number of clicks that nurses spend in the EMR are major issues that most EMR systems have. This implies that companies using EMR’s should implement user monitoring to pinpoint the issues they do have so that they can be fixed and the work of physicians and clinicians can be improved

Using the Decomposed Theory of Planned Behaviour to explain Healthcare Consumer Adoption of Electronic Health Records

An Electronic Health Record (EHR) can be defined as the digital version of an individual’s medical history. EHRs are intended to improve the quality and efficiency of healthcare, decrease costs and prevent medical errors. Previous studies have shown that achievement of the potential benefits from EHRs depends largely upon the adoption and continued use of EHR services by health care consumers (Esmaeilzadeh and Sambasivan 2017; Hanna et al. 2017). Further research, therefore, is necessary to better understand the factors that influence consumer EHR adoption. The proposed study aims to investigate the factors influencing consumer adoption of EHRs. A model based on the Decomposed Theory of Planned Behaviour (DTPB) (Taylor and Todd 1995) provides the theoretical framework for the research. The goal is to improve understanding of how health care consumers perceive this technology and the factors that influence their intentions to use it

Electronic Health Records and Patient Empowerment in US: from the Legal Perspective

Objective: to examine the American electronic health records from a legal perspective. Results: the EHR system presents characteristics from the five aspects: accessibility, coordination, sustained care, decision making, and privacy. Conclusion: The US law in the field of Patient-Centered Health Information Technology has many elements of patient empowerment. There is still a gap between the system is and the system should be. It is found that first, A mandatory adoption of EHR system; second, privacy should be further ensured; and third, the accessibility should be further improved

How nurses perceive the impact of health IT applications on their performance and satisfaction: Examining the organizational, social, and personal factors

Applying information technology tools in the healthcare industry is an appropriate solution to integrate and record medical data and provide complete access of patients’ information. However, the effectiveness of these technologies depends on their successful implementation and adaptation. This study addresses the impact of result observability, autonomy, perceived barriers, task structure, privacy and security anxiety, and communication (social) patterns on the perception of the performance and satisfaction of nurses using IT applications in healthcare. Furthermore, the effects of nurses’ years of experience, age, different hospitals, different electronic medical records (EMR) applications, and personality factors are examined as a moderator factors on the relationships between the organizational and social factors, and nurses’ performance and satisfaction. This study proposes a model of the relationship of organizational and social variables as predictor factors on the perception of performance and satisfaction with EMR among nurses. Multivariate linear regression was used to build models for the perception of performance and the perception of EMR satisfaction. Professional autonomy, communication patterns, privacy and security anxiety, and result observability are the most important predictors for the nurses’ perception of performance relationship. Personality factors do not have a direct relationship with the perception of performance and satisfaction; however, they have moderator effects on the relationship of the independent and dependent variables. Based on the result, financial incentives and sufficient training could influence the nurses’ perception of EMR effectiveness. Based on the findings of this study, the healthcare administrators could focus on increasing employee awareness about the results and tangible benefits of EMR applications and their effects on their performance and satisfaction. EMR development companies in collaboration with healthcare administrators could design the EMR applications more flexible in terms of professional autonomy and give the healthcare staff more freedom to make decisions and deliver care to patients. Moreover, EMR companies may need to reconsider the communication patterns among healthcare staff and patients

Patient Adoption of Smart Cards

This paper adapts the Unified Theory of Acceptance and Use Technology Model (UTAUT) to assess the factors impacting the adoption of smart cards in Medicaid Health Home context. We contribute to the theory by including three constructs specific to smart card and health devices: (i) concern for error, (ii) sickness orientation (iii) concern for data security. Utilizing a survey design we collected responses from 116 participants who are ethnic minorities, enrolled in a Medicaid Health Home program or from a high-risk population. We developed a conceptual model and an instrument to measure the patient’s likelihood to use the smart card. The concern for error, social influence and sickness orientation significantly impact the likelihood to use the smart card. Our results show that patients are more concerned about prevention of errors as compared to security breaches

Factors Affecting the Behavioral Intention to Use Standalone Electronic Personal Health Record Applications by Adults in Egypt

Standalone electronic personal health record can be a useful tool that enables individuals to store, arrange and share their health information easily and they can build a history of their health timeline which is crucial for raising healthcare quality and better self-management, the adoption rate of these applications has been identified in several countries to be low and slowly progressing.Although there are some applications of standalone ePHR available in the market for usage free of charge but it’s almost not adopted at all, this study will investigate some of the factors that might affect the adoption of ePHR technology by adults in Egypt and provide business professionals a better picture for what can motivate or hinder the adoption process to achieve better adoption rates and eliminate the barriers.In order to ensure a comprehensive contextual analysis, researchers analyzed the research in hand with the perspective of the proposed contextual framework, the Nine Elements Framework/Model (Elsafty, 2018) that analyzes social studies research in general, and business/management reseaerches as well.Using the nine elements framework, the authors used it to discover the underlying factors that are causing the problems faced by the research in hand, and resulted in the coming contextual analysis defining the research scope and focus, which in the case of this paper is on Perceived usefulness and perceived ease of use were adapted from TAM that was initially developed by Fred Davis (1989) and they proved to have a high predictive power of behavioral intention in CHI context, The extensions of TAM including UTAUT & UTAUT2 seems to be irrelevant to this research context since UTAUT is more oriented towards the organizational context (Venkatesh et al., 2012) and UTAUT2 added factors, Price value seems to be irrelevant in this research context as we are already studying platforms that are provided free of charge, Hedonic motivation maybe irrelevant to this context as healthcare related service is mostly associated with seriousness and urgency, also testing unimplemented platforms that are not yet adopted makes from the habit unrealistic experience that may be inaccurate to measure.Since other several researches recommended extending these factors with other additional factors to make it more relevant to the healthcare consumer context (Kim & Park, 2012), these factors may include health-related factors, technology-related factors and personal-related factors. Findings in this research revealed that adoption rate in Egypt is still very low and high demand for this service which makes this research is significant as it’s trying to find out the reasons behind this gap, perceived usefulness, perceived ease of use, (privacy and security), eHealth literacy, personalization and awareness had a significant impact on behavioral intention to use standalone ePHR applications. Personalization was found to have the strongest effect on behavioral intention followed by perceived usefulness. Health status was found to have an insignificant effect on behavioral intention which indicates the interest of people with different health statuses in standalone ePHR

Integrating Information Technology to Healthcare and Healthcare Management: Improving Quality, Access, Efficiency, Equity, and Healthy Lives

A study published in 2022 identified the top 10 Countries with the best healthcare as (1) Denmark, (2) Switzerland, (3) Australia, (4) France, (5) Singapore, (6) The United Kingdom, (7) Germany, (8) Canada, (9) Austria, and (10) Japan. The United States spends more money per capita on healthcare than any other country. Still, the United States healthcare did not make the top twenty. Another study published in 2021 ranked the US last in access to healthcare, equity, and outcomes among the 11 high income countries, despite spending a far greater share of its GDP on healthcare (Luhby, 2021). The World Health Organization’s ranking of the world’s health systems put France at #1and the United States at #37 (World Health Organization, 2019). This paper examines a broad IT related healthcare literature and seven key IT tools and technologies that should be integrated into a comprehensive U.S. healthcare system. Properly integrating these IT tools and technologies should narrow the gap and improve the five critical success factors: Quality, Access, Efficiency, Equity, and Healthy lives