Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

<p>Abstract</p> <p>Background</p> <p>Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular.</p> <p>Methods</p> <p>The study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis.</p> <p>Results</p> <p>Health care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general.</p> <p>Conclusions</p> <p>The implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and confidentiality of electronic information exchange can be improved by developing tools to evaluate the legitimacy of access to electronic records, by increasing health care providers' awareness of the need to be careful when using patient data, and by measures to limit access to sensitive patient data. Improving health care providers' recording behaviour is important to improve the reliability and quality of electronically exchanged patient data.</p

Security in the Dutch electronic patient record system

In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a mandatory infrastructure for exchanging medical records of most if not all patients in the Netherlands among authorized parties (particularly, physicians), the EPD has to address a number of requirements, ranging from scalability and performance to security and privacy - as well as usability in practice. The EPD is partially centralized. Patient records are stored decentrally, while a central component takes care of authentication and authorization of health professionals and of the mechanics required for exchanging patient records. The requirements for the EPD, as well as high-level descriptions of solutions and protocols, are described in a set of documents that are publicly available. This paper describes the security and privacy implications of the EPD design, argues where it falls short, and briefly discusses some improvements that may alleviate some of the risks that exist in the current design

Controlled dissemination of Electronic Medical Records

Building upon a security analysis of the Dutch electronic patient record system, this paper describes an approach to construct a fully decentralized patient record system, using controlled disclosure of references to medical records. This paper identifies several paths that can be used to disclose references. Contrary to many existing national-scale system designs, our approach avoids centralization and ensures that patients (and/or their family doctors) remain implicitly or explicitly in control over the disclosure of their information, keeping the network of healthcare professionals who can access a patient's information to a minimum

Mansion, A Distributed Multi-Agent System

In this position summary we present work in progress on a worldwide, scalable multi-agent system, based on a paradigm of hyperlinked rooms. The framework offers facilities for managing distribution, security and mobility aspects for both active elements (agents) and passive elements (objects) in the system. Our framework offers separation of logical concepts from physical representation, distribution support, mobility support, and a security architecture

A probabilistic perspective on re-identifiability

A quasi-identifier is a set of attributes that can be used to re-identify entries in anonymized data sets. A group of individuals is considered about whom quasi-identifying numerical information is disclosed such as date of birth, age, weight, and height. The fraction of individuals is determined whose information is unique in that group and hence is identifiable unambiguously. Nonuniformity can be captured well by a single number, the Kullback-Leibler distance. For example sets of real microdata, given approximations based on Kullback-Leibler distances are accurate. Second, the effect of disclosing more specific or less specific information is analyzed experimentally. Third, the effect of correlation between numerical attributes is measured. A formula gives the re-identifiability level. The approximations are validated using publicly available demographic data sets