Factors Influencing the Adoption of Advanced Cryptographic Techniques for Data Protection of Patient Medical Records.

OBJECTIVES: Healthcare organizations that maintain and process Electronic Medical Records are at risk of cyber-attacks, which can lead to breaches of confidentiality, financial harm, and possible interference with medical care. State-of-the-art methods in cryptography have the potential to offer improved security of medical records; nonetheless, healthcare providers may be reluctant to adopt and implement them. The objectives of this study were to assess current data management and security procedures; to identify attitudes, knowledge, perceived norms, and self-efficacy regarding the adoption of advanced cryptographic techniques; and to offer guidelines that could help policy-makers and data security professionals work together to ensure that patient data are both secure and accessible. METHODS: We conducted 12 in-depth semi-structured interviews with managers and individuals in key cybersecurity positions within Israeli healthcare organizations. The interviews assessed perceptions of the feasibility and benefits of adopting advanced cryptographic techniques for enhancing data security. Qualitative data analysis was performed using thematic network mapping. RESULTS: Key data security personnel did not perceive advanced cybersecurity technologies to be a high priority for funding or adoption within their organizations. We identified three major barriers to the adoption of advanced cryptographic technologies for information security: barriers associated with regulators; barriers associated with healthcare providers; and barriers associated with the vendors that develop cybersecurity systems. CONCLUSIONS: We suggest guidelines that may enhance patient data security within the healthcare system and reduce the risk of future data breaches by facilitating cross-sectoral collaboration within the healthcare ecosystem.

Implementation of a Personalized Digital App for Pediatric Preanesthesia Evaluation and Education: Ongoing Usability Analysis and Dynamic Improvement Scheme.

BACKGROUND: Preanesthesia evaluation is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plans for patients, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last 2 decades, eHealth and mobile health (mHealth) settings have gradually replaced part of the face-to-face encounters as the platform for preanesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Nevertheless, there is a lack of studies examining the effectiveness of surgical mHealth apps focusing on the pediatric preanesthetic setting and addressing their usability among families. OBJECTIVE: This study describes a dynamic approach for the development process of GistMD's preanesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. METHODS: The study was conducted in 4 departments at a 1500-bed quaternary, academic medical center in Tel Aviv, Israel. During the study period, the link to the preanesthesia system was sent via SMS text messages to families whose children were about to undergo surgery. The system included preanesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Continuous collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. RESULTS: During 141 days of implementation, the link to the GistMD preanesthesia management system was sent to 769 families, and product-fit actions were implemented during this term: (1) changing text message scheduling for addressing learnability and accessibility, resulting in a significant increase of 27% (χ21=12.65, P<.001) in view rates and 27.4% (χ21=30.01, P<.001) in satisfaction rates; (2) reducing the number of screens to increase efficiency and operability, leading to a significant decrease of 8.6% in cases where users did not perform any activity on the system after logging in (χ21=6.18, P=.02); (3) conducting a patient-focused campaign in 2 departments aimed at addressing memorability, leading to significant increases in 8 of the 12 usability indicators. CONCLUSIONS: Our results indicate that mHealth product-fit decisions originating from theory-based approaches and ongoing usability data analysis allow tailoring of the most appropriate responses for usability gaps, as reflected in increased use rates and satisfaction. In the case of the preanesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains.

What Does the Public Prefer Versus What Is the Public Ready to Forgo?

The present study uses a novel approach to assess the publics' ability to cope with priority setting and rationing in health care by asking what the public is willing to forego. Items for disinvestment were presented in three separated dimensions: Categories of medical care, quality of service, and items representing social values. A telephone survey was conducted among a representative sample of the Israeli public (N = 609). The response rate was 51%. We identify a few items that a high proportion of the population express readiness to forgo: a drug for smoking cessation, budgets for improving appearance and comfort in medical facilities, and a product for preventing surgical scars. Furthermore, over a quarter of the public was ready to forgo many other items. We found that less than 10% justified their selection in terms of "personally not important to me," while most respondents evaluated the items they chose to forgo as "less effective or less essential in comparison to others." The study found that most respondents, when exposed to a range of health system components, were able to identify at least one item that they will be willing to forgo in a time of economic crisis.

Truth-telling and doctor-assisted death as perceived by Israeli physicians.

BACKGROUND: Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients about a poor medical prognosis, and assisting terminally ill patients in ending their lives. METHODS: Attitudes towards medico-ethical dilemmas were examined through a nationwide online survey conducted among members of the Israeli Medical Association, yielding 2926 responses. RESULTS: Close to 60% of the respondents supported doctor-assisted death, while one third rejected it. Half of the respondents opposed disclosure of the full truth about a poor medical prognosis, and the others supported it. Support for truth-telling was higher among younger physicians, and support for doctor-assisted death was higher among females and among physicians practicing in hospitals. One quarter of respondents supported both truth-telling and assisted death, thereby exhibiting respect for patients' autonomy. This approach characterizes younger doctors and is less frequent among general practitioners. Another quarter of the respondents rejected truth-telling, yet supported assisted death, thereby manifesting compassionate pragmatism. This was associated with medical education, being more frequent among doctors educated in Israel, than those educated abroad. All this suggests that both personal attributes and professional experience affect attitudes of physicians to ethical questions. CONCLUSIONS: Examination of attitudes to two debatable medical dilemmas allowed portrayal of the multi-faceted medico-ethical scene in Israel. Moreover, this study, demonstrates that one can probe the ethical atmosphere of a given medical community, at various time points by using a few carefully selected questions.

Using the social structure of markets as a framework for analyzing vaccination debates: The case of emergency polio vaccination.

The framework of the social structure of markets was used to analyze an online debate revolving around an emergency poliovirus vaccination campaign in Israel. Examination of a representative sample of 200 discussions revealed the activity of three parties: authoritative agents promoting vaccinations, alternative agents promoting anti-vaccination, both representing sellers, and the impartial agents, representing the customers-the general public deliberating whether to comply with vaccination or not. Both sellers interacted with consumers using mechanisms of luring and convincing. The authoritative agents conveyed their message by exhibiting professionalism, building trust and offering to share information. The alternative agents spread doubts and evoked negative emotions of distrust and fear. Among themselves, the alternative agents strived to discredit the authoritative agents, while the latter preferred to ignore the former. Content analysis of discussions conducted by the general public reveal reiteration of the messages conveyed by the sellers, implying that the transaction of pro and anti-vaccination ideas indeed took place. We suggest that the framework of the market as a social structure can be applied to the analysis of other vaccination debates, and thereby provide additional insights into vaccination polemics.