Classification of Challenges and Threats in Healthcare Cybersecurity: A Systematic Review.

The rapid development of electronic health has highlighted the essential position information security holds today in the healthcare industry. Indeed, healthcare organisations have increasingly become targets for cyberattacks. The authors investigated cybersecurity challenges through identifying cases within the academic literature related to cybersecurity threats and vulnerabilities present within healthcare settings. The fast adoption of healthcare information systems has exposed the healthcare industry to numerous kinds of cyberattacks, thereby prompting the international academic community to investigate these threats. There are various cybersecurity challenges and vulnerabilities within healthcare that could later be exploited and lead to cybercrimes. As security systems continue to develop, the interest in cybersecurity as a form of defense and protection is expected to grow.

Medication Errors and Patient Safety: Evaluation of Physicians' Responses to Medication-Related Alert Overrides in Clinical Decision Support Systems.

BACKGROUND: Clinical decision support systems (CDSS) can enhance patient safety and reduce medication errors by giving physicians alerts while dispensing medications. Physicians inappropriately override these alerts for various reasons, which can possibly lead to medication errors and impact patient safety. OBJECTIVE: To assess the appropriateness of overridden major medication-related alerts, to investigate the reasons behind inappropriate overriding, and to evaluate if medication errors occur in inappropriately overridden alerts. METHODS: A mixed-methods study was conducted.. Quantitative: Retrospective observation to evaluate the appropriateness of major drug-dose related alert overrides. A simple random sample was taken from appropriate and inappropriate overrides and reviewed for medication errors. Qualitative: Semi-Structured Interviews were conducted with ten consultant physicians from various specialties. Interviews were transcribed and coded inductively then analyzed using Thematic Content Analysis. RESULTS: Out of 1087 alert overrides that were evaluated for appropriateness, 738 were inappropriately overridden (67.89%). In a sample of 283 inappropriate and 92 appropriate overrides; the resulted medication errors were 7 and 0, respectively. Qualitative analysis resulted in three emergent themes; Judgement, Experience & Guidelines, CDSS Issues & Limitations, Physician Behavior & Safety. CONCLUSION: The majority of alerts were found to be inappropriately overridden. This can be attributed to physician reliance on their clinical knowledge and medication databases, having the pharmacists' checks, and alert fatigue. CDSS alerts can be improved by making them more prominent and suppressing or descaling unnecessary alerts. The drop-down justification list can be enhanced by adding free text options and relating recommended dosing to disease or specialty.

Improving access to care for children with cancer through implementation of an electronic referral system (IMPACT): A single-center experience from Saudi Arabia.

BACKGROUND: Delayed access to cancer care has been associated with childhood cancer death. Improving timely access to cancer care is the first important step in the cancer treatment journey. We introduced an electronic referral system (e-RS) to improve timely access to cancer care. This study aimed to assess the impact of implementing an e-RS on timely access to cancer care. METHODS: A retrospective cross-sectional study of pediatric oncology patients selected through a consecutive nonprobability sampling technique was performed to determine the turnaround time (TAT) of children with cancer diagnosed 12 months before and after implementation of the e-RS. TAT was defined as time in hours from referral to approval for admission. RESULTS: Of the 326 pediatric oncology patients diagnosed between January 2014 and December 2015, 59.9% were male and 40.1% were female. Median age for both sexes was 5.0 years (interquartile range [IQR]: 2.5-9.0 years). Among these, 98.2% were Saudi nationals. Hematological malignancies accounted for 50.6% of referrals and 16.6% had lymphoma. The median TAT of the manual referral system (m-RS) and e-RS was 18 h (IQR: 2-25 h) and 2 h (IQR: 1-16 h; P = .0001), median length of hospital stay during first admission was 11 days versus 9 days (P = .14), and death events occurred in 11 patients versus zero patients referred using the m-RS versus e-RS (P = .003), respectively. CONCLUSION: The introduction of an e-RS was associated with more rapid processing of pediatric patients for cancer treatment and fewer patient deaths during the initial evaluation and treatment during that time period.

Social Media and the Orthopaedic Surgeon: a Mixed Methods Study.

INTRODUCTION: Social media continues to grow in size, and popularity, The prevalence of social networking continues to develop and will likely play an increasing role in all aspects of society and business, including in healthcare services. This rapid growth has directly influenced healthcare professionals in the clinical setting. AIM: To assess the perceptions and usage of SM (SM) by OSs (OS) in Jeddah, Saudi Arabia, and its impact on their profession, and to evaluate their level of awareness of the potential risks on their practice. METHODS: Quantitative: A cross-sectional survey was distributed to practicing OSs in 15 healthcare centers in Jeddah, Saudi Arabia (µ=323) using convenience sampling. Data was analyzed using SPSS. Qualitative: Eight OSs were recruited by purposive and snowball sampling and interviewed using a semi-structured approach. Data was analyzed using thematic content analysis. RESULTS: The Quantitative survey revealed that 165 OSs participated (RR=51%). OSs who use SM partly or entirely for professional purposes represent 53.7% (n=87). The remaining OSs were excluded. Virtually 90% were 40 years old or younger. Residents were less likely to reply to medical questions on SM (p=0.035). It was found that 74.7% of OSs use SM daily. The most commonly used platform was Twitter (75.9%), with Instagram and Snapchat being significantly more used by younger OSs (p= 0.013 and 0.003, respectively). The results of the Qualitative interviews revealed four themes: Guidelines, Ethics and Professionalism; Usage and Perceptions; Doctor-Patient Relationship; Quality of Online Content. CONCLUSION: OSs' perceptions and usage were generally cautious. The major concerns were patient confidentiality, along with ethical and legal consequences. The need to contribute to quality online content was evident. Lack of formal guidelines was a continuous theme. The development of national guidelines on SM use in the orthopaedic profession is recommended.

Blockchain Technologies: Opportunities for Solving Real-World Problems in Healthcare and Biomedical Sciences.

INTRODUCTION: Blockchain technology is associated with the financial industry, but it can be applied to other industries. The supporting architecture of blockchain has the immense potential to transform the delivery of healthcare, medical, clinical, and life sciences, due to the extended functionality and distinct features of its distributed ledger. The potential scale of impact is comparable to that seen with the introduction of TCP/IP. Blockchain technology has captured the interest of healthcare providers and biomedical scientists within various healthcare domains such as longitudinal healthcare records, automated claims, drug development, interoperability in population health, consumer health, patient portals, medical research, data security, and reducing costs with supply chain management. It is not yet clear if blockchain is going to disrupt healthcare, but healthcare organizations are monitoring its potential closely for prospective concepts like secure patient IDs. Realistically, the adoption and implementation of blockchains will be a gradual evolution over time, but now is the time to take a fresh look at its possibilities in healthcare and biomedical sciences. Blockchain technology revolutionary solutions are bringing us closer to the possibility of every patient record being able to send updates to an open-source, community-wide trusted ledger that is accessible and understood across organizations with guaranteed integrity. AIM AND METHODS: This paper discusses as a review some potential areas of opportunity for blockchain in the health and biomedical sciences fields. RESULTS AND CONCLUSIONS: This paper describes and synthesizes 20 examples of real-world use-case scenarios for blockchains in healthcare and biomedical practice.

The UK's National Programme for IT: Why was it dismantled?

This paper discusses the UK's National Programme for IT (NPfIT), which was an ambitious programme launched in 2002 with an initial budget of some £6.2 billion. It attempted to implement a top-down digitization of healthcare in England's National Health Service (NHS). The core aim of the NPfIT was to bring the NHS' use of information technology into the 21st century, through the introduction of an integrated electronic patient record systems, and reforming the way that the NHS uses information, and hence to improve services and the quality of patient care. The initiative was not trusted by doctors and appeared to have no impact on patient safety. The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations. The NPfIT was officially dismantled in September 2011. Deemed the world's largest civil IT programme, its failure and ultimate demise sparked a lot of interest as to the reasons why. This paper summarises the underlying causes that lead to dismantling the NPfIT. At the forefront of those circumstances were the lack of adequate end user engagement, the absence of a phased change management approach, and underestimating the scale of the project.