Information security and privacy in the healthcare sector is an issue of growing importance. The adoption of digital patient records, increased regulation, provider consolidation, and the increasing need for information between patients, providers, and payers, all point towards the need for better information security. We critically survey the research literature on information security and privacy in healthcare, published in both information systems, non-information systems disciplines including health informatics, public health, law, medicine, and popular trade publications and reports. In this paper, we provide a holistic view of the recent research and suggest new areas of interest to the information systems community.

Objective. To estimate the incremental effects of transitions in electronic health record (EHR) system capabilities on hospital process quality. Data Source. Hospital Compare (process quality), Health Information and Management Systems Society Analytics (EHR use), and Inpatient Prospective Payment System (hospital characteristics) for 2006-2010. Study Setting. Hospital EHR systems were categorized into five levels (Level_0 to Level_4) based on use of eight clinical applications. Level_3 systems can meet 2011 EHR "meaningful use" objectives. Process quality was measured as composite scores on a 100-point scale for heart attack, heart failure, pneumonia, and surgical care infection prevention. Statistical analyses were conducted using fixed effects linear panel regression model for all hospitals, hospitals stratified on condition-specific baseline quality, and for large hospitals. Principal Findings. Among all hospitals, implementing Level_3 systems yielded an incremental 0.35-0.49 percentage point increase in quality (over Level_2) across three conditions. Hospitals in bottom quartile of baseline quality increased 1.16-1.61 percentage points across three conditions for reaching Level_3. However, transitioning to Level_4 yielded an incremental decrease of 0.90-1.0 points for three conditions among all hospitals and 0.65-1.78 for bottom quartile hospitals. Conclusions. Hospitals transitioning to EHR systems capable of meeting 2011 meaningful use objectives improved process quality, and lower quality hospitals experienced even higher gains. However, hospitals that transitioned to more advanced systems saw quality declines. Key Words. Electronic health record, EHR meaningful use, acute-care hospitals, inpatient process quality, panel data analysis Electronic health records (EHRs) are expected to play a key role in improving the quality of U.S. health care (IOM 2001(IOM , 2003Blumenthal 2010;Buntin, Jain, and Blumenthal 2010). EHRs can improve quality of care delivery in

Objective To determine whether the use of computerized physician order entry (CPOE) and electronic medication administration records (eMAR) is associated with better quality of medication administration at medium-to-large acute-care hospitals. Data/study setting A retrospective cross-sectional analysis of data from three sources: CPOE/eMAR usage from HIMSS Analytics (2010), medication quality scores from CMS Hospital Compare (2010), and hospital characteristics from CMS Acute Inpatient Prospective Payment System (2009). The analysis focused on 11 quality indicators (JanuaryeDecember 2009) at 2603 medium-to-large ($100 beds), non-federal acute-care hospitals measuring proportion of eligible patients given (or prescribed) recommended medications for conditions, including acute myocardial infarction, heart failure, and pneumonia, and surgical care improvement. Using technology adoption by 2008 as reference, hospitals were coded: (1) eMAR-only adopters (n¼986); (2) CPOE-only adopters (n¼115); and (3) adopters of both technologies (n¼804); with non-adopters of both technologies as reference group (n¼698). Hospitals were also coded for duration of use in 2-year increments since technology adoption. Hospital characteristics, historical measure-specific patient volume, and propensity scores for technology adoption were used to control for confounding factors. The analysis was performed using a generalized linear model (logit link and binomial family). Principal findings Relative to non-adopters of both eMAR and CPOE, the odds of adherence to all measures (except one) were higher by 14e29% for eMAR-only hospitals and by 13e38% for hospitals with both technologies, translating to a marginal increase of 0.4e2.0 percentage points. Further, each additional 2 years of technology use was associated with 6e15% higher odds of compliance on all medication measures for eMAR-only hospitals and users of both technologies. Conclusions Implementation and duration of use of health information technologies are associated with improved adherence to medication guidelines at US hospitals. The benefits are evident for adoption of eMAR systems alone and in combination with CPOE.

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