Healthcare information technology's relativity problems: a typology of how patients' physical reality, clinicians' mental models, and healthcare information technology differ

Smith, Sean W.; Koppel, Ross

doi:10.1136/amiajnl-2012-001419

Cited by 69 publications

(55 citation statements)

References 15 publications

(6 reference statements)

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“…Sally does not check whether it is indeed her account and her patient, nor does the system, and she accidentally updates the wrong patient's record under Tina's name. Incidents like these are not uncommon in hospitals [1], [3].…”

Section: Background and Related Workmentioning

confidence: 95%

“…2 The adversary is using the terminal while the user is writing nearby. 3 Mean (and standard-deviation) FNR for all subjects, excluding Subject 1.…”

Section: ) Accuracymentioning

confidence: 99%

“…The problem with this approach is that a single timeout period does not work for everyone and often timeout periods are blind to context [2], [3]. Another approach is to use a proximity sensor that detects a users' departure and log them out, but these sensors are unreliable in crowded environments [4].…”

Section: Introductionmentioning

confidence: 98%

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ZEBRA: Zero-Effort Bilateral Recurring Authentication

Mare

Markham

Cornelius

et al. 2014

2014 IEEE Symposium on Security and Privacy

120

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Common authentication methods based on passwords, tokens, or fingerprints perform one-time authentication and rely on users to log out from the computer terminal when they leave. Users often do not log out, however, which is a security risk. The most common solution, inactivity timeouts, inevitably fail security (too long a timeout) or usability (too short a timeout) goals. One solution is to authenticate users continuously while they are using the terminal and automatically log them out when they leave. Several solutions are based on user proximity, but these are not sufficient: they only confirm whether the user is nearby but not whether the user is actually using the terminal. Proposed solutions based on behavioral biometric authentication (e.g., keystroke dynamics) may not be reliable, as a recent study suggests.To address this problem we propose Zero-Effort Bilateral Recurring Authentication (ZEBRA). In ZEBRA, a user wears a bracelet (with a built-in accelerometer, gyroscope, and radio) on her dominant wrist. When the user interacts with a computer terminal, the bracelet records the wrist movement, processes it, and sends it to the terminal. The terminal compares the wrist movement with the inputs it receives from the user (via keyboard and mouse), and confirms the continued presence of the user only if they correlate. Because the bracelet is on the same hand that provides inputs to the terminal, the accelerometer and gyroscope data and input events received by the terminal should correlate because their source is the same -the user's hand movement. In our experiments ZEBRA performed continuous authentication with 85 % accuracy in verifying the correct user and identified all adversaries within 11 s. For a different threshold that trades security for usability, ZEBRA correctly verified 90 % of users and identified all adversaries within 50 s.

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Section: Background and Related Workmentioning

confidence: 95%

“…2 The adversary is using the terminal while the user is writing nearby. 3 Mean (and standard-deviation) FNR for all subjects, excluding Subject 1.…”

Section: ) Accuracymentioning

confidence: 99%

See 1 more Smart Citation

ZEBRA: Zero-Effort Bilateral Recurring Authentication

Mare

Markham

Cornelius

et al. 2014

2014 IEEE Symposium on Security and Privacy

120

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show abstract

“…Specifically, 5 types of identified misrepresentations include (1) EHR data that are too narrowly focused, (2) EHR data that are too broadly focused, (3) display of data that "miss" the critical reality, (4) contradictory, redundant, or confusing data, and (5) data distortions reflected both by users and by sensors. 22 While content and workflow needs may overlap between clinical professions, nurses' experience with EHRs is likely to be different from that of their physician colleagues. The purpose of this review is to systematically investigate published literature addressing the nurse experience with EHR-related unintended consequences.…”

mentioning

confidence: 99%

A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record

Gephart

Carrington

Finley

2015

Nursing Administration Quarterly

103

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In response to unprecedented financial government incentives, electronic health record (EHR) adoption has tripled since 2009. While EHR benefits are emphasized, research demonstrates that adoption may result in unintended consequences that nurse administrators can anticipate and mitigate. Unintended consequences are defined as unplanned effects, whether positive or negative. Little is known about nursing perceptions and experience of unintended consequences arising from EHR implementation, and nursing studies are minimal in comparison with research on experience among their interprofessional colleagues. The purpose of this article is to present the state of the science on nurses' experiences with unintended consequences of EHRs derived from a systematic review that includes 4 original studies. Findings demonstrate that nurses experience changes to workflow, must continually adapt to meet patient's needs in the context of imperfect EHR systems, and have difficulty accessing the information they need to make patient care decisions. Even so, most state they would not revert to paper records if given the choice. Implications for nurse administrators include the need for continual engagement with nurses along the continuum of EHR design, as well as the need to encourage nurses to speak up and acknowledge workflow changes that threaten patient safety or do not support work efficiency.

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“…It routinely publishes data cheering the number of EHRs sold and focuses on extolling the virtues of HIT via its publications, programs, funding, and reports. It actively solicits stories of successful implementations even though there are data to suggest that up to 70 % of software implementations are failures [ 50 ]. Indeed, the ONC often funds HIT-enthusiasts but has been far less generous to those who are less-than-enthusiastic about the software -as if we only learn from our successes and not from our diffi culties.…”

Section: The Offi Ce Of the National Coordinatormentioning

confidence: 95%

Great Promises of Healthcare Information Technology Deliver Less

Koppel

2016

Health Informatics

Self Cite

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Healthcare Information Technology (HIT) continues to hold immense promise for reducing medical errors, collecting instant and vast data from across medical providers, increasing effi ciency, improving clinician and patient satisfaction, sharing data, guiding clinicians with up-to-date fi ndings, and facilitating teamwork within and across professions. Yet, almost everywhere clinicians fi nd this technology frustrating and falling short of its promised benefi ts. In this chapter I examine the reasons for this chasm between promises and reality. In doing so, I review the many benefi ts of healthcare Information Technology (IT), the origins of electronic health records in both academic and commercial settings, government policies intended to spur the economy and encourage implementation of healthcare IT, the forces infl uencing those policies, vendor contracts, in addition to the role of the Offi ce of the National Coordinator of Healthcare IT and of other offi ces in the Bush and Obama administrations. I also explore the barriers to establishing data standards, interoperability, full and transparent evaluations of EHRs and similar technologies, sharing of problematic EHR screen shots, and rapid remediation of healthcare IT-linked diffi culties. Healthcare IT, despite its problems, provides many and essential benefi ts, and will continue to improve. To that end, I offer suggestions for bringing the promise and reality closer together.

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Healthcare information technology's relativity problems: a typology of how patients' physical reality, clinicians' mental models, and healthcare information technology differ

Cited by 69 publications

References 15 publications

ZEBRA: Zero-Effort Bilateral Recurring Authentication

ZEBRA: Zero-Effort Bilateral Recurring Authentication

A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record

Great Promises of Healthcare Information Technology Deliver Less

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