Secure Electronic Communication Research Articles

Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians.

Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. This study aimed to survey nurse and physician readiness to adopt these tools. An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.

Multiple Image Based Dual Steganography Using Arnold Transform and Block Code Encoding

Security plays a crucial role in the field of Social media network. Securing the data become one among the largest challenges in the present scenario. Whenever we expect concerning the cyber security, the primary issue that involves our mind is ‘cyber crimes’ that are increasing vastly day by day. Embedding secret message into the image (Steganography) is associated with art and science of secure data communication wherever the key information or confidential information is hidden in host file. It's employed incompletely different helpful applications like secure electronic communication, health care and military. Confidential information’s are unremarkably keep in digital media and transmitted via network cause of rapid growth of internet. In this paper, steganography techniques which might be used to safeguard the information from intruders. Here, Steganographic technique is used to hide multiple secret images into a single 24-bit cover image using Least Significant Bit (LSB) and dual steganography method. Multiple secret images are scrambled and encoded before hiding into cover image using Arnold Transform and Block Code Encoding. The Proposed technique is Block Code Encoding to convert Secret message to binary and bit pairs to form safer information. The main goals of proposed work offers security and high limit based steganography plan of concealing a massive size secret image into a bit size cover image, to enhance security using dual steganography, image quality and to reduce error.

Physician Perception of the Role of the Patient Portal in Pediatric Health.

The patient portal, increasingly available to patients, allows secure electronic communication with physicians. Although physician attitude toward the portal plays a crucial role in patient adoption, little information regarding physician opinion of the portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed using an online quantitative questionnaire and structured interviews. Physicians reported the portal's role in more communication efficiency for patients, parents, and providers. The portal's acceptance also introduces new challenges such as frequent questions from some parents and medical visit avoidance.

Wound Concerns and Healthcare Consumption of Resources after Colorectal Surgery: An Opportunity for Innovation?

Significant portions of patients undergoing colorectal surgical procedures have minor incision disturbances, yet very few meet definitions for surgical site infection (SSI). We sought to investigate the natural history of incision disturbances with a focus on the patient experience and resource utilization. We hypothesize that patients who have an incision disturbance consume frequent healthcare resources in the post-operative period despite the fact that most never receive a diagnosis of SSI. A 24-month prospective observational study was undertaken at an academic institution. Patients undergoing elective colorectal operation by two board-certified colorectal surgeons were followed prospectively for 90 days. Incisions were photographed serially and clinically characterized beginning as early as post-operative day two and at follow-up visits. The primary outcome was patient concern for an incision disturbance. Three surgeons reviewed clinical data and photographs to determine the presence of an incisional surgical infection, and diagnosis required agreement from two of three surgeons. There were 171 patients included; 31 (15%) sought evaluation from a healthcare provider for concerns related to their incision including 46 telephone calls, six emergency department visits, seven primary care visits, 10 home health and 40 surgical clinic visits. Incision erythema and drainage were the most common sources of patient concern. Mean body mass index was higher in patients with concern for incision disturbances (34 vs. 28 kg/m2, p < 0.0001). Ultimately, 8% (14/171) received a diagnosis of SSI by study criteria while only 2% (4/171) were captured as having an SSI by the institutional National Surgical Quality Improvement Program database (p < 0.0001). Patients undergoing colorectal surgical procedures commonly are concerned with post-operative incision disturbance, yet few are associated with a diagnosis of SSI, and in-person evaluation yields frequent utilization of healthcare resources. This presents an opportunity for secure electronic communication with the surgical team and the patient to potentially reduce consumption of healthcare resources.

Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial.

Communication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care. Primary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age. Thirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group. E-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care.

Experimental Review of “Grey Level Modification” Steganography

Steganography is the science of hidden writing schemes in which the presence of concealed information is not noticeable. It is a gifted approach for secure electronic communication and transmission of secret data safely over the internet. This paper is the detailed experimental analysis and review of Level Modification Steganography for Secret Communication. Analysis is based on popular image quality measures, security analysis, visual analysis, bit plane analysis and worst case situation. Experimental result of selected method of steganogrphgy is compared with the basic Least Significant Bit substitution and Least Significant Bit matching method of steganography. All these results are checked for both the color and grayscale images. Moreover this review and analysis could be a deep understanding of most popular and simple steganography method such as Grey Level Modification, Least Significant Bit substitution, Least Significant Bit matching etc and will be a helpful analysis for presenting new approaches in this field.

Distributed Group Key Management for Secure Electronic Communication

With the popularity of group-oriented applications, secure electronic communication among all group members has become a major issue. This paper proposes a distributed group-oriented key management scheme for secure electronic communication. The scheme deploys Elliptic Curve Diffie-Hellman (ECDH) which is more lightweight as compared to regular Diffie-Hellman. According to the security analysis, the proposed scheme provides a number of desirable security properties, including group key secrecy, forward secrecy and backward secrecy.

Impact of electronic messaging on the patient-physician interaction

Patients are interested in secure electronic communication with their health-care providers, but physicians have been slow to adopt the technique into their practice. We have therefore reviewed the literature on secure patient messaging. Relevant studies were identified by Medline search which produced 1065 publications. Of these, 71 relevant articles were read independently by two reviewers. Currently available messaging systems allow for asynchronous communication, physician reimbursement and automated supporting functions such as triaging of patient messages and integration of messaging into medical records. The review showed that patients are satisfied with the use of secure physician messaging systems and find such services to be convenient, time-saving and useful. Physicians do not report adverse effects from their use. Legal concerns with electronic messaging include compliance with privacy standards. The economic benefits of secure messaging systems are most immediately apparent for larger health-care groups and hospitals, although smaller practices will also benefit in the long run. Secure patient-physician messaging is a convenient and useful addition to the health-care infrastructure. It can be expected that the identification of secure providers, integration with reimbursement systems and initial uptake by larger health-care organizations will speed up the adoption into routine health care.

Privacy vs Usability: A Qualitative Exploration of Patients' Experiences With Secure Internet Communication With Their General Practitioner

Background Direct electronic communication between patients and physicians has the potential to empower patients and improve health care services. Communication by regular email is, however, considered a security threat in many countries and is not recommended. Systems which offer secure communication have now emerged. Unlike regular email, secure systems require that users authenticate themselves. However, the authentication steps per se may become barriers that reduce use.Objectives The objective was to study the experiences of patients who were using a secure electronic communication system. The focus of the study was the users' privacy versus the usability of the system.Methods Qualitative interviews were conducted with 15 patients who used a secure communication system (MedAxess) to exchange personal health information with their primary care physician.Results Six main themes were identified from the interviews: (1) supporting simple questions, (2) security issues, (3) aspects of written communication, (4) trust in the physician, (5) simplicity of MedAxess, and (6) trouble using the system. By using the system, about half of the patients (8/15) experienced easier access to their physician, with whom they tended to solve minor health problems and elaborate on more complex illness experiences. Two thirds of the respondents (10/15) found that their physician quickly responded to their MedAxess requests. As a result of the security barriers, the users felt that the system was secure. However, due to the same barriers, the patients considered the log-in procedure cumbersome, which had considerable negative impact on the actual use of the system.Conclusions Despite a perceived need for secure electronic patient-physician communication systems, security barriers may diminish their overall usefulness. A dual approach is necessary to improve this situation: patients need to be better informed about security issues, and, at the same time, their experiences of using secure systems must be studied and used to improve user interfaces.

The role of primary care non-physician clinic staff in e-mail communication with patients

Background: Few studies have explicitly addressed how e-mail technology may affect non-physician clinic staff, even though these staff typically manage tasks well suited to e-mail communication such as requests for prescription renewals, laboratory and test results, and referral authorizations. Goal: We conducted a survey of staff members at 10 primary care clinics in Boston to further evaluate non-physician staff attitudes towards e-mail use with patients. We subsequently re-surveyed staff at three of these clinics after the implementation of Patient Gateway, an application designed to facilitate secure electronic communication between patients and the clinics. Results: Before Patient Gateway implementation, 88% of surveyed staff were already using e-mail at least once a day for work-related communication. Many of these staff members (24%) were already using e-mail with patients. Forty-eight percent of staff members thought that increasing e-mail use with patients could improve the quality of care their practices delivered. However, staff reported having some hesitations about increasing e-mail use with patients, mostly relating to security, confidentiality, and workload. After Patient Gateway implementation, users reported high satisfaction with the application and staff in general (users and non-users of Patient Gateway) felt more enthusiastic about increasing e-mail use with patients. Conclusions: In order to maximize the potential of staff–patient e-mail, it is important that concerns relating to security, confidentiality, and workflow are addressed, and patients must be given guidelines for the appropriate use of e-mail. Secure applications designed with these issues in mind are likely to be well received by staff members, and in turn physicians.

An environment for security protocol intrusion detection

Secure electronic communication relies on cryptography. Even with perfect encryption, communication may be compromised without effective security protocols for key exchange, authentication, etc. We are now seeing proliferation of large secure environments characterized by high volume, encrypted traffic between principals, facilitated by Public Key Infrastructures (PKI). PKIs are dependent on security protocols. Unfortunately, security protocols are susceptible to subtle errors. To date, we have relied on formal methods to tell us if security protocols are effective. These methods do not provide complete or measurable protocol security. Security protocols are also subject to the same implementation and administrative vulnerabilities as communication protocols. As a result, we will continue to operate security protocols that have flaws. In this paper, we describe a method and architecture to detect intrusions in security protocol environments such as Public Key Infrastructures. Our method is based on classic intrusion detection techniques of knowledge-based and behavior-based techniques detection. 2 Section

An authorization model for a public key management service

Public key management has received considerable attention from both the research and commercial communities as a useful primitive for secure electronic commerce and secure communication. While the mechanics of certifying and revoking public keys and escrowing and recovering private keys have been widely explored, less attention has been paid to access control frameworks for regulating access to stored keys by different parties. In this article we propose such a framework for a key management service that supports public key registration, lookup, and revocation, and private key escrow, protected use (e.g., to decrypt selected messages), and recovery. We propose an access control model using a policy based on principal, ownership, and authority relationships on keys. The model allows owners to grant to others (and revoke) privileges to execute various actions on their keys. The simple authorization language is very expressive, enabling the specification of authorizations for composite subjects that can be fully specified (ground) or partially specified, thus making the authorizations applicable to all subjects satisfying some conditions. We illustrate how the access control policy and the authorizations can easily be expressed through a simple and restricted, hence efficiently computable, form of logic language.