The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Digital transformation in healthcare is being driven by the need to improve quality, reduce costs and enhance the patient experience of healthcare delivery. It does this through both the direct intervention of technology to create new diagnostic and treatment opportunities, but also through the improved use of information to create more engaging and efficient care processes. Objective: In a modern digital hospital, improved clinical and business processes are often driven through enhancing the information flows which support them. To understand an organization’s ability to transform their information flows requires a clear understanding of the capabilities of an organization’s information technology infrastructure. To date, hospital facilities have been challenged by the absence of uniform ways of describing this infrastructure that would enable them to benchmark where they are and create a vision of where they would like to be. Whilst there an industry assessment measure for electronic medical record (EMR) adoption using the HIMSS Analytics EMR Adoption Model (EMRAM), there is no equivalent for assessing the infrastructure and associated technology capabilities for digital hospitals. It is important to fill this gap as hospital administrators and clinicians need to know how and why to invest in supporting information infrastructure to realize the benefits in patient safety and patient care. Methods: Using an Operational Framework for Capability Maturity Modelling, devised specifically for healthcare, information use characteristics are used to define eight Information Systems maturity levels and associated technology infrastructure capabilities. These levels are mapped to user experiences to create a linkage between technology infrastructure and experience outcomes. Subsequently, specific technology capabilities are deconstructed to identify the technology features required to meet each maturity level. Results: The resulting assessment framework clearly defines 164 individual capabilities across the five technology domains and eight maturity levels in the infrastructure continuum. These level-dependent capabilities characterize the ability of the hospital’s information infrastructure to support the business of digital hospitals including clinical and administrative requirements. Further, it allows the addition of a scoring calculation for each capability, domain and the overall infrastructure, and identifies critical requirements to meet each of the eight maturity levels. Conclusions: This new Infrastructure Maturity Assessment framework will allow digital hospitals to assess the maturity of their infrastructure in terms of their digital transformation aligning to business outcomes and to meet the desired level of clinical and operational competency. It provides the ability to establish an international benchmark of hospital infrastructure performance, whilst identifying weaknesses in current infrastructure capability. Further, it provides a business case justification and roadmap for subsequent digital transformation and demonstrates the derived value of moving from one maturity level to the next. As such, this framework will lead the information driven, digital transformation in healthcare.

In an environment that is only now addressing the security issues of medical devices as a constituent part of IT networks, a new wave of technological development is threatening to swamp healthcare. The Healthcare Internet of Things (HIoT) encompasses the new embedded sensing capabilities of devices together with the availability of always being connected, to improve patient care whilst reducing costs. This development highlights existing security threats as well as creating new vulnerabilities, making the once comprehensive endpoint data transfer frameworks less identifiable and challenging current techniques for information security. This paper reviews the new environment using HIoT, to identify the challenges for security and the impact of this on interoperability in the healthcare setting. Each device and sensor is a potential point of vulnerability for entire networks. The low power design, limited processing and storage capabilities, together with a lack of standard interfaces will also add to the complexity of effective security solutions. Understanding these challenges is vital for anyone engaged in healthcare, as the impact of HIoT will be far-reaching for patients, clinicians, healthcare providers, and healthcare delivery. Making security the enabler of safe and protected data transfer, exchange, and use, is fundamental to using this technology.

Background: Self-management (SM) plays an important role in supporting patients’ adaptation to and management of the symptoms of chronic diseases. Cancer is a chronic disease that requires patients to have responsibility in management. Digital technology has the potential to enhance SM support, but there is little data on what SM skills are most commonly supported by digital technology. Objective: This review aimed to examine the SM core skills that were enabled and supported by digital interventions in people with cancer and identify any predictors of the effect of digital health intervention on SM core skills. Methods: Three electronic databases (MEDLINE, Scopus, and CINAHL) were searched for papers, published from January 2010 to February 2022, that reported randomized controlled trials (RCTs) involving patients with cancer or survivors of cancer where a digital technology intervention was evaluated and change in 1 or more SM core skills was a measured outcome. Results: This systematic review resulted in 12 studies that were eligible to identify which SM core skills were enabled and supported by digital intervention. The total number of participants in the 12 studies was 2627. The most common SM core skills targeted by interventions were decision-making, goal setting, and partnering with health professionals. A total of 8 (67%) out of 12 RCTs demonstrated statistically significant improvement in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning. A total of 5 (62%) out of 8 positive RCTs used theoretical considerations in their study design; whereas in 1 (25%) out of 4 negative RCTs, theoretical considerations were used. In 3 studies, some factors were identified that were associated with the development of SM core skills, which included younger age (regression coefficient [RC]=–0.06, 95% CI –0.10 to –0.02; P=.002), computer literacy (RC=–0.20, 95% CI –0.37 to –0.03; P=.02), completing cancer treatment (Cohen d=0.31), male sex (SD 0.34 in social functioning; P=.009), higher education (SD 0.19 in social functioning; P=.04), and being a recipient of chemotherapy (SD 0.36 in depression; P=.008). In all 3 studies, there were no shared identical factors that supported the development of SM core skills, whereby each study had a unique set of factors that supported the development of SM core skills. Conclusions: Digital technology for patients with cancer appears to improve SM core skills including decision-making, goal setting, and partnering with health care partners. This effect is greater in people who are younger, male, educated, highly computer literate, completing cancer treatment, or a recipient of chemotherapy. Future research should focus on targeting multiple SM core skills and identifying predictors of the effect of digital technology intervention. Trial Registration: PROSPERO CRD42021221922; https://tinyurl.com/mrx3pfax