Insights March 2013

Jabberwocky: The Nonsense of Clinician eHealth Security

Juanita Fernando

Enthusiasts of eHealth implementations for use in clinical care settings claim axiomatic privacy and security (P&S) outcomes. Evidently, “eHealth” has acquired meaning for the enthusiasts when, as with Jabberwocky, the claims seem to make their own sense. Yet emerging work suggests the claim may be nonsensical. The openEHR and other international endeavours have advanced efforts to overcome the technical mismatch between clinical settings and much eHealth, so enabling technically secure tools.

However an understanding of the actual work context is needed to fully appreciate the factors that influence P&S in eHealth. Thus, this work analyses clinician critiques of eHealth experiences in relation to the Jabberwocky to support an understanding of P&S in care contexts. Twenty three medical, nursing and allied health clinicians working in Australia (Victoria) participated in this qualitative study examining work practices with P&S for patient care.

Participants criticised slow, inefficient eHealth information systems permeated by usability errors. EHealth applications expanded workloads and system demands were onerous, increasing the clinicians’ scepticism of reliance on information technology. Consequently many clinicians had developed trade-offs to avoid reliance on them.

The trade-offs include IT support avoidance and shared passwords to PKI and computer accounts. Handover-sheets populated by transcribed notes were circulated between clinicians. The practices ensure paper persistence and escalate threats to data confidentiality, integrity and availability. Study evidence suggests claims about P&S tools that are inherent to eHealth applications are nonsensical, foster unintended consequences, hamper patient care and represent a larger P&S threat than indicated by most studies to date.

About the Author(s)

Faculty Nursing Medicine & Health Sciences, Monash University, Australia:


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