Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals
Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals
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DOI：
10.1001/jamainternmed.2020.0515
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发表时间：
2020-06-01
影响因子：
39
通讯作者：
Miller, David P., Jr.
中科院分区：
文献类型：
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作者：
Latulipe, Celine;Mazumder, Syeda Fatema;Miller, David P., Jr.
这项横断面研究探讨了代理访问成人患者门户网站在独立经营和系统附属的美国hospital.Importance的使用和风险患者门户网站可以帮助护理人员更好地管理病人的护理，但护理人员如何访问患者门户网站可能会威胁到病人的安全和隐私。目的确定向成年患者的护理人员提供代理账户的医院的比例，与护理人员共享密码，并使患者能够限制护理人员看到的信息类型。设计、设置和参与者这项全国性横断面研究包括电话调查，于2018年5月21日至2018年12月20日进行。随机选择的样本包括来自美国各州和哥伦比亚特区的1家独立医院和1家卫生系统附属综合医疗医院。排除了专科医院和那些没有患者门户网站的医院。一位采访者假扮成一位老年病人的女儿，给每家医院打电话，询问医院的病人门户实践。访谈者使用结构化调查问卷获取有关代理账户可用性、密码共享和患者控制自己信息的信息。主要结果和测量主要结果是为成年患者的护理人员提供代理账户的医院比例。次要结果是医院的比例与工作人员赞同密码共享和比例，允许成年患者限制提供给护理人员的信息类型。结果排除后，共有102家医院（51家卫生系统附属医院和51家独立医院）纳入研究。在这些医院中，69家（68%）为成年患者的护理人员提供代理账户，26家（25%）没有。在102家医院中的7家（7%），接受调查的人员不知道是否有代理账户。在94家医院询问患者和护理人员之间的密码共享时，42家医院（45%）的工作人员赞同这种做法。在提供代理账户的医院中，69家医院中只有13家（19%）提供控制，使患者能够限制代理人可以看到的信息类型。结论和相关性这项研究发现，几乎一半的受访医院工作人员建议密码共享，很少有医院允许患者限制代理访问的信息类型。这些研究结果表明，医院和电子健康记录（HER）供应商需要改进代理帐户的可用性和设置过程，使护理人员能够在不侵犯患者隐私的情况下照顾患者。问题医院是否允许护理人员以保护安全和隐私的方式访问患者门户网站？结果在102家美国医院的横断面研究中，68%的样本中的医院提供代理帐户的成年患者的护理人员，45%的医院人员接受调查赞同共享的登录凭据，和19%的医院，提供代理帐户，使患者能够限制他们的护理人员看到的信息类型。这项研究的结果表明，医院和电子健康记录供应商应共同努力，以提高代理帐户的可用性和设置，不仅方便护理人员访问，而且保护患者健康信息的隐私和安全。
This cross-sectional study examines the use and risks of proxy access to adult patient portals in independently operated and system-affiliated US hospitals.Importance Patient portals can help caregivers better manage care for patients, but how caregivers access the patient portal could threaten patient security and privacy. Objective To identify the proportions of hospitals that provide proxy accounts to caregivers of adult patients, endorse password sharing with caregivers, and enable patients to restrict the types of information seen by their caregivers. Design, Setting, and Participants This national cross-sectional study included a telephone survey and was conducted from May 21, 2018, to December 20, 2018. The randomly selected sample comprised 1 independent hospital and 1 health system-affiliated general medical hospital from every US state and the District of Columbia. Specialty hospitals and those that did not have a patient portal in place were excluded. An interviewer posing as the daughter of an older adult patient called each hospital to ask about the hospital's patient portal practices. The interviewer used a structured questionnaire to obtain information on proxy account availability, password sharing, and patient control of their own information. Main Outcomes and Measures The primary outcome was the proportion of hospitals that provided proxy accounts to caregivers of adult patients. Secondary outcomes were the proportion of hospitals with personnel who endorsed password sharing and the proportion that allowed adult patients to limit the types of information available to caregivers. Results After exclusions, a total of 102 (51 health system-affiliated and 51 independent) hospitals were included in the study. Of these hospitals, 69 (68%) provided proxy accounts to caregivers of adult patients and 26 (25%) did not. In 7 of 102 hospitals (7%), the surveyed personnel did not know if proxy accounts were available. In the 94 hospitals asked about password sharing between the patient and caregiver, personnel in 42 hospitals (45%) endorsed the practice. Among hospitals that provided proxy accounts, only 13 of the 69 hospitals (19%) offered controls that enabled patients to restrict the types of information their proxies could see. Conclusions and Relevance This study found that almost half of surveyed hospital personnel recommended password sharing and that few hospitals enabled patients to limit the types of information seen by those with proxy access. These findings suggest that hospitals and electronic health record (HER) vendors need to improve the availability and setup process of proxy accounts in a way that allows caregivers to care for patients without violating their privacy.Question Do hospitals allow caregivers to access patient portals in a manner that protects security and privacy? Findings In this cross-sectional study of 102 US hospitals, 68% of hospitals in the sample offered proxy accounts to caregivers of adult patients, 45% of the hospital personnel surveyed endorsed sharing of login credentials, and 19% of hospitals that provided proxy accounts enabled patients to limit the types of information seen by their caregivers. Meaning Findings of this study suggest that hospitals and electronic health record vendors should work together to improve the availability and setup of proxy accounts not only to facilitate caregiver access but also to protect the privacy and security of patient health information.