Visible to the public Biblio

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Book Chapter
Ross Koppel, University of Pennsylvania, Sean W. Smith, Dartmouth College, Jim Blythe, University of Southern California, Vijay Kothari, Dartmouth College.  2015.  Workarounds to Computer Access in Healthcare Organizations: You Want My Password or a Dead Patient? Studies in Health Technology and Informatics Driving Quality Informatics: Fulfilling the Promise . 208

Workarounds to computer access in healthcare are sufficiently common that they often go unnoticed. Clinicians focus on patient care, not cybersecurity. We argue and demonstrate that understanding workarounds to healthcare workers’ computer access requires not only analyses of computer rules, but also interviews and observations with clinicians. In addition, we illustrate the value of shadowing clinicians and conducing focus groups to understand their motivations and tradeoffs for circumvention. Ethnographic investigation of the medical workplace emerges as a critical method of research because in the inevitable conflict between even well-intended people versus the machines, it’s the people who are the more creative, flexible, and motivated. We conducted interviews and observations with hundreds of medical workers and with 19 cybersecurity experts, CIOs, CMIOs, CTO, and IT workers to obtain their perceptions of computer security. We also shadowed clinicians as they worked. We present dozens of ways workers ingeniously circumvent security rules. The clinicians we studied were not “black hat” hackers, but just professionals seeking to accomplish their work despite the security technologies and regulations.
 

Conference Paper
Journal Article
Ross Koppel, University of Pennsylvania, Sean W. Smith, Dartmouth College, Jim Blythe, University of Southern California, Vijay Kothari, Dartmouth College.  2015.  Workarounds to Computer Access in Healthcare Organizations: You Want My Password or a Dead Patient? Information Technology and Communications in Health.

Workarounds to computer access in healthcare are sufficiently common that they often go unnoticed. Clinicians focus on patient care, not cybersecurity. We argue and demonstrate that understanding workarounds to healthcare workers’ computer access requires not only analyses of computer rules, but also interviews and observations with clinicians. In addition, we illustrate the value of shadowing clinicians and conducing focus groups to understand their motivations and tradeoffs for circumvention. Ethnographic investigation of the medical workplace emerges as a critical method of research because in the inevitable conflict between even well-intended people versus the machines, it’s the people who are the more creative, flexible, and motivated. We conducted interviews and observations with hundreds of medical workers and with 19 cybersecurity experts, CIOs, CMIOs, CTO, and IT workers to obtain their perceptions of computer security. We also shadowed clinicians as they worked. We present dozens of ways workers ingeniously circumvent security rules. The clinicians we studied were not “black hat” hackers, but just professionals seeking to accomplish their work despite the security technologies and regulations.

Presentation
Jim Blythe, University of Southern California, Ross Koppel, University of Pennsylvania, Vijay Kothari, Dartmouth College, Sean W. Smith, Dartmouth College.  2014.  Ethnography of Computer Security Evasions in Healthcare Settings: Circumvention as the Norm.

Healthcare professionals have unique motivations, goals, perceptions, training, tensions, and behaviors, which guide workflow and often lead to unprecedented workarounds that weaken the efficacy of security policies and mechanisms. Identifying and understanding these factors that contribute to circumvention, as well as the acts of circumvention themselves, is key to designing, implementing, and maintaining security subsystems that achieve security goals in healthcare settings. To this end, we present our research on workarounds to computer security in healthcare settings without compromising the fundamental health goals. We argue and demonstrate that understanding workarounds to computer security, especially in medical settings, requires not only analyses of computer rules and processes, but also interviews and observations with users and security personnel. In addition, we discuss the value of shadowing clinicians and conducting focus groups with them to understand their motivations and tradeoffs for circumvention. Ethnographic investigation of workflow is paramount to achieving security objectives.

Presented at Safety, Security, Privacy and Interoperability of Health Information Technologies (HealthTec 2014), August 19, 2014 in San Diego, CA. See video at URL below.