Cyber-attacks are a permanent and substantial threat to health systems: Education must reflect that.

Cyber-attacks on healthcare institutions have increased in recent years and have made headlines through the COVID-19 pandemic. With the fallout of attacks increasingly reported in academic research and in the media, there is a real urgency to address cyber-threats that must be augmented across and within health systems. Until now, clinical healthcare professionals have considered cyber-attacks on healthcare organisations a predominantly information and communication technology issue, but this perception is no longer fit-for-purpose. This commentary provides insights into the scale of cyber-attacks and their impact on staff wellbeing, arguing that cybersecurity education for all staff in healthcare organisations must be improved through online resources, simulation, and gaming. The role of national educators, policymakers, and multilateral organisations in achieving this is outlined alongside implications for future policy and practice.

Use and impact of virtual primary care on quality and safety: public perspectives during the COVID-19 pandemic (preprint)

BackgroundWith the onset of COVID-19, primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted on the quality and safety of care. AimTo evaluate patient use of virtual primary care models during COVID-19 in terms of change in uptake, perceived impact on the quality and safety of care, and willingness of future use. Design and settingAn online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. MethodsMcNemar tests were conducted to test pre- and post pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. ResultsRespondents (N=6,326) reported an increased use of telephone consultations (+6.3%, P<.001), patient-initiated services (+1.5%, n=98, p<0.001), video consultations (+1.4%, P<.001), remote triage (+1.3, p<0.001), and secure messaging systems (+0.9%, P=.019). Experience rates using virtual care technologies were higher for men (2.39{+/-}0.96 vs 2.29{+/-}0.92, P<.001), those with higher literacy (2.75{+/-}1.02 vs 2.29{+/-}0.92, P<.001), and participants from Germany (2.54{+/-}0.91, P<.001). Healthcare timeliness and efficiency were the quality dimensions most often reported as being positively impacted by virtual technologies (60.2%, n=2,793 and 55.7%, n=2,401, respectively), followed by effectiveness (46.5%, n=1,802), safety (45.5%, n=1,822), patient-centredness (45.2%, n=45.2) and equity (42.9%, n=1,726). Interest in future use was highest for telephone consultations (55.9%), followed by patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%), and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. ConclusionFuture work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use across different patient groups. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.