Various Internet services are taking on a greater role in providing resources that facilitate clinical education, clinical practice and professional collaboration. At the same time, the incidence of Internet-based threats to a hospital network are also increasing, both from a legal standpoint (e.g., HIPAA compliance) and from technical attacks from spyware, computer viruses and other sources.
The purpose of this statement is to lay out network access recommendations that the ASA feels best facilitate modern clinical practice, without opening hospital IT infrastructure to undue technical or legal risk.
As websites, companies and products may change over time, all specific product recommendations will be in the appendix and not in the body of the paper.
Many institutions block access to all video streaming. We recommend against this, as many websites host videos that teach the performance of technical procedures. (A)
Many institutions block access to all sites that sell things, i.e., e-commerce websites. We recommend against this, as many medical resources, organizations and foundations have an associated store somewhere on their site. (B)
Many institutions block access to sites that contain keywords deemed unnecessary in the workplace. Many particularly block keywords related to the anatomy and patient behaviors relevant to the practice of Obstetrics and Gynecology. We recommend against this as such keyword blocking will also prevent access to many online Obstetric and Gynecology resources. (C)
In the event that an institution does decide to employ site blocking, whitelisting (approving specific sites) and blacklisting (blocking specific sites) on a category-by-category basis may be employed. We recommend caution employing either technique and further recommend that a small pilot location, with advance education, and a protocol to reverse the site blocking be established before widespread implementation.
Many institutions block access to all sites that offer forums and social networking. We recommend against this as many have become valuable community resources where physicians gather and collaborate. (D)
Many institutions block access to all sites that stream music. We recommend against this, specifically for computers in the operating rooms, as music has been shown to facilitate surgery. (E) (1,2)
Many institutions block access to all sites that facilitate the sharing of files. We recommend against this, as shared nonexecutable data files have become the de facto tool for inter-institutional collaboration. (F) We do not, however, recommend that users be allowed to execute binary files downloaded from the Internet. Further, while some authors recommend against allowing the use of file sharing applications (3) in a hospital environment, we wish to point out the difference between the services we recommend, which are designed to allow collaboration between colleagues and the older “Napster” style of file sharing applications that facilitate the public exchange of private files between strangers. We agree that this second type of service has no place in a health care environment.
Lastly, many of the above resources require a modern Web browser in order to function. Many hospitals and medical facilities still use version 6 of Microsoft Internet Explorer. This product is well over 10 years old, and, beyond the ASA, Microsoft itself recommends against its use today. We recommend that health care institutions make available a recent make of browser to their clinicians. (4)
The segregation of clinical and nonclinical data systems may aid healthcare facilities in securing their clinical data while still allowing professionally useful internet access. Strategies for implementing such segregation are beyond the scope of these recommendations.
A. www.nejm.org/multimedia/medical-videos, www.youtube.com, www.vimeo.com
D. www.sermo.com.com, www.kevinmd.com
E. www.pandora.com, www.slacker.com
F. www.dropbox.com, drive.google.com, skydrive.live.com
1. Allen K, Blascovich J, Effects of Music on Cardiovascular Reactivity Among Surgeons
2. Schneider AJ, Biebuyck JF, Music in the operating-room.
Lancet. 1990 Jun 9;335(8702):1407.
3. Taitsman J, Grimm CM, Agrawal, S, Protecting Patient Privacy and Data Security
NEJM. 2013; 368:977-979
4. "The Internet Explorer 6 Countdown." Internet Explorer 6 Countdown. N.p., n.d. Web. 27 Mar. 2013