Abstract
Patients' privacy is critical in healthcare but users of Electronic Health Records (EHR) frequently circumvent existing security rules to perform their daily work. Users are so-called the weakest link in security but they are, many times, part of the solution when they are involved in systems' design. In the healthcare domain, the focus is to treat patients (many times with scarce technological, time and human resources) and not to secure their information. Therefore, security must not interfere with this process but be present, nevertheless. Security usability issues must also be met with interdisciplinary knowledge from human-computer-interaction, social sciences and psychology. The main goal of this paper is to raise security and usability awareness with the analysis of users' interaction logs of a BreakTheGlass (BTG) feature. This feature is used to restrict access to patient reports to a group of healthcare professionals within an EHR but also permit access control override in emergency and/or unexpected situations. The analysis of BTG user interaction logs allows, in a short time span and transparently to the user, revealing security and usability problems. This log analysis permits a better choice of methodologies to further apply in the investigation and resolution of the encountered problems.

Abstract
The goal of the OPTIM project is to optimize the graphical user interface of an electronic health record (EHR) by predicting clinical documents' relevance and provide a ranked list of relevant documents for the given user at a certain time. This paper describes the architecture of the relevance assignment and ranking prototype and some implementation issues. The prototype's design is based on two components: OPTIM Core, with logical representation, estimation server's integration and the webservice layer, and the OPTIM WebUI, with the user interface for presenting the results. The prototype was tested in integration with an EHR using a simulated environment. The results were encouraging but yet they revealed a certain lack of security (confidentiality). It has now the capacity of rating 10 documents per second. Nonetheless, the integration of features such as rating clinical relevance based on mathematical models can be included in existing EHR potentially improving their usability.

Abstract
Traditional follow-up of patients with cardiovascular devices is still an activity that, in addition to serving an increasing population, requires a considerable amount of time and specialized human and technical resources. Our aim was to evaluate the applicability of the CareLink (R) (Medtronic, Minneapolis, MN) remote monitoring system as a complementary option to the follow-up of patients with implanted devices, between in-office visits. Evaluated outcomes included both clinical (event detection and time to diagnosis) and nonclinical (patient's satisfaction and economic costs) aspects. An observational, longitudinal, prospective study was conducted with patients from a Portuguese central hospital sampled by convenience during 1 week (43 patients). Data were collected in four moments: two in-office visits and two remote evaluations, reproducing 1 year of clinical follow-up. Data sources included health records, implant reports, initial demographic data collection, follow-up printouts, and a questionnaire. After selection criteria were verified, 15 patients (11 men [73%]) were included, 63.4 +/- 10.8 years old, re-presenting 14.0 +/- 6.3 implant months. Clinically, 15 events were detected (9 by remote monitoring and 6 by patient-initiated activation), of which only 9 were symptomatic. We verified that remote monitoring could detect both symptomatic and asymptomatic events, whereas patient-initiated activation only detected symptomatic ones (p = 0.028). Moreover, the mean diagnosis anticipation in patients with events was approximately 58 days (p < 0.001). In nonclinical terms, we observed high or very high satisfaction (67% and 33%, respectively) with using remote monitoring technology, but still 8 patients (53%) stated they preferred in-office visits. Finally, the introduction of remote monitoring technology has the ability to reduce total follow-up costs for patients by 25%. We conclude that the use of this system constitutes a viable complementary option to the follow-up of patients with implantable devices, between in-office visits.

Abstract
Background: An asynchronous eLearning system was developed for radiographers in order to promote a better knowledge about senology and mammography. Objectives: to assess the learners' satisfaction. Methods: Target population included radiographers and radiography students, in order to assess eLearning satisfaction according to different experience levels in breast imaging. Satisfaction was measured through a questionnaire developed especially for eLearning systems, using a seven-point Likert scale. Main topics related are content, interface, personalization and learning community. Results: Overall, 85% of learners were satisfied with the course and 87,5% considered that the course is successful. Main areas that were evaluated by most learners in a positive way were interface and content (between six and seven-point); on the other hand, learning community presented a wider distribution of answers. Conclusions: The course provides an overall high degree of learner satisfaction, thus providing more effective knowledge gain on breast imaging for radiographers.

Abstract
The incidence of colorectal cancer cases in the Portuguese Institute of Oncology of Porto created the need of a telenursing program in the Gastro-Intestinal Cancer Unit. After staging, treatment may involve surgery radio and chemotherapy (either oral or IV). Patients with no treatment after surgery are scheduled for medical exams every 3 months in the first 2 years. Patients on chemotherapy need to be compliant and to have a close monitoring of adverse events. The GI Cancer Unit uses a telenursing information system to help assess colorectal cancer patients' follow-up after surgery, medical treatment compliance and adverse events. A mixed-methods evaluation was done to a) describe the target population, b) detect problems in the telenursing information system, and c) suggest changes to meet users' requirements. From 181 outbound phone calls, representing 67 patients (49 in treatment and 18 in follow-up), patients' main characteristics were extracted and system's problems were identified by the intervening nurses. Recommendations will be useful for a further development of the system.

Abstract
The amount of data currently being produced, stored and used in hospital settings is stressing information technology infrastructure, making clinical reports to be stored in secondary memory devices. The aim of this work was to develop a model that predicts the probability of visualization, within a certain period after production, of each clinical report. We collected log data, from January 2013 till May 2011, from an existing virtual patient record, in a tertiary university hospital in Porto, Portugal, with information on report creation and report first-time visualization dates, along with contextual information. The main factors associated with visualization were defined using logistic regression. These factors were then used as explanatory variables for predicting the probability of a piece of information being accessed after production, using Kaplan-Meier analysis and the Weibull probability distribution. Clinical department, type of encounter and report type were found significantly associated with time-to-visualization and probability of visualization.