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<dc:title>Security practices and insider threats in Spanish healthcare centers: a survey-based risk assessment</dc:title>
<dc:creator>Herrera Montano, Isabel</dc:creator>
<dc:creator>Góngora Alonso, Susel</dc:creator>
<dc:creator>Sañudo García, Soledad</dc:creator>
<dc:creator>García Aranda, José Javier</dc:creator>
<dc:creator>Rodrígues, Joel J.P.C.</dc:creator>
<dc:creator>Torre Díez, Isabel de la</dc:creator>
<dc:description>Producción Científica</dc:description>
<dc:description>Introduction: Insider threats pose a critical risk in healthcare environments, where Hospital Information Systems&#xd;
(HIS) manage sensitive patients data. Authorized users may intentionally or accidentally compromise data&#xd;
confidentiality, integrity, and availability. This study assessed information security practices from the perspec-&#xd;
tive of healthcare professionals in Spanish medical centers.&#xd;
Methods: A descriptive, analytical, cross-sectional study was conducted using a survey administered to 41&#xd;
healthcare professionals with access to confidential data. The survey covered access control, encryption at rest&#xd;
and in transit, communication channels, and data usage control. Descriptive statistics, Chi-square tests, and&#xd;
Cram´er’s V were applied to identify significant associations. K-means clustering and Silhouette coefficient were&#xd;
used to define user profiles. Principal Component Analysis (PCA) was used to visualize behavior patterns. A&#xd;
Random Forest model identified the most relevant predictive variables.&#xd;
Results: Critical security gaps were detected, 31.7 % reported no control over data usage. Only 29.3 % encrypted&#xd;
data at rest and 36.6 % during transmission. Over 40 % used personal email or messaging apps to share sensitive&#xd;
data, and 97.6 % relied solely on passwords for authentication. These practices are inadequate to mitigate insider&#xd;
threats.&#xd;
Conclusion: There is an urgent need to strengthen insider data protection. Security strategies should be tailored to&#xd;
user risk profiles. Measures must include strong authentication, full encryption, and stricter control of data&#xd;
transmission to reduce exposure to insider threats (intentionally or unintentionally) in healthcare settings.&#xd;
Additionally, there is a need to promote continuous cybersecurity training.</dc:description>
<dc:date>2025-11-10T11:43:17Z</dc:date>
<dc:date>2025-11-10T11:43:17Z</dc:date>
<dc:date>2026</dc:date>
<dc:type>info:eu-repo/semantics/article</dc:type>
<dc:identifier>International Journal of Medical Informatics, 2025, vol. 205, p. 106107</dc:identifier>
<dc:identifier>1386-5056</dc:identifier>
<dc:identifier>https://uvadoc.uva.es/handle/10324/79507</dc:identifier>
<dc:identifier>10.1016/j.ijmedinf.2025.106107</dc:identifier>
<dc:identifier>106107</dc:identifier>
<dc:identifier>International Journal of Medical Informatics</dc:identifier>
<dc:identifier>205</dc:identifier>
<dc:language>eng</dc:language>
<dc:relation>https://www.sciencedirect.com/science/article/pii/S1386505625003247</dc:relation>
<dc:rights>info:eu-repo/semantics/openAccess</dc:rights>
<dc:rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</dc:rights>
<dc:rights>© 2025 The Author(s)</dc:rights>
<dc:rights>Attribution-NonCommercial-NoDerivatives 4.0 Internacional</dc:rights>
<dc:publisher>Elsevier</dc:publisher>
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