Discussion: Technology and the Future in Health Care–Transformational Trends and Forces

Discussion: Technology and the Future in Health Care–Transformational Trends and Forces ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Technology and the Future in Health Care–Transformational Trends and Forces In this Discussion you are asked to select an emerging technology and evaluate its cost-effectiveness and potential adoption. Many novel technologies require significant rethinking of current workflows, roles, culture, and financial models. You are asked to consider how the technology you chose affects these aspects of the current health ecosystem. Likewise, leaders must also consider that some emerging technologies completely lack a financial policy framework. Discussion: Technology and the Future in Health Care–Transformational Trends and Forces To prepare: Assess an emerging technology trend in the Learning Resources or one that you prefer to research on your own. Post : Select one emerging trend in the health care and/or health care technology industry. What are three take-a-ways from this course that you could use to implement this trend? Given the financial alignment models in the health care industry today, would this technology be readily accepted and cost justified? If yes, explain. If no, what changes in financing policy would have to occur to deem this technology sustainable? conceptual_privacy_framework_for_health.pdf wearable_tech_boom_advances_to_the_brain.pdf an_open_platform_for_personal_.pdf cloud_assisted_body_area_networks._state_of_the_art_and_future.pdf RESEARCH ARTICLE Conceptual Privacy Framework for Health Information on Wearable Device Seyedmostafa Safavi*, Zarina Shukur Unit of Cyber Security, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, 43600, Bangi, Malaysia *[email protected] Abstract OPEN ACCESS Citation: Safavi S, Shukur Z (2014) Conceptual Privacy Framework for Health Information on Wearable Device. PLoS ONE 9(12): e114306. doi:10.1371/journal.pone.0114306 Editor: Muhammad Khurram Khan, King Saud University, Kingdom of Saudi Arabia, Saudi Arabia Received: August 17, 2014 Accepted: November 8, 2014 Published: December 5, 2014 Copyright: ß 2014 Safavi, Shukur. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Wearable health tech provides doctors with the ability to remotely supervise their patients’ wellness. It also makes it much easier to authorize someone else to take appropriate actions to ensure the person’s wellness than ever before. Information Technology may soon change the way medicine is practiced, improving the performance, while reducing the price of healthcare. We analyzed the secrecy demands of wearable devices, including Smartphone, smart watch and their computing techniques, that can soon change the way healthcare is provided. However, before this is adopted in practice, all devices must be equipped with sufficient privacy capabilities related to healthcare service. In this paper, we formulated a new improved conceptual framework for wearable healthcare systems. This framework consists of ten principles and nine checklists, capable of providing complete privacy protection package to wearable device owners. We constructed this framework based on the analysis of existing mobile technology, the results of which are combined with the existing security standards. The approach also incorporates the market share percentage level of every app and its respective OS. This framework is evaluated based on the stringent CIA and HIPAA principles for information security. This evaluation is followed by testing the capability to revoke rights of subjects to access objects and ability to determine the set of available permissions for a particular subject for all models Finally, as the last step, we examine the complexity of the required initial setup. Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper. Funding: This research was supported by The National University of Malaysia (UKM) grant ERGS/1/2013/ICT04/UKM/01/1. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Introduction Given that healthcare is one of the most important aspects of not only our lives, but also economy, it is not surprising that it is gaining attention in wearable technology. Healthcare provision via wearable devices brought changes in PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 1 / 16 Conceptual Privacy Framework for Health Information on Wearable Device treatment and examination of patients, as well as research and development in different areas. Given that the advanced communications technology has ensured that most individuals own Smartphones, which are capable of using 3rd party applications and many more devices connected to it, it was logical to find the ways for healthcare to benefit from this trend. Discussion: Technology and the Future in Health Care–Transformational Trends and Forces This prompted the emergence of a new field called Mobile Health that, according to World Health Organization (WHO), has enabled health checkups to be conducted via Smartphone or some other type of wearable device. It is envisaged that, soon, health management and supervision will be conducted with the help of functions like sound, SMS and MMS, Bluetooth and other services [1] (Figure 1). On the other hand, Google has already made significant progress in this field, by introducing wearable OS called Android Wear and the new types of wearable devices, such as Android watches and Google Glasses (the glasses that can provide their wearer with information and collect it at the same time). Google developers have proposed the idea of inbuilt technology that can use sensors to provide all kinds of information about the user’s health [2]. The applications recently announced by Apple (HealthKit), Google (Google Fit) and Samsung (S Health) facilitate health monitoring through sensors that measure a user’s heart rate and a gyroscope that calculates a user’s movement. This technology and API along it may help providers to collect the most relevant data, because the glasses are something most individuals are used to wearing. Producing devices with such capability could bring much more innovation to the healthcare system. Rapid growth in the number of subscribers to technology, such as cell phone, can ensure connectivity and usability throughout the healthcare system. According to the report by Wu et al. [3], usage of cellular technology, Smartphones in particular, in the medical field is increasing, since the devices can be used to record patient’s medical history, symptoms and details about lifestyle. This information can assist physicians in providing treatment and diagnosis in a safe and effective way. Findings of similar research studies indicate that, with more widespread health IT adoption, we can have an effective means to improve the quality and safety of healthcare [4]. However, this innovation also poses an issue of ensuring that protected health information (PHI) is not misused, (protected health information (PHI) is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual). A study recently published by comScore suggests that the number of cell phone subscribers in the US increased from 49 to 76.8 million between 2010 and 2011 [5], [6]. As shown in Figure 2, the demand for portable devices like Smartphone can ensure that they are widely available in healthcare. It is important to note that, if mobile healthcare technology is to be widely utilized, it must be ensured that the client is given full control of the data, even if a different party owns the applications. Thus, issues are likely to rise when one party decides to share information with different companies for profit. Hence, in the context of the healthcare system, it is necessary to apply privacy and safety rules [7]. PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 2 / 16 Conceptual Privacy Framework for Health Information on Wearable Device Figure 1. Mobile sensors and area of coverage. doi:10.1371/journal.pone.0114306.g001 While wearable healthcare provision devices could bring us better lifestyle and remove the need to regularly visit clinics, it may introduce greater security and privacy issues to our society [8], [9]. Healthcare technology gadgets have to be designed with the aim of improving health, as well as keeping the client out of privacy and secrecy difficulties. Clearly, there is a potential for misuse of health information, which must be addressed.Discussion: Technology and the Future in Health Care–Transformational Trends and Forces In this paper, we propose a concise, improved and effective privacy framework for wearable device manufacturers, as well as application developers, capable of Figure 2. Adoption of mobile health initiatives and phases, globally [1]. doi:10.1371/journal.pone.0114306.g002 PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 3 / 16 Conceptual Privacy Framework for Health Information on Wearable Device providing greater privacy and security to the wearable device owners. The framework consists of two parts—the principles and the checklists. Since the framework is related to the privacy of health information on a wearable device, several critical aspects are considered when constructing the framework. For creating the checklists, we propose: N N N Wearable technology that includes the device technology and its operating system, Functionalities of health apps, System architecture based on PHR standard. For formulating the principles, we offer: N N Expanding the existing privacy and security framework related to health information, Conducting a healthcare system projects case study. The proposed framework is subsequently compared with other frameworks based on six CIA and HIPAA principles pertaining to Information Security, namely Confidentiality, Integrity, Availability, Authenticity, Non-repudiation and Information security analysis. This paper is organized as follows: Section 2 presents a review of the aforementioned aspects, while the proposed framework is described in Section 3. In Section 4, we evaluate the framework, and Section 5 concludes the work. Review on Technology and Health Application 1. Popular PHR Architectures Wearable technology, and especially mobile health, can bring advanced supervision to any place at any time without the need for the patient to visit the clinic. As a result, the cost of healthcare can be substantially reduced. To record medical history, two standard formats, Personal Health Record (PHR) and Electronic Health Record (EHR), are used. While PHR is designed by the patient, EHR is designed and supported by the healthcare supplier, such as a clinic or hospital system. Since PHRs contain significant amount of data and must be subjected to stringent privacy rules and controls, they are the main focus of this paper. Presently, Google [10] healthcare service and Microsoft [11], are the two main PHR providers, as shown in Figure 3. Both companies offer applications that permit the users to control their own PHI with the help of Internet. This enables collation of PHI from different sources pertaining to the same person. Moreover, the user can change the elements in the existing record, as well as share the content with family or healthcare providers. Once they have created a Microsoft account, users can control and handle their own or family member’s PHR, as well as authorize others to handle their own PHRs at any time and level. As mentioned earlier, as clients can share their own data with whomever they choose, they are effectively accepting the risks associated with the process. PHRs with different PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 4 / 16 Conceptual Privacy Framework for Health Information on Wearable Device Figure 3. PHR model provided by Microsoft [13]. doi:10.1371/journal.pone.0114306.g003 types of protection designs [12] indicate that it is likely that how service providers handle the sensitive data and protect the health information will change in the future. Via Internet, the clients can check the submitted information and visit schedules at anytime, as well as choose a specific doctor to visit. Discussion: Technology and the Future in Health Care–Transformational Trends and Forces This method involves client sharing the PHI across the PHR model, which may also include receiving data associated with financial claims and lab results by multiple suppliers. Similarly, physicians will receive all the necessary information about the patient across the system. As the PHR model is based on users holding their data on a central repository, the client must keep and share the entire PHI data via Internet or portable devices. Presently, this includes flash memory or Smartphone, but the number of options is likely to expand in the future. It is essential, however, that these allow the user to add and change fields of database records using the device or a dedicated Internet website. This model authorizes suitable devices to run processes on user PHR information with specific technology. In case of different vendors providing PHR, a set of standards must be imposed. For example, if a Smartphone health gadget seller supplies a specific application that can record the information received by the same device, it must be recognizable by all other devices involved in the healthcare system and allow the patient to access data with the help of seller’s Internet site. In addition, privacy in mobile health in organizations should be using the same client-centric PHRs. Presently, many service providers can provide cellular connectivity. While this reduces the price of technology and expands its usage, it poses much greater risk to security and privacy. PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 5 / 16 Conceptual Privacy Framework for Health Information on Wearable Device 2. Operating System Main Features The most popular platforms are largely similar in terms of allowing the users to receive useful applications. However, their operating systems are typically incompatible. As shown in Figure 4, ideally the platform should be able handle all types of health care devices, with the focus on wearable gadgets that always stay with the user. The Android Operating System designer and developer (Google company) is focusing on health system since many users use the device and would like to benefit from it in terms of improving their health and fitness. As shown in Figure 4, the operating system needs to support features that can help applications to connect to the wearable device and have hardware that can receive and store data in real time. In case of any issues or noticeable changes in the user’s health, the wearable device should automatically start working in emergency mode. Among the three most widely used operating systems available in the market, only Android has included built-in connectivity to Bluetooth Health Device Profile (HDP) system [15]. 3. Brief Review on Popular Wearable Devices As of April 2014, the Unit of Cyber Security in Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia (UKM) has completed analysis of some wearable devices that are still not available to public worldwide, namely Google Glass from Google Company and Galaxy Gear Fit designed and developed for wearable system from Samsung. As an appointed explorer (the first author) for the latest wearable devices, we found that, with the sensors available in these wearable devices and help of API, healthcare providers can record data and protect the device owner. Presently, they can use the technology to find out the position of the user and record the number of steps taken, along with other fitness measurements, including heart rate measured by the built-in sensor, these devices are incapable of recording and transmitting data, such as location, without connection to a Wi-Fi network or a specific smartphone (Figure 5). This scenario may change with the recently announced Android Wear devices (e.g. Galaxy Live, LG G-Watch R, Moto 360), as well as the Apple Watch, which has a Healthkit system, and the Samsung Gear S, which includes 3G, GPS, and a heart rate monitor. After proper analysis of devices, we concluded that the mechanism that ensures data security is presently lacking, which must be changed in later versions. Data protection is crucial for widespread use of these devices as a means of keeping daily checks of user’s health and lifestyle. Thus, this point is added to our checklist. 4. Review of Health Apps We analyzed the applications made for different Operating Systems in Table 1, based on the platform, functionality and targeted audience of the specified application. In this study, the strategy of selecting applications follows three main PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 6 / 16 Conceptual Privacy Framework for Health Information on Wearable Device Figure 4. Comparison of Market share percentage and main healthcare features supported by three mobile OS platforms [14]. doi:10.1371/journal.pone.0114306.g004 criteria: (1) category, which refers to the listed applications categorized under the patients’ section, (2) download per application, or the popularity of the application that can lead users to find more useful applications under the first criteria, and (3) the mobile operating system covered by the selected application. After conducting an extensive analysis of applications, we conclude that proper transparency in application, ease of User Interface (UI) use, customer interaction with the system and having moderator and privacy settings are the most important aspects of wearable healthcare applications. Hence, these elements are included into the newly proposed framework.Discussion: Technology and the Future in Health Care–Transformational Trends and Forces The Proposed Framework The proposed framework considers the client control across the healthcare information, implying the power to share data with a specific organization or a particular person relevant to the subject. At the same time, it is essential to Figure 5. Google Glass design (front view) [1]. doi:10.1371/journal.pone.0114306.g005 PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 7 / 16 Conceptual Privacy Framework for Health Information on Wearable Device Table 1. Applications that we have reviewed. Application Platforms Functions Main Audience S Health by Samsung Android It can help you achieve your fitness goals by monitoring your fitness levels during workouts and throughout the day. The application will be connected to wearable devices to monitor your health at all times Patient Davis’s Laboratory and Diagnostic Tests Android, BlackBerry, iOS, Palm OS, Windows Mobile. User will receive care before, during, and after the test; RSS receives feeds of clinical lab-product news. Patient Pocket Guide to Diagnostic Tests Android, BlackBerry, iOS, Palm OS, Windows Mobile. Clinical settings laboratory procedures; diagnostic imaging tests; complex algorithms flowcharts will be ready at all times; laboratory tests; images are color images; and cloud support app. Patient/Clinics Labs 360 Android, BlackBerry, iOS, Palm OS, Windows Mobile. Providing values; cross-reference available; up to date Healthcare providers 5MCC Android, BlackBerry, iOS, Palm OS, Windows Mobile Diagnostic information, algorithms and flowcharts available; drug therapy in every case available. Doctor/Patient 5MIDC Android, BlackBerry, iOS, Palm OS, Windows Mobile Alphabetically listed topics of interest Patient/Healthcare providers/Doctor ID Notes Palm OS Organs, illnesses and related treatments, different types of indexing. Doctor/Patient P.M.I.D Palm OS, Windows Mobile Guideline and therapy suggestion; users will be categorized by physical history and therapy specify to the same user. Patient/Healthcare providers S.G Antimicrobial Therapy Palm OS, Windows Mobile, iOS, BlackBerry. Facility to search; categories available; organized diseases & historical conditions; organized drug info; very efficient navigation. Doctor/Patient ePocrates ID Palm OS, Windows Mobile, iOS, BlackBerry, Android 900 infections, pathogens and drugs recorded in its database; anatomic location and price details by alphabetical categories; ability to record personal notes and information in the database. Doctor Mobipocket Reader BlackBerry, Windows Mobile, eBooks library; search in the dictionary; customizable display. Symbian OS, Palm OS Doctor/Patient J.H.A.Guide iOS, Android, Palm OS, Includes expert noted information about illnesses; drug lists and Windows Mobile, BlackBerry interactions; Info on anti-microbial agents; Doctor Palm LabDX Palm OS, Windows CE Alphabetical tests listed; includes test info; mostly info about testing. Doctor/Patient UpToDate iOS, web-enabled smartphone Includes 14000 physicians, drug topics and related information; provides search filters to find the information in three categories: adult, pediatric, patient. Doctor/Patient EyeChart iOS Complete eye charts used by professionals. Doctor/Patient Lab Unit Converter iOS Conversions and tests, ability to search lab results. Doctor … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10