Antto Seppälä

A Conceptual Framework and Principles for Trusted Pervasive Health

Background Ubiquitous computing technology, sensor networks, wireless communication and the latest developments of the Internet have enabled the rise of a new concept—pervasive health—which takes place in an open, unsecure, and highly dynamic environment (ie, in the information space). To be successful, pervasive health requires implementable principles for privacy and trustworthiness. Objective This research has two interconnected objectives. The first is to define pervasive health as a system and to understand its trust and privacy challenges. The second goal is to build a conceptual model for pervasive health and use it to develop principles and polices which can make pervasive health trustworthy. Methods In this study, a five-step system analysis method is used. Pervasive health is defined using a metaphor of digital bubbles. A conceptual framework model focused on trustworthiness and privacy is then developed for pervasive health. On that model, principles and rules for trusted information management in pervasive health are defined. Results In the first phase of this study, a new definition of pervasive health was created. Using this model, differences between pervasive health and health care are stated. Reviewed publications demonstrate that the widely used principles of predefined and static trust cannot guarantee trustworthiness and privacy in pervasive health. Instead, such an environment requires personal dynamic and context-aware policies, awareness, and transparency. A conceptual framework model focused on information processing in pervasive health is developed. Using features of pervasive health and relations from the framework model, new principles for trusted pervasive health have been developed. The principles propose that personal health data should be under control of the data subject. The person shall have the right to verify the level of trust of any system which collects or processes his or her health information. Principles require that any stakeholder or system collecting or processing health data must support transparency and shall publish its trust and privacy attributes and even its domain specific policies. Conclusions The developed principles enable trustworthiness and guarantee privacy in pervasive health. The implementation of principles requires new infrastructural services such as trust verification and policy conflict resolution. After implementation, the accuracy and usability of principles should be analyzed.

Trust information-based privacy architecture for ubiquitous health.

Background Ubiquitous health is defined as a dynamic network of interconnected systems that offers health services independent of time and location to a data subject (DS). The network takes place in open and unsecure information space. It is created and managed by the DS who sets rules that regulate the way personal health information is collected and used. Compared to health care, it is impossible in ubiquitous health to assume the existence of a priori trust between the DS and service providers and to produce privacy using static security services. In ubiquitous health features, business goals and regulations systems followed often remain unknown. Furthermore, health care-specific regulations do not rule the ways health data is processed and shared. To be successful, ubiquitous health requires novel privacy architecture. Objective The goal of this study was to develop a privacy management architecture that helps the DS to create and dynamically manage the network and to maintain information privacy. The architecture should enable the DS to dynamically define service and system-specific rules that regulate the way subject data is processed. The architecture should provide to the DS reliable trust information about systems and assist in the formulation of privacy policies. Furthermore, the architecture should give feedback upon how systems follow the policies of DS and offer protection against privacy and trust threats existing in ubiquitous environments. Methods A sequential method that combines methodologies used in system theory, systems engineering, requirement analysis, and system design was used in the study. In the first phase, principles, trust and privacy models, and viewpoints were selected. Thereafter, functional requirements and services were developed on the basis of a careful analysis of existing research published in journals and conference proceedings. Based on principles, models, and requirements, architectural components and their interconnections were developed using system analysis. Results The architecture mimics the way humans use trust information in decision making, and enables the DS to design system-specific privacy policies using computational trust information that is based on systems’ measured features. The trust attributes that were developed describe the level systems for support awareness and transparency, and how they follow general and domain-specific regulations and laws. The monitoring component of the architecture offers dynamic feedback concerning how the system enforces the polices of DS. Conclusions The privacy management architecture developed in this study enables the DS to dynamically manage information privacy in ubiquitous health and to define individual policies for all systems considering their trust value and corresponding attributes. The DS can also set policies for secondary use and reuse of health information. The architecture offers protection against privacy threats existing in ubiquitous environments. Although the architecture is targeted to ubiquitous health, it can easily be modified to other ubiquitous applications.

Development of personal wellness information model for pervasive healthcare

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Healthcare Information Exchange in Regional eHealth Networks Implications for Initiatives in Advancing Shared Care

Healthcare information exchange (HIE) has been refined from point-to-point messaging to wide-area networks integrating multiple service providers. Presently, federated information systems connect more than 25 hospitals with 60 municipal health centres in three Finnish hospital districts. The usability and benefits of these regional eHealth networks (RHIN) were studied in a subset of 10.000 end-users from secondary and primary care in these hospital districts. The usability of several functions was assessed by on-line survey in 72 physicians and the benefits by interviewing 30 health care professionals after subsequent operational use of RHIN in patient care. Although the survey revealed physician dissatisfaction with several key functions of usability, user experiences indicated that 85 % of the doctors and nurses found HIE with RHIN to have a beneficial effect on patient care. This information may be applied when reshaping the human context of shared care and migrating RHIN to upgraded national eHealth network.

Collaborative Approach for Sustainable Citizen-Centered Health Care

Health care systems are in transition to citizen-centered care with focus on prevention, proactive and personalized services and healthy lifestyles. Innovative technologies enable citizens’ empowerment and allow them to manage their complete health and wellness. Citizen-centered tools collect life-long cross-institutional information and data from health care providers and citizens. From the health care organizations viewpoint the new paradigm implies changes in the ways how the services are produced, how they are offered for use and in the contents of the services. Research with the citizen-centered health paradigm has been active and many significant results have been achieved, for instance improvements in citizens’ lifestyle, weight loss, reduction of the duration of hospitalization, better accessibility of health related information and improved communication between the care providers. Based on our literature review we present in this chapter the approaches, achievements, barriers and challenges of citizen-centered health paradigm. We propose a new innovative approach to build the next generation, collaborative health information space that links the care providers and citizens together and helps them to access the distributed health resources any time anywhere. The visional, sustainable citizen-centered health environment offers means to gradually migrate from the current situation to a citizen-centered care environment where citizens have a participatory role in health care activities.

Research on Trusted Personal Health and Wellness Information in Ubiquitous Health Information Space

Information structures of current electronic pa- tient record systems (EHRs) are based on the traditional pa- per-based documentation systems. The semantic interoperabil- ity of these systems is limited and security aspects are static. The usability and usefulness of these systems to citizen-based care model is very limited. In this research we identify the shift to pervasive health care where any type of health and welfare related data can be collected and linked at a personal basis. In this research context aware information model for the lifelong personal wellness record (LPWR) and a new security architec- ture will be developed. These will enable access, use and shar- ing of multi-source heterogeneous health and wellness related data and information dynamically in a trusted way in a ubiqui- tous health information space. Research outline, current state and expected outcomes are presented in this paper.

Feasibility analysis of the privacy attributes of the personal wellness information model.

A feasibility analysis has been performed to study the applicability of privacy attributes with a developed wellness information model. Information privacy concerns specifically access to individually identifiable personal information and ones ability to control information about oneself. We carried out a user scenario walk-through of the privacy attributes related to the wellness components. The walk-through showed a need to relate self-regulating privacy policies to the pervasive context so that during various trust-building processes, a person is aware and can control the use, disclosure and even secondary use of his personal, private wellness information.

Privacy-Related Context Information for Ubiquitous Health

Background Ubiquitous health has been defined as a dynamic network of interconnected systems. A system is composed of one or more information systems, their stakeholders, and the environment. These systems offer health services to individuals and thus implement ubiquitous computing. Privacy is the key challenge for ubiquitous health because of autonomous processing, rich contextual metadata, lack of predefined trust among participants, and the business objectives. Additionally, regulations and policies of stakeholders may be unknown to the individual. Context-sensitive privacy policies are needed to regulate information processing. Objective Our goal was to analyze privacy-related context information and to define the corresponding components and their properties that support privacy management in ubiquitous health. These properties should describe the privacy issues of information processing. With components and their properties, individuals can define context-aware privacy policies and set their privacy preferences that can change in different information-processing situations. Methods Scenarios and user stories are used to analyze typical activities in ubiquitous health to identify main actors, goals, tasks, and stakeholders. Context arises from an activity and, therefore, we can determine different situations, services, and systems to identify properties for privacy-related context information in information-processing situations. Results Privacy-related context information components are situation, environment, individual, information technology system, service, and stakeholder. Combining our analyses and previously identified characteristics of ubiquitous health, more detailed properties for the components are defined. Properties define explicitly what context information for different components is needed to create context-aware privacy policies that can control, limit, and constrain information processing. With properties, we can define, for example, how data can be processed or how components are regulated or in what kind of environment data can be processed. Conclusions This study added to the vision of ubiquitous health by analyzing information processing from the viewpoint of an individual’s privacy. We learned that health and wellness-related activities may happen in several environments and situations with multiple stakeholders, services, and systems. We have provided new knowledge regarding privacy-related context information and corresponding components by analyzing typical activities in ubiquitous health. With the identified components and their properties, individuals can define their personal preferences on information processing based on situational information, and privacy services can capture privacy-related context of the information-processing situation.

Trust-based information system architecture for personal wellness

Modern eHealth, ubiquitous health and personal wellness systems take place in an unsecure and ubiquitous information space where no predefined trust occurs. This paper presents novel information model and an architecture for trust based privacy management of personal health and wellness information in ubiquitous environment. The architecture enables a person to calculate a dynamic and context-aware trust value for each service provider, and using it to design personal privacy policies for trustworthy use of health and wellness services. For trust calculation a novel set of measurable context-aware and health information-sensitive attributes is developed. The architecture enables a person to manage his or her privacy in ubiquitous environment by formulating context-aware and service provider specific policies. Focus groups and information modelling was used for developing a wellness information model. System analysis method based on sequential steps that enable to combine results of analysis of privacy and trust concerns and the selection of trust and privacy services was used for development of the information system architecture. Its services (e.g. trust calculation, decision support, policy management and policy binding services) and developed attributes enable a person to define situation-aware policies that regulate the way his or her wellness and health information is processed.