ABSTRACT
Introduction: Clinical data exchange between physicians and other medical experts has become more common in recent years, especially since the shift to home office has increased due to the Covid-19 pandemic. This can be problematic for sleep specialists since sleep recordings cannot be easily transferred in a safe and secure manner - A typical recording contains a large volume of sensitive data with multiple parameters (e.g., brain activity, heart rate, pulse oximetry, respiratory flow, cardiac current flow).Therefore, in sleep medicine, a platform that allows safe uploading, downloading, and sharing of patient data is necessary for quality control. Method(s): A new multi-level encryption and decryption software called XNAT was developed by the ASCLEPIOS project to ensure the safety of clinical data exchanges. The clinical and technical partners together trialed this platform and assessed the functionality for sensitive data transfer. The sensitive data used in this assessment were 19 original home sleep recordings (6-channel polysomnographic data). Result(s): The clinical and technical partners successfully uploaded 19 raw European Data Format (+) files (sleep recordings) to the XNAT platform, which were immediately pseudonymized. The XNAT platform provided all necessary and important functions in the context of data security: Firstly, all uploaded data followed data privacy regulations and were encrypted with symmetric searchable encryption, attribute-based access control services, attribute-based encryption, and functional encryption. Secondly, all uploaded data could be successfully decrypted, downloaded, annotated, and re-uploaded by both clinical and technical partners. This meant that events in the recordings could be marked and labeled with the suspected relevant medical terms. These annotations were subsequently visible to all other collaborating partners and could be amended if the annotations were incorrect. As a result, sleep scoring with quality control was conducted remotely by both partners. Conclusion(s): Overall, the multi-level encryption platform developed by the ASCLEPIOS project allowed both clinical and technical partners to keep sensitive patient data secure whilst being able to collaborate with one another on the same patient data. This opens new opportunities for sleep specialists to gain a second opinion and quality control.
ABSTRACT
Telemedicine has advanced and grown enormously during the last 10 years. Due to the Sars-CoV2 pandemia the pace of digitalizing diagnostics and therapy in the field of sleep medicine has accelerated. In Germany the main fields of sleep telemedicine are the group of sleep disordered breathing and the group of insomnias. Although there are several initiatives which aim an inventing digital sleep technologies as telemedical recording of relevant data for the diagnostics of obstructive apnea syndrome or digital applications for the treatment of insomnia coordinated approaches are being developed. The German Sleep Society aims on coordinating all initiatives with several approaches. Here the main focus is the standard which a needed for quality aspects. Another aspect is to transform the German health system, which is divided into the public and the private health insurance system, into a more flexible and digital friendly one accepting that sleep medicine is one of the best example to implement digital techniques for telemedicine. The German state of the art in the field of sleep telemedicine will be reflected to open the chance for other countries to have a deeper insight in the challenges and shortcomings for implementing sleep telemedicine in a highly sophisticated health care system.