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1.
Ethics Hum Res ; 44(4): 2-13, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1929793

ABSTRACT

We assessed public perspectives of microbiome research privacy risks before and after a nationwide emergency was declared in the United States regarding the Covid-19 pandemic. From January to July of 2020, we conducted an online survey of perceived privacy risks of microbiome research among U.S. adults. Among 3,106 participants (the preemergency group), most expressed that the microbiome posed privacy risks similar to those associated with DNA (60.3%) or medical records (50.6%) and that they would prefer detailed explanations (70.2%) of risk in consent materials. Only 8.9% reported moderate to high familiarity with microbiome privacy risks. In adjusted analyses, individuals who participated in the study after the Covid-19 emergency was declared (the Covid-19 emergency group) were less likely to express that microbiome privacy risks were similar to those of DNA or medical records and more likely to report familiarity with the privacy risks of microbiomes. There was a trend toward increased concern after the Covid-19 emergency was declared (p = 0.053). Overall, the study revealed that many U.S. adults believe that microbiome privacy risks are similar to those associated with DNA or medical records, and they prefer detailed explanations in consent documents. Individuals who participated after the Covid-19 emergency was declared reported greater knowledge of microbiome privacy risks but had more concern.


Subject(s)
COVID-19 , Microbiota , Adult , Confidentiality , Humans , Pandemics , Privacy , United States
2.
Sensors (Basel) ; 22(11)2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-1892945

ABSTRACT

This paper presents an optimization of the medication delivery drone with the Internet of Things (IoT)-Guidance Landing System based on direction and intensity of light. The IoT-GLS was incorporated into the system to assist the drone's operator or autonomous system to select the best landing angles for landing. The landing selection was based on the direction and intensity of the light. The medication delivery drone system was developed using an Arduino Uno microcontroller board, ESP32 DevKitC V4 board, multiple sensors, and IoT mobile apps to optimize face detection. This system can detect and compare real-time light intensity from all directions. The results showed that the IoT-GLS has improved the distance of detection by 192% in a dark environment and exhibited an improvement in face detection distance up to 147 cm in a room with low light intensity. Furthermore, a significant correlation was found between face recognition's detection distance, light source direction, light intensity, and light color (p < 0.05). The findings of an optimal efficiency of facial recognition for medication delivery was achieved due to the ability of the IoT-GLS to select the best angle of landing based on the light direction and intensity.


Subject(s)
Internet of Things , Mobile Applications , Confidentiality , Unmanned Aerial Devices
3.
Int J Environ Res Public Health ; 19(9)2022 05 05.
Article in English | MEDLINE | ID: covidwho-1820284

ABSTRACT

BACKGROUND: The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS: 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS: Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS: Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.


Subject(s)
COVID-19 , Ophthalmology , Telemedicine , COVID-19/epidemiology , Confidentiality , Humans , Pandemics
4.
PLoS One ; 17(4): e0266916, 2022.
Article in English | MEDLINE | ID: covidwho-1793498

ABSTRACT

The lack of data outsourcing in healthcare management systems slows down the intercommunication and information sharing between different entities. A standard solution is outsourcing the electronic health record (EHR) to a cloud service provider (CSP). The outsourcing of the EHR should be performed securely without compromising the CSP functionalities. Searchable encryption would be a viable approach to ensure the confidentiality of the data without compromising searchability and accessibility. However, most existing searchable encryption solutions use centralised architecture. These systems have trust issues as not all the CSPs are fully trusted or honest. To address these problems, we explore blockchain technology with smart contract applications to construct a decentralised system with auditable yet immutable data storage and access. First, we propose a blockchain-based searchable encryption scheme for EHR storage and updates in a decentralised fashion. The proposed scheme supports confidentiality of the outsourced EHR, keyword search functionalities, verifiability of the user and the server, storage immutability, and dynamic updates of EHRs. Next, we implement a prototype using JavaScript and Solidity on the Ethereum platform to demonstrate the practicality of the proposed solution. Finally, we compare the performance and security of the proposed scheme against existing solutions. The result indicates that the proposed scheme is practical while providing the desired security features and functional requirements.


Subject(s)
Blockchain , Cloud Computing , Computer Security , Confidentiality , Delivery of Health Care , Electronic Health Records
5.
Int J Environ Res Public Health ; 19(7)2022 03 30.
Article in English | MEDLINE | ID: covidwho-1785638

ABSTRACT

Counterfeiting drugs has been a global concern for years. Considering the lack of transparency within the current pharmaceutical distribution system, research has shown that blockchain technology is a promising solution for an improved supply chain system. This study aims to explore the current solution proposals for distribution systems using blockchain technology. Based on a literature review on currently proposed solutions, it is identified that the secrecy of the data within the system and nodes' reputation in decision making has not been considered. The proposed prototype uses a zero-knowledge proof protocol to ensure the integrity of the distributed data. It uses the Markov model to track each node's 'reputation score' based on their interactions to predict the reliability of the nodes in consensus decision making. Analysis of the prototype demonstrates a reliable method in decision making, which concludes with overall improvements in the system's confidentiality, integrity, and availability. The result indicates that the decision protocol must be significantly considered in a reliable distribution system. It is recommended that the pharmaceutical distribution systems adopt a relevant protocol to design their blockchain solution. Continuous research is required further to increase performance and reliability within blockchain distribution systems.


Subject(s)
Blockchain , Confidentiality , Pharmaceutical Preparations , Reproducibility of Results , Technology
6.
Front Public Health ; 10: 814163, 2022.
Article in English | MEDLINE | ID: covidwho-1776011

ABSTRACT

Privacy protection for health data is more than simply stripping datasets of specific identifiers. Privacy protection increasingly means the application of privacy-enhancing technologies (PETs), also known as privacy engineering. Demands for the application of PETs are not yet met with ease of use or even understanding. This paper provides a scope of the current peer-reviewed evidence regarding the practical use or adoption of various PETs for managing health data privacy. We describe the state of knowledge of PETS for the use and exchange of health data specifically and build a practical perspective on the steps needed to improve the standardization of the application of PETs for diverse uses of health data.


Subject(s)
Confidentiality , Privacy , Computer Security , Humans
7.
Compr Psychiatry ; 115: 152300, 2022 05.
Article in English | MEDLINE | ID: covidwho-1773227

ABSTRACT

BACKGROUND: As the COVID-19 pandemic continues, there is an increasing reliance on community health workers (CHWs) to achieve its control especially in low, and middle-income countries (LMICs). An increase in the demand for their services and the challenges they already face make them prone to mental health illness. Therefore, there is a need to further support the mental health and well-being of CHWs during the COVID-19 pandemic. METHODS: We organised a workshop on Zoom to deliberate on relevant components of an intervention package for supporting the mental health of CHWs in LMICs during the COVID-19 pandemic. We used a thematic analysis approach to summarise deliberations from this workshop. OUTCOMES: Participants identified the need for a hub for coordinating CHW activities, a care coordination team to manage their health, training programs aimed at improving their work performance and taking control of their health, a communication system that keeps them in touch with colleagues, family, and the communities they serve. They cautioned against confidentiality breaches while handling personal health information and favoured tailoring interventions to the unique needs of CHWs. Participants also advised on the need to ensure job security for CHWs and draw on available resources in the community. To measure the impact of such an intervention package, participants encouraged the use of mixed methods and a co-designed approach. INTERPRETATION: As CHWs contribute to the pandemic response in LMICs, their mental health and well-being need to be protected. Such protection can be provided by using an intervention package that harnesses inputs from members of the broader health system, their families, and communities.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Community Health Workers/education , Community Health Workers/psychology , Confidentiality , Developing Countries , Humans , Mental Health , Pandemics/prevention & control
8.
J Med Internet Res ; 24(3): e30619, 2022 03 17.
Article in English | MEDLINE | ID: covidwho-1770890

ABSTRACT

Clinical epidemiology and patient-oriented health care research that incorporates neighborhood-level data is becoming increasingly common. A key step in conducting this research is converting patient address data to longitude and latitude data, a process known as geocoding. Several commonly used approaches to geocoding (eg, ggmap or the tidygeocoder R package) send patient addresses over the internet to web-based third-party geocoding services. Here, we describe how these approaches to geocoding disclose patients' personally identifiable information (PII) and how the subsequent publication of the research findings discloses the same patients' protected health information (PHI). We explain how these disclosures can occur and recommend strategies to maintain patient privacy when studying neighborhood effects on patient outcomes.


Subject(s)
Disclosure , Personally Identifiable Information , Confidentiality , Geographic Mapping , Humans
9.
Nat Commun ; 13(1): 1678, 2022 03 30.
Article in English | MEDLINE | ID: covidwho-1768824

ABSTRACT

Linear mixed models are commonly used in healthcare-based association analyses for analyzing multi-site data with heterogeneous site-specific random effects. Due to regulations for protecting patients' privacy, sensitive individual patient data (IPD) typically cannot be shared across sites. We propose an algorithm for fitting distributed linear mixed models (DLMMs) without sharing IPD across sites. This algorithm achieves results identical to those achieved using pooled IPD from multiple sites (i.e., the same effect size and standard error estimates), hence demonstrating the lossless property. The algorithm requires each site to contribute minimal aggregated data in only one round of communication. We demonstrate the lossless property of the proposed DLMM algorithm by investigating the associations between demographic and clinical characteristics and length of hospital stay in COVID-19 patients using administrative claims from the UnitedHealth Group Clinical Discovery Database. We extend this association study by incorporating 120,609 COVID-19 patients from 11 collaborative data sources worldwide.


Subject(s)
COVID-19 , Algorithms , COVID-19/epidemiology , Confidentiality , Databases, Factual , Humans , Linear Models
11.
Ciênc. Saúde Colet ; 25(supl.1): 2487-2492, Mar. 2020.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1725055

ABSTRACT

Resumo Dados ganham cada vez mais importância e valor na busca de respostas para enfrentar a COVID-19 tanto para a ciência quanto para as autoridades sanitárias. Em virtude da dificuldade de realizar diagnóstico da infecção na população em geral, iniciativas apoiadas em tecnologias digitais vêm sendo desenvolvidas por governos ou empresas privadas para possibilitar rastreamentos de sintomas, contatos e deslocamentos de modo a apoiar estratégias de acompanhamento e avaliação na vigilância de contágios. A despeito da importância e necessidade dessas iniciativas, questionamentos acerca da quantidade e tipos de dados pessoais coletados, processados, compartilhados e utilizados em nome da saúde pública, bem como os concomitantes ou posteriores usos desses dados, suscitam questionamentos éticos, legais e técnicos. Desafios que apontam para a necessidade de novos modelos de governança de dados e de tecnologias, responsáveis e transparentes, para controlar o Sars-Cov2 e as futuras emergências de saúde pública.


Abstract Data has become increasingly important and valuable for both scientists and health authorities searching for answers to the COVID-19 crisis. Due to difficulties in diagnosing this infection in populations around the world, initiatives supported by digital technologies are being developed by governments and private companies to enable the tracking of the public's symptoms, contacts and movements. Considering the current scenario, initiatives designed to support infection surveillance and monitoring are essential and necessary. Nonetheless, ethical, legal and technical questions abound regarding the amount and types of personal data being collected, processed, shared and used in the name of public health, as well as the concomitant or posterior use of this data. These challenges demonstrate the need for new models of responsible and transparent data and technology governance in efforts to control SARS-COV2, as well as in future public health emergencies.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Population Surveillance/methods , Global Health , Coronavirus Infections/epidemiology , Privacy , Health Records, Personal , Pandemics , Betacoronavirus , Contact Tracing/methods , Coronavirus Infections , Confidentiality , Social Media , Data Anonymization
12.
PLoS One ; 17(1): e0262609, 2022.
Article in English | MEDLINE | ID: covidwho-1643269

ABSTRACT

BACKGROUND: The use of linked healthcare data in research has the potential to make major contributions to knowledge generation and service improvement. However, using healthcare data for secondary purposes raises legal and ethical concerns relating to confidentiality, privacy and data protection rights. Using a linkage and anonymisation approach that processes data lawfully and in line with ethical best practice to create an anonymous (non-personal) dataset can address these concerns, yet there is no set approach for defining all of the steps involved in such data flow end-to-end. We aimed to define such an approach with clear steps for dataset creation, and to describe its utilisation in a case study linking healthcare data. METHODS: We developed a data flow protocol that generates pseudonymous datasets that can be reversibly linked, or irreversibly linked to form an anonymous research dataset. It was designed and implemented by the Comprehensive Patient Records (CPR) study in Leeds, UK. RESULTS: We defined a clear approach that received ethico-legal approval for use in creating an anonymous research dataset. Our approach used individual-level linkage through a mechanism that is not computer-intensive and was rendered irreversible to both data providers and processors. We successfully applied it in the CPR study to hospital and general practice and community electronic health record data from two providers, along with patient reported outcomes, for 365,193 patients. The resultant anonymous research dataset is available via DATA-CAN, the Health Data Research Hub for Cancer in the UK. CONCLUSIONS: Through ethical, legal and academic review, we believe that we contribute a defined approach that represents a framework that exceeds current minimum standards for effective pseudonymisation and anonymisation. This paper describes our methods and provides supporting information to facilitate the use of this approach in research.


Subject(s)
Biomedical Research/methods , Confidentiality , Data Anonymization , Biomedical Research/ethics , Datasets as Topic , Electronic Data Processing/ethics , Electronic Data Processing/methods , Electronic Health Records/organization & administration , Humans , Information Storage and Retrieval , United Kingdom
13.
Int J Health Geogr ; 21(1): 1, 2022 01 19.
Article in English | MEDLINE | ID: covidwho-1633795

ABSTRACT

This article provides a state-of-the-art summary of location privacy issues and geoprivacy-preserving methods in public health interventions and health research involving disaggregate geographic data about individuals. Synthetic data generation (from real data using machine learning) is discussed in detail as a promising privacy-preserving approach. To fully achieve their goals, privacy-preserving methods should form part of a wider comprehensive socio-technical framework for the appropriate disclosure, use and dissemination of data containing personal identifiable information. Select highlights are also presented from a related December 2021 AAG (American Association of Geographers) webinar that explored ethical and other issues surrounding the use of geospatial data to address public health issues during challenging crises, such as the COVID-19 pandemic.


Subject(s)
COVID-19 , Privacy , Confidentiality , Humans , Pandemics , Public Health , SARS-CoV-2 , Social Justice
14.
Medicina (Kaunas) ; 57(12)2021 Nov 30.
Article in English | MEDLINE | ID: covidwho-1542664

ABSTRACT

Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional-patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.


Subject(s)
COVID-19 , Telemedicine , Confidentiality , Humans , Pandemics , SARS-CoV-2
15.
J Med Internet Res ; 23(11): e24460, 2021 11 15.
Article in English | MEDLINE | ID: covidwho-1518430

ABSTRACT

BACKGROUND: Patient-centered health care information systems (PHSs) enable patients to take control and become knowledgeable about their own health, preferably in a secure environment. Current and emerging PHSs use either a centralized database, peer-to-peer (P2P) technology, or distributed ledger technology for PHS deployment. The evolving COVID-19 decentralized Bluetooth-based tracing systems are examples of disease-centric P2P PHSs. Although using P2P technology for the provision of PHSs can be flexible, scalable, resilient to a single point of failure, and inexpensive for patients, the use of health information on P2P networks poses major security issues as users must manage information security largely by themselves. OBJECTIVE: This study aims to identify the inherent security issues for PHS deployment in P2P networks and how they can be overcome. In addition, this study reviews different P2P architectures and proposes a suitable architecture for P2P PHS deployment. METHODS: A systematic literature review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Thematic analysis was used for data analysis. We searched the following databases: IEEE Digital Library, PubMed, Science Direct, ACM Digital Library, Scopus, and Semantic Scholar. The search was conducted on articles published between 2008 and 2020. The Common Vulnerability Scoring System was used as a guide for rating security issues. RESULTS: Our findings are consolidated into 8 key security issues associated with PHS implementation and deployment on P2P networks and 7 factors promoting them. Moreover, we propose a suitable architecture for P2P PHSs and guidelines for the provision of PHSs while maintaining information security. CONCLUSIONS: Despite the clear advantages of P2P PHSs, the absence of centralized controls and inconsistent views of the network on some P2P systems have profound adverse impacts in terms of security. The security issues identified in this study need to be addressed to increase patients' intention to use PHSs on P2P networks by making them safe to use.


Subject(s)
COVID-19 , Health Information Systems , Confidentiality , Humans , Patient-Centered Care , SARS-CoV-2
16.
Biomed Res Int ; 2021: 6967166, 2021.
Article in English | MEDLINE | ID: covidwho-1476881

ABSTRACT

Health big data has already been the most important big data for its serious privacy disclosure concerns and huge potential value of secondary use. Measurements must be taken to balance and compromise both the two serious challenges. One holistic solution or strategy is regarded as the preferred direction, by which the risk of reidentification from records should be kept as low as possible and data be shared with the principle of minimum necessary. In this article, we present a comprehensive review about privacy protection of health data from four aspects: health data, related regulations, three strategies for data sharing, and three types of methods with progressive levels. Finally, we summarize this review and identify future research directions.


Subject(s)
Confidentiality , Health Records, Personal , Privacy , Consumer Health Information , Genomics , Health Insurance Portability and Accountability Act , Humans , Information Dissemination , Models, Theoretical , United States
17.
J Med Internet Res ; 23(10): e28613, 2021 10 28.
Article in English | MEDLINE | ID: covidwho-1417034

ABSTRACT

BACKGROUND: As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice. OBJECTIVE: This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed. METHODS: We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology. RESULTS: We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy. CONCLUSIONS: Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.


Subject(s)
Blockchain , COVID-19 , Confidentiality , Data Management , Electronic Health Records , Humans , SARS-CoV-2
18.
Nat Med ; 27(9): 1486-1488, 2021 09.
Article in English | MEDLINE | ID: covidwho-1410409
19.
Yearb Med Inform ; 30(1): 226-232, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1392945

ABSTRACT

OBJECTIVE: This survey article presents a literature review of relevant publications aiming to explore whether the EU's General Data Protection Regulation (GDPR) has held true during a time of crisis and the implications that arose during the COVID-19 outbreak. METHOD AND RESULTS: Based on the approach taken and the screening of the relevant articles, the results focus on three themes: a critique on GDPR; the ethics surrounding the use of digital health technologies, namely in the form of mobile applications; and the possibility of cross border transfers of said data outside of Europe. Within this context, the article reviews the arising themes, considers the use of data through mobile health applications, and discusses whether data protection may require a revision when balancing societal and personal interests. CONCLUSIONS: In summary, although it is clear that the GDPR has been applied through a mixed and complex experience with data handling during the pandemic, the COVID-19 pandemic has indeed shown that it was a test the GDPR was designed and prepared to undertake. The article suggests that further review and research is needed to first ensure that an understanding of the state of the art in data protection during the pandemic is maintained and second to subsequently explore and carefully create a specific framework for the ethical considerations involved. The paper echoes the literature reviewed and calls for the creation of a unified and harmonised network or database to enable the secure data sharing across borders.


Subject(s)
COVID-19 , Computer Security/legislation & jurisprudence , Data Collection/ethics , Information Dissemination/ethics , Computer Security/ethics , Confidentiality , Data Collection/legislation & jurisprudence , European Union , Government Regulation , Humans , Information Dissemination/legislation & jurisprudence
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