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1.
Int J Environ Res Public Health ; 18(24)2021 12 20.
Article in English | MEDLINE | ID: covidwho-1580709

ABSTRACT

The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance.


Subject(s)
COVID-19 , Pandemics , Humans , Information Storage and Retrieval , Privacy , SARS-CoV-2
2.
J Med Internet Res ; 23(2): e25120, 2021 02 25.
Article in English | MEDLINE | ID: covidwho-1575528

ABSTRACT

Multisite medical data sharing is critical in modern clinical practice and medical research. The challenge is to conduct data sharing that preserves individual privacy and data utility. The shortcomings of traditional privacy-enhancing technologies mean that institutions rely upon bespoke data sharing contracts. The lengthy process and administration induced by these contracts increases the inefficiency of data sharing and may disincentivize important clinical treatment and medical research. This paper provides a synthesis between 2 novel advanced privacy-enhancing technologies-homomorphic encryption and secure multiparty computation (defined together as multiparty homomorphic encryption). These privacy-enhancing technologies provide a mathematical guarantee of privacy, with multiparty homomorphic encryption providing a performance advantage over separately using homomorphic encryption or secure multiparty computation. We argue multiparty homomorphic encryption fulfills legal requirements for medical data sharing under the European Union's General Data Protection Regulation which has set a global benchmark for data protection. Specifically, the data processed and shared using multiparty homomorphic encryption can be considered anonymized data. We explain how multiparty homomorphic encryption can reduce the reliance upon customized contractual measures between institutions. The proposed approach can accelerate the pace of medical research while offering additional incentives for health care and research institutes to employ common data interoperability standards.


Subject(s)
Computer Security/ethics , Information Dissemination/ethics , Privacy/legislation & jurisprudence , Technology/methods , Humans
3.
J Med Internet Res ; 23(2): e23467, 2021 02 09.
Article in English | MEDLINE | ID: covidwho-1574242

ABSTRACT

BACKGROUND: Many countries across the globe have released their own COVID-19 contact tracing apps. This has resulted in the proliferation of several apps that used a variety of technologies. With the absence of a standardized approach used by the authorities, policy makers, and developers, many of these apps were unique. Therefore, they varied by function and the underlying technology used for contact tracing and infection reporting. OBJECTIVE: The goal of this study was to analyze most of the COVID-19 contact tracing apps in use today. Beyond investigating the privacy features, design, and implications of these apps, this research examined the underlying technologies used in contact tracing apps. It also attempted to provide some insights into their level of penetration and to gauge their public reception. This research also investigated the data collection, reporting, retention, and destruction procedures used by each of the apps under review. METHODS: This research study evaluated 13 apps corresponding to 10 countries based on the underlying technology used. The inclusion criteria ensured that most COVID-19-declared epicenters (ie, countries) were included in the sample, such as Italy. The evaluated apps also included countries that did relatively well in controlling the outbreak of COVID-19, such as Singapore. Informational and unofficial contact tracing apps were excluded from this study. A total of 30,000 reviews corresponding to the 13 apps were scraped from app store webpages and analyzed. RESULTS: This study identified seven distinct technologies used by COVID-19 tracing apps and 13 distinct apps. The United States was reported to have released the most contact tracing apps, followed by Italy. Bluetooth was the most frequently used underlying technology, employed by seven apps, whereas three apps used GPS. The Norwegian, Singaporean, Georgian, and New Zealand apps were among those that collected the most personal information from users, whereas some apps, such as the Swiss app and the Italian (Immuni) app, did not collect any user information. The observed minimum amount of time implemented for most of the apps with regard to data destruction was 14 days, while the Georgian app retained records for 3 years. No significant battery drainage issue was reported for most of the apps. Interestingly, only about 2% of the reviewers expressed concerns about their privacy across all apps. The number and frequency of technical issues reported on the Apple App Store were significantly more than those reported on Google Play; the highest was with the New Zealand app, with 27% of the reviewers reporting technical difficulties (ie, 10% out of 27% scraped reviews reported that the app did not work). The Norwegian, Swiss, and US (PathCheck) apps had the least reported technical issues, sitting at just below 10%. In terms of usability, many apps, such as those from Singapore, Australia, and Switzerland, did not provide the users with an option to sign out from their apps. CONCLUSIONS: This article highlighted the fact that COVID-19 contact tracing apps are still facing many obstacles toward their widespread and public acceptance. The main challenges are related to the technical, usability, and privacy issues or to the requirements reported by some users.


Subject(s)
Attitude , COVID-19/prevention & control , Contact Tracing/methods , Mobile Applications , Privacy , Australia , Data Collection , Disease Outbreaks , Geographic Information Systems , Georgia (Republic) , Humans , Italy , New Zealand , Norway , SARS-CoV-2 , Singapore , Switzerland , Technology , United States , Wireless Technology
4.
BMC Med Ethics ; 22(1): 164, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1575423

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has highlighted once more the great need for comprehensive access to, and uncomplicated use of, pre-existing patient data for medical research. Enabling secondary research-use of patient-data is a prerequisite for the efficient and sustainable promotion of translation and personalisation in medicine, and for the advancement of public-health. However, balancing the legitimate interests of scientists in broad and unrestricted data-access and the demand for individual autonomy, privacy and social justice is a great challenge for patient-based medical research. METHODS: We therefore conducted two questionnaire-based surveys among North-German outpatients (n = 650) to determine their attitude towards data-donation for medical research, implemented as an opt-out-process. RESULTS: We observed a high level of acceptance (75.0%), the most powerful predictor of a positive attitude towards data-donation was the conviction that every citizen has a duty to contribute to the improvement of medical research (> 80% of participants approving data-donation). Interestingly, patients distinguished sharply between research inside and outside the EU, despite a general awareness that universities and public research institutions cooperate with commercial companies, willingness to allow use of donated data by the latter was very low (7.1% to 29.1%, depending upon location of company). The most popular measures among interviewees to counteract reservations against commercial data-use were regulation by law (61.4%), stipulating in the process that data are not sold or resold (84.6%). A majority requested control of both the use (46.8%) and the protection (41.5%) of the data by independent bodies. CONCLUSIONS: In conclusion, data-donation for medical research, implemented as a combination of legal entitlement and easy-to-exercise-right to opt-out, was found to be widely supported by German patients and therefore warrants further consideration for a transposition into national law.


Subject(s)
Biomedical Research , COVID-19 , Attitude , Humans , Privacy , SARS-CoV-2
5.
J Healthc Eng ; 2021: 1550993, 2021.
Article in English | MEDLINE | ID: covidwho-1571447

ABSTRACT

The outbreak of the novel coronavirus has exposed many problems in the auxiliary information system for epidemic prevention and control, which needs to be resolved by using methods such as the antitampering of logistics data and the management and control of epidemic materials. This article discusses the introduction of emerging technologies such as Radio Frequency Identification (RFID), which support privacy protection into the auxiliary information system for epidemic prevention and control. Recently, this paper found that Khwaja et al.'s protocol (RAPUS protocol) is susceptible to database impersonation attacks and reader impersonation attacks. Therefore, this article proposes the enhanced protocol, which not only perfectly solves the problems of the abovementioned protocols but also comprehensively compares multiple protocols. The enhanced protocol has higher efficiency and security. The security of the proposed protocol (RAPUS + protocol) is analyzed by GNY logic and the AVISPA model. The designed scheme can help realize the safety and traceability of epidemic prevention materials and improve the automation and decision-making efficiency of the epidemic prevention.


Subject(s)
COVID-19 , Radio Frequency Identification Device , Humans , Privacy , SARS-CoV-2
6.
Lancet Digit Health ; 3(12): e760, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526011
7.
8.
Stud Health Technol Inform ; 286: 11-15, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1508509

ABSTRACT

Law and regulation have not received much attention as part of the context shaping and being shaped by health informatics. Telemedicine, data, devices and software, and electronic health records (EHRs) are examples of how technologies are affected by privacy, intellectual property protections, and other law and regulation.


Subject(s)
Medical Informatics , Telemedicine , Electronic Health Records , Pandemics , Privacy
9.
BMJ Glob Health ; 6(Suppl 5)2021 07.
Article in English | MEDLINE | ID: covidwho-1476469

ABSTRACT

In August 2020, India announced its vision for the National Digital Health Mission (NDHM), a federated national digital health exchange where digitised data generated by healthcare providers will be exported via application programme interfaces to the patient's electronic personal health record. The NDHM architecture is initially expected to be a claims platform for the national health insurance programme 'Ayushman Bharat' that serves 500 million people. Such large-scale digitisation and mobility of health data will have significant ramifications on care delivery, population health planning, as well as on the rights and privacy of individuals. Traditional mechanisms that seek to protect individual autonomy through patient consent will be inadequate in a digitised ecosystem where processed data can travel near instantaneously across various nodes in the system and be combined, aggregated, or even re-identified.In this paper we explore the limitations of 'informed' consent that is sought either when data are collected or when they are ported across the system. We examine the merits and limitations of proposed alternatives like the fiduciary framework that imposes accountability on those that use the data; privacy by design principles that rely on technological safeguards against abuse; or regulations. Our recommendations combine complementary approaches in light of the evolving jurisprudence in India and provide a generalisable framework for health data exchange that balances individual rights with advances in data science.


Subject(s)
Ecosystem , Privacy , Humans , India , Informed Consent , Social Responsibility , United States
10.
Medicina (Kaunas) ; 57(10)2021 Oct 09.
Article in English | MEDLINE | ID: covidwho-1463751

ABSTRACT

The need to fight a highly aggressive virus such as SARS-CoV-2 has compelled governments to put in place measures, which, in the name of health protection, have constrained many freedoms we all enjoy, including freedom of movement, both nationally and within the European Union. In order to encourage and facilitate the return to free movement, the European Parliament has launched a "COVID-19 digital certificate". A spirited debate centered around the use of this certificate is still ongoing among scholars, many of whom have pointed out the uncertainties relative to COVID-19 immunity, privacy issues and the risk of discriminatory effects. The authors, while highlighting some critical aspects, argue that the COVID digital certificate in its current approved version can effectively help prevent the spread of the infection and promote free movement, while upholding the right to health as much as possible. However, they also stress the need for a thorough information campaign to illustrate the advantages and limitations of this document in order to avoid creating a false sense of security in the public opinion, who may wrongly assume that the emergency has been overcome for good.


Subject(s)
COVID-19 , Public Health , European Union , Humans , Privacy , SARS-CoV-2
11.
J Med Internet Res ; 23(9): e26317, 2021 09 16.
Article in English | MEDLINE | ID: covidwho-1443941

ABSTRACT

BACKGROUND: Along with the proliferation of health information technologies (HITs), there is a growing need to understand the potential privacy risks associated with using such tools. Although privacy policies are designed to inform consumers, such policies have consistently been found to be confusing and lack transparency. OBJECTIVE: This study aims to present consumer preferences for accessing privacy information; develop and apply a privacy policy risk assessment tool to assess whether existing HITs meet the recommended privacy policy standards; and propose guidelines to assist health professionals and service providers with understanding the privacy risks associated with HITs, so that they can confidently promote their safe use as a part of care. METHODS: In phase 1, participatory design workshops were conducted with young people who were attending a participating headspace center, their supportive others, and health professionals and service providers from the centers. The findings were knowledge translated to determine participant preferences for the presentation and availability of privacy information and the functionality required to support its delivery. Phase 2 included the development of the 23-item privacy policy risk assessment tool, which incorporated material from international privacy literature and standards. This tool was then used to assess the privacy policies of 34 apps and e-tools. In phase 3, privacy guidelines, which were derived from learnings from a collaborative consultation process with key stakeholders, were developed to assist health professionals and service providers with understanding the privacy risks associated with incorporating HITs as a part of clinical care. RESULTS: When considering the use of HITs, the participatory design workshop participants indicated that they wanted privacy information to be easily accessible, transparent, and user-friendly to enable them to clearly understand what personal and health information will be collected and how these data will be shared and stored. The privacy policy review revealed consistently poor readability and transparency, which limited the utility of these documents as a source of information. Therefore, to enable informed consent, the privacy guidelines provided ensure that health professionals and consumers are fully aware of the potential for privacy risks in using HITs to support health and well-being. CONCLUSIONS: A lack of transparency in privacy policies has the potential to undermine consumers' ability to trust that the necessary measures are in place to secure and protect the privacy of their personal and health information, thus precluding their willingness to engage with HITs. The application of the privacy guidelines will improve the confidence of health professionals and service providers in the privacy of consumer data, thus enabling them to recommend HITs to provide or support care.


Subject(s)
Medical Informatics , Privacy , Adolescent , Humans , Informed Consent , Policy , Risk Assessment
12.
Sci Rep ; 11(1): 18716, 2021 09 21.
Article in English | MEDLINE | ID: covidwho-1434152

ABSTRACT

The COVID-19 pandemic has seen one of the first large-scale uses of digital contact tracing to track a chain of infection and contain the spread of a virus. The new technology has posed challenges both for governments aiming at high and effective uptake and for citizens weighing its benefits (e.g., protecting others' health) against the potential risks (e.g., loss of data privacy). Our cross-sectional survey with repeated measures across four samples in Germany ([Formula: see text]) focused on psychological factors contributing to the public adoption of digital contact tracing. We found that public acceptance of privacy-encroaching measures (e.g., granting the government emergency access to people's medical records or location tracking data) decreased over the course of the pandemic. Intentions to use contact tracing apps-hypothetical ones or the Corona-Warn-App launched in Germany in June 2020-were high. Users and non-users of the Corona-Warn-App differed in their assessment of its risks and benefits, in their knowledge of the underlying technology, and in their reasons to download or not to download the app. Trust in the app's perceived security and belief in its effectiveness emerged as psychological factors playing a key role in its adoption. We incorporate our findings into a behavioral framework for digital contact tracing and provide policy recommendations.


Subject(s)
COVID-19/epidemiology , Contact Tracing , Perception , Adult , Aged , COVID-19/pathology , COVID-19/virology , Cross-Sectional Studies , Female , Germany/epidemiology , Humans , Logistic Models , Male , Middle Aged , Mobile Applications , Pandemics , Privacy , Public Health , SARS-CoV-2/isolation & purification , Severity of Illness Index , Trust
13.
J Child Adolesc Psychopharmacol ; 31(7): 464-474, 2021 09.
Article in English | MEDLINE | ID: covidwho-1429159

ABSTRACT

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto. Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.


Subject(s)
Adolescent Health Services/organization & administration , COVID-19 , Child Health Services/organization & administration , Clinical Protocols/standards , Home Care Services , Mental Health Services/organization & administration , Patient Safety , Privacy , Telemedicine , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Computer Communication Networks/standards , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Home Care Services/ethics , Home Care Services/standards , Home Care Services/trends , Humans , SARS-CoV-2 , Telemedicine/ethics , Telemedicine/methods , United States
14.
JMIR Mhealth Uhealth ; 9(10): e30871, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1406797

ABSTRACT

BACKGROUND: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. OBJECTIVE: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. METHODS: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the "outbreak of a contagious disease." In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning "after the disease outbreak has dissipated." We analyzed interview transcripts using reflexive thematic analysis. RESULTS: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of "the greater good." The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. CONCLUSIONS: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance.


Subject(s)
COVID-19 , Motivation , Humans , Pandemics/prevention & control , Privacy , Public Health Surveillance , SARS-CoV-2 , United States/epidemiology
15.
Asian J Psychiatr ; 65: 102850, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1401151

ABSTRACT

In view of restrictions imposed to control COVID-19 pandemic, there has been a surge in online survey-based studies because of its ability to collect data with greater ease and faster speed compared to traditional methods. However, there are important concerns about the validity and generalizability of findings obtained using the online survey methodology. Further, there are data privacy concerns and ethical issues unique to these studies due to the electronic and online nature of survey data. Here, we describe some of the important issues associated with poor scientific quality of online survey findings, and provide suggestions to address them in future studies going ahead.


Subject(s)
COVID-19 , Pandemics , Humans , Internet , Privacy , SARS-CoV-2 , Surveys and Questionnaires
16.
Health Inf Manag ; 50(1-2): 13-25, 2021.
Article in English | MEDLINE | ID: covidwho-1398797

ABSTRACT

BACKGROUND: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. OBJECTIVE: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. METHOD: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. RESULTS: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. CONCLUSION: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. IMPLICATIONS: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.


Subject(s)
Consumer Health Information/legislation & jurisprudence , Consumer Health Information/standards , Health Literacy , Patient Rights , Privacy , Access to Information , COVID-19 , Humans , SARS-CoV-2
17.
J Am Med Inform Assoc ; 28(9): 2002-2008, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-1393285

ABSTRACT

In this perspective we want to highlight the rise of what we call "digital phenotyping" or inferring insights about peopleãs health and behavior from their digital devices and data, and the challenges this introduces. Indeed, the collection, processing, and storage of data comes with significant ethical, security and data governance considerations. The COVID-19 pandemic has laid bare the importance of scientific data and modeling, both to understand the nature and spread of the disease, and to develop treatment. But digital devices have also played a (controversial) role, with track and trace systems and increasingly "vaccine passports" being rolled out to help societies open back up. These systems epitomize a wider and longer-standing trend towards seeing almost any form of personal data as potentially health data, especially with the rise of consumer health trackers and other gadgets. Here, we offer an overview of the risks this introduces, drawing on the earlier revolution in genomic sequencing, and propose guidelines to help protect privacy whilst utilizing personal data to help get society back up to speed.


Subject(s)
COVID-19 , Pandemics , Humans , Privacy , SARS-CoV-2
19.
20.
Can J Public Health ; 111(4): 454-457, 2020 08.
Article in English | MEDLINE | ID: covidwho-1389875

ABSTRACT

Sharing data expediently for pandemic response purposes exposes healthcare providers in Canada to significant regulatory uncertainty. Duplicative and contradictory ethical and legal duties flowing from overlapping sources can stifle flows of medical data among clinicians, researchers, and institutions. Authorities should support caregivers and accelerate research by providing clear guidance to the health sector. Institutions should foster robust data stewardship and standardize their practices to those recognized among the international health informatics community. Reform is critical to ensuring Canadian healthcare providers can deliver efficient health responses that are integrated with dispersed and disparate national and international approaches.


Subject(s)
Biomedical Research , Coronavirus Infections/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Privacy/legislation & jurisprudence , Public Health , COVID-19 , Canada/epidemiology , Humans
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