Privacy and Security (PriSec), Department of Mathematics and Computer Science, Karlstad University, Karlstad, Sweden.
School of Informatics, University of Skövde, Skövde, Sweden.
JMIR Mhealth Uhealth. 2019 Mar 20;7(3):e11642. doi: 10.2196/11642.
BACKGROUND: Community-based primary care focuses on health promotion, awareness raising, and illnesses treatment and prevention in individuals, groups, and communities. Community Health Workers (CHWs) are the leading actors in such programs, helping to bridge the gap between the population and the health system. Many mobile health (mHealth) initiatives have been undertaken to empower CHWs and improve the data collection process in the primary care, replacing archaic paper-based approaches. A special category of mHealth apps, known as mHealth Data Collection Systems (MDCSs), is often used for such tasks. These systems process highly sensitive personal health data of entire communities so that a careful consideration about privacy is paramount for any successful deployment. However, the mHealth literature still lacks methodologically rigorous analyses for privacy and data protection. OBJECTIVE: In this paper, a Privacy Impact Assessment (PIA) for MDCSs is presented, providing a systematic identification and evaluation of potential privacy risks, particularly emphasizing controls and mitigation strategies to handle negative privacy impacts. METHODS: The privacy analysis follows a systematic methodology for PIAs. As a case study, we adopt the GeoHealth system, a large-scale MDCS used by CHWs in the Family Health Strategy, the Brazilian program for delivering community-based primary care. All the PIA steps were taken on the basis of discussions among the researchers (privacy and security experts). The identification of threats and controls was decided particularly on the basis of literature reviews and working group meetings among the group. Moreover, we also received feedback from specialists in primary care and software developers of other similar MDCSs in Brazil. RESULTS: The GeoHealth PIA is based on 8 Privacy Principles and 26 Privacy Targets derived from the European General Data Protection Regulation. Associated with that, 22 threat groups with a total of 97 subthreats and 41 recommended controls were identified. Among the main findings, we observed that privacy principles can be enhanced on existing MDCSs with controls for managing consent, transparency, intervenability, and data minimization. CONCLUSIONS: Although there has been significant research that deals with data security issues, attention to privacy in its multiple dimensions is still lacking for MDCSs in general. New systems have the opportunity to incorporate privacy and data protection by design. Existing systems will have to address their privacy issues to comply with new and upcoming data protection regulations. However, further research is still needed to identify feasible and cost-effective solutions.
背景:以社区为基础的初级保健工作重点是促进个人、群体和社区的健康,提高认识,并治疗和预防疾病。社区卫生工作者(CHWs)是此类计划的主要执行者,有助于弥合民众与卫生系统之间的差距。许多移动医疗(mHealth)举措已经开展,旨在增强 CHWs 的能力,并改善初级保健的数据收集过程,取代过时的纸质方法。一类特殊的移动医疗应用程序,称为移动医疗数据采集系统(MDCSs),通常用于此类任务。这些系统处理整个社区的高度敏感的个人健康数据,因此,任何成功的部署都必须非常重视隐私问题。然而,移动医疗文献仍然缺乏关于隐私和数据保护的严格方法分析。
目的:本文提出了 MDCS 的隐私影响评估(PIA),系统地识别和评估潜在的隐私风险,特别强调控制和缓解策略,以处理负面隐私影响。
方法:隐私分析遵循 PIA 的系统方法。作为案例研究,我们采用了 GeoHealth 系统,这是一种大型 MDCS,被家庭健康战略中的 CHWs 使用,该战略是提供以社区为基础的初级保健的巴西计划。所有 PIA 步骤都是在研究人员(隐私和安全专家)之间的讨论基础上进行的。威胁和控制的识别特别基于文献综述和工作组会议。此外,我们还收到了初级保健专家和巴西其他类似 MDCS 软件开发人员的反馈。
结果:GeoHealth PIA 基于源自欧盟通用数据保护条例的 8 个隐私原则和 26 个隐私目标。与此相关的是,确定了 22 个威胁组,共 97 个子威胁和 41 个建议控制措施。主要发现包括,我们观察到,可以通过管理同意、透明度、可干预性和数据最小化等控制措施,在现有 MDCS 上增强隐私原则。
结论:尽管已经有大量研究涉及数据安全问题,但一般来说,移动医疗数据采集系统在多个方面的隐私问题仍未得到足够重视。新系统有机会通过设计纳入隐私和数据保护。现有的系统将不得不解决其隐私问题,以遵守新的和即将出台的数据保护法规。然而,仍需要进一步研究以确定可行且具有成本效益的解决方案。
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