Privacy by Design: Informed Consent and Internet of Things for Smart Health

Mapping Ethical Artificial Intelligence Policy Landscape: A Mixed Method Analysis

As more national governments adopt policies addressing the ethical implications of artificial intelligence, a comparative analysis of policy documents on these topics can provide valuable insights into emerging concerns and areas of shared importance. This study critically examines 57 policy documents pertaining to ethical AI originating from 24 distinct countries, employing a combination of computational text mining methods and qualitative content analysis. The primary objective is to methodically identify common themes throughout these policy documents and perform a comparative analysis of the ways in which various governments give priority to crucial matters. A total of nineteen topics were initially retrieved. Through an iterative coding process, six overarching themes were identified: principles, the protection of personal data, governmental roles and responsibilities, procedural guidelines, governance and monitoring mechanisms, and epistemological considerations. Furthermore, the research revealed 31 ethical dilemmas pertaining to AI that had been overlooked previously but are now emerging. These dilemmas have been referred to in different extents throughout the policy documents. This research makes a scholarly contribution to the expanding field of technology policy formulations at the national level by analyzing similarities and differences among countries. Furthermore, this analysis has practical ramifications for policymakers who are attempting to comprehend prevailing trends and potentially neglected domains that demand focus in the ever-evolving field of artificial intelligence.

Future pHealth Ecosystem-Holistic View on Privacy and Trust

Modern pHealth is an emerging approach to collecting and using personal health information (PHI) for personalized healthcare and personalized health management. For its products and services, it deploys advanced technologies such as sensors, actuators, computers, mobile phones, etc. Researchers have shown that today's networked information systems, such as pHealth ecosystems, miss appropriate privacy solutions, and trust is only an illusion. In the future, the situation will be even more challenging because pHealth ecosystems will be highly distributed, dynamic, increasingly autonomous, and multi-stakeholder, with the ability to monitor the person's regular life, movements, emotions, and health-related behavior in real time. In this paper, the authors demonstrate that privacy and trust in ecosystems are system-level problems that need a holistic, system-focused solution. To make future pHealth ethically acceptable, privacy-enabled, and trustworthy, the authors have developed a conceptual five-level privacy and trust model as well as a formula that describes the impact of privacy and trust factors on the level of privacy and trust. Furthermore, the authors have analyzed privacy and trust challenges and possible solutions at each level of the model. Based on the analysis performed, a proposal for future ethically acceptable, trustworthy, and privacy-enabled pHealth is developed. The solution combines privacy as personal property and trust as legally binding fiducial duty approaches and uses a blockchain-based smart contract agreement to store people's privacy and trust requirements and service providers' promises.

Advancing digital health Equity: Directions for behavioral and social science research

The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice.

Should my robot know what's best for me? Human–robot interaction between user experience and ethical design

To integrate social robots in real-life contexts, it is crucial that they are accepted by the users. Acceptance is not only related to the functionality of the robot but also strongly depends on how the user experiences the interaction. Established design principles from usability and user experience research can be applied to the realm of human–robot interaction, to design robot behavior for the comfort and well-being of the user. Focusing the design on these aspects alone, however, comes with certain ethical challenges, especially regarding the user’s privacy and autonomy. Based on an example scenario of human–robot interaction in elder care, this paper discusses how established design principles can be used in social robotic design. It then juxtaposes these with ethical considerations such as privacy and user autonomy. Combining user experience and ethical perspectives, we propose adjustments to the original design principles and canvass our own design recommendations for a positive and ethically acceptable social human–robot interaction design. In doing so, we show that positive user experience and ethical design may be sometimes at odds, but can be reconciled in many cases, if designers are willing to adjust and amend time-tested design principles.

Comprehension, Perception, and Projection

Health social networks (HSNs) allow individuals with health information needs to connect and discuss health-related issues online. Political-technology intertwinement (e.g. GDPR and Digital Technology) highlights that users need to be aware, understand, and willing to provide electronic consent (eConsent) when sharing personal information online. The objective of this study is to explore the ‘As-Is’ factors which impact individuals’ decisional autonomy when consenting to the privacy policy (PP) and Terms and Conditions (T&Cs) on a HSN. We use a Situational Awareness (SA) lens to examine decision autonomy when providing eConsent. A mixed-methods approach reveals that technical and privacy comprehension, user perceptions, and projection of future consequences impact participants’ decision autonomy in providing eConsent. Without dealing with the privacy paradox at the outset, decision awareness and latterly decision satisfaction is negatively impacted. Movement away from clickwrap online consent to customised two-way engagement is the way forward for the design of eConsent.

The role of 5G for digital healthcare against COVID-19 pandemic: Opportunities and challenges

COVID-19 pandemic caused a massive impact on healthcare, social life, and economies on a global scale. Apparently, technology has a vital role to enable ubiquitous and accessible digital health services in pandemic conditions as well as against “re-emergence” of COVID-19 disease in a post-pandemic era. Accordingly, 5G systems and 5G-enabled e-health solutions are paramount. This paper highlights methodologies to effectively utilize 5G for e-health use cases and its role to enable relevant digital services. It also provides a comprehensive discussion of the implementation issues, possible remedies and future research directions for 5G to alleviate the health challenges related to COVID-19.

Mathematical Reconciliation of Medical Privacy Policies

Healthcare data are arguably the most private of personal data. This very private information in the wrong hands can lead to identity theft, prescription fraud, insurance fraud, and an array of other crimes. Electronic-health systems such as My Health Record in Australia holds great promise in sharing medical data and improving healthcare quality. But, a key privacy issue in these systems is the misuse of healthcare data by “authorities.” The recent General Data Protection Regulation (GDPR) introduced in the EU aims to reduce personal-data misuse. But, there are no tools currently available to accurately reconcile a domestic E-health policy against the GDPR to identify discrepancies. Reconciling privacy policies is also non-trivial, because policies are often written in free text, making them subject to human interpretation.

In this article, we propose a tool that allows the description of E-health privacy policies, represents them using formal constructs making the policies precise and explicit. Using this formal framework, our tool can automatically reconcile a domestic E-health policy against the GDPR to identify violations and omissions. We use our prototype to illustrate several critical flaws in Australia’s My Health Record policy, including a non-compliance with GDPR that allows healthcare providers to access medical records by default.

A Blockchain-Based Consent Platform for Active Assisted Living: Modeling Study and Conceptual Framework

BACKGROUND

Recent advancements in active assisted living (AAL) technologies allow older adults to age well in place. However, sensing technologies increase the complexity of data collection points, making it difficult for users to consent to data collection. One possible solution for improving transparency in the consent management process is the use of blockchain, an immutable and timestamped ledger.

OBJECTIVE

This study aims to provide a conceptual framework based on technology aimed at mitigating trust issues in the consent management process.

METHODS

The consent management process was modeled using established methodologies to obtain a mapping of trust issues. This mapping was then used to develop a conceptual framework based on previous monitoring and surveillance architectures for connected devices.

RESULTS

In this paper, we present a model that maps trust issues in the informed consent process; a conceptual framework capable of providing all the necessary underlining technologies, components, and functionalities required to develop applications capable of managing the process of informed consent for AAL, powered by blockchain technology to ensure transparency; and a diagram showing an instantiation of the framework with entities comprising the participants in the blockchain network, suggesting possible technologies that can be used.

CONCLUSIONS

Our conceptual framework provides all the components and technologies that are required to enhance the informed consent process. Blockchain technology can help overcome several privacy challenges and mitigate trust issues that are currently present in the consent management process of data collection involving AAL technologies.

Electronic consenting for conducting research remotely: A review of current practice and key recommendations for using e-consenting

BACKGROUND

Electronic approaches are becoming more widely used to obtain informed consent for research participation. Electronic consent (e-consent) provides an accessible and versatile approach to the consenting process, which can be enhanced with audio-visual and interactive features to improve participant engagement and comprehension of study procedures. Best practice guidance underpinned by ethical principles is required to ensure effective implementation of e-consent for use in research.

AIM

To identify the key considerations for successful and ethical implementation of e-consent in the recruitment of participants to research projects which are conducted remotely.

METHODS

Electronic database searches of CINAHL, Medline, Embase, DARE, HTA, PubMed, the Cochrane Library, Scopus, Web of Science, NHS Evidence, and hand-searches of reference lists were performed. Primary research studies of adult (≥ 18 years old) research participants using e-consent, published in English language, peer-reviewed journals between 2010-2020 were eligible for inclusion.

RESULTS

Of the initial 665 identified studies, 18 met the inclusion criteria: 6 cohort studies, 5 qualitative studies, 4 randomised control trials, 2 mixed-methods studies and one case-control study. Critical appraisal of included studies using Critical Appraisal Skills Program (CASP) tools suggested a low to moderate risk of bias in most studies (n = 15). Key practice recommendations for researchers using e-consent were identified around five primary themes: 1) accessibility and user-friendliness of e-consent, 2) user engagement and comprehension, 3) customisability to participant preferences and demographics, 4) data security and 5) impact on research teams.

CONCLUSION

E-consenting approaches are generally well received by participants, with most studies reporting user-friendly interfaces and sufficient participant comprehension of consenting documentation.

IMPLICATIONS FOR PRACTICE

E-consent may facilitate remotely-conducted research by offering a feasible and robust alternative to face-to-face consenting approaches, however paper-based options should still be offered, based on participant preference. Customising e-consenting platforms may improve accessibility for individuals with specific needs, and increase engagement with study information. Research teams must offer prospective participants opportunities to discuss study information in real-time.

Protecting the privacy of technology users who have cognitive disabilities: Identifying areas for improvement and targets for change

Introduction

Information Technologies (IT) may serve assistive roles that facilitate the interaction of people living with cognitive disabilities (CD) within their environments. However, there are some notable concerns related to privacy threats associated with the use of IT. The purpose of this study was to examine how assistive technology developers may best adapt over time to develop their IT to be resilient against threats to privacy. We therefore focused on the following areas: (1) developers' knowledge and practices related to privacy protection; (2) challenges when applying recommended practices, and; (3) preferred channels to acquire knowledge.

Method

We conducted semi-structured interviews with ten technology developers who are members of the AGE-WELL network undertaking research and development of assistive technologies to be used by people who have cognitive disabilities. We used an inductive-deductive method for the analysis of qualitative data to examine participant responses and generate themes related to the study goals.

Results

Principal themes that emerged from the data include practices specific to populations with CD, challenges to obtaining consent to use of information, and preferred channels to acquire knowledge.

Conclusion

We identify areas of focus for developing a knowledge mobilization strategy to improve relevant policies and practices.

A Digital Substance-Use Harm Reduction Intervention for Students in Higher Education (MyUSE): Protocol for Project Development

BACKGROUND

Digital interventions have been identified as a possible tool for reducing the harm caused by illicit drug use among students attending higher education (ie, college students). However, the success of interventions in this area has been hampered by a lack of user involvement and behavior change theory in their design. The My Understanding of Substance use Experiences (MyUSE) project combines a rigorous user-centered design (UCD) methodology and a robust behavioral change framework to develop a digitally delivered harm reduction intervention for illicit drug use among students in higher education.

OBJECTIVE

This project aims to design and develop a digital intervention that targets drug use-related harm among students in higher education.

METHODS

The MyUSE project will take place over 3 phases. The first phase was exploratory in nature, involving 3 systematic reviews, a large survey, and student workshops to gather a comprehensive evidence base to guide the project. The second phase is the development stage of the project, involving the use of the Behavior Change Wheel theoretical framework to determine the behavior change techniques of the intervention and the use of the UCD methodology to guide the development of the digital intervention. The third phase is the evaluation stage, whereby the intervention will undergo a 5-stage evaluation process to comprehensively evaluate its impacts.

RESULTS

The exploratory phase 1 of the MyUSE project was completed in December 2018. Phase 2 is currently underway, and phase 3 is due to begin in September 2020.

CONCLUSIONS

Higher education institutions (HEIs) are ideally placed to intervene and support students in the area of illicit drug use but are constrained by limited resources. Current digital interventions in this area are sparse and have several weaknesses. The MyUSE project combines a UCD approach with a robust behavior change framework to develop a digitally delivered intervention that is economically viable, effective in changing behavior, usable and acceptable to students, and able to sustain long-term implementation in HEIs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17829.

Security and Privacy in IoT-Cloud-Based e-Health Systems—A Comprehensive Review

When the Internet and other interconnected networks are used in a health system, it is referred to as “e-Health.” In this paper, we examined research studies from 2017–2020 to explore the utilization of intelligent techniques in health and its evolution over time, particularly the integration of Internet of Things (IoT) devices and cloud computing. E-Health is defined as “the ability to seek, find, understand and appraise health information derived from electronic sources and acquired knowledge to properly solve or treat health problems. As a repository for health information as well as e-Health analysis, the Internet has the potential to protect consumers from harm and empower them to participate fully in informed health-related decision-making. Most importantly, high levels of e-Health integration mitigate the risk of encountering unreliable information on the Internet. Various research perspectives related to security and privacy within IoT-cloud-based e-Health systems are examined, with an emphasis on the opportunities, benefits and challenges of the implementation such systems. The combination of IoT-based e-Health systems integrated with intelligent systems such as cloud computing that provide smart objectives and applications is a promising future trend.

Evaluation of patient perception towards dynamic health data sharing using blockchain based digital consent with the Dovetail digital consent application: A cross sectional exploratory study

Background

New patient-centric integrated care models are enabled by the capability to exchange the patient’s data amongst stakeholders, who each specialise in different aspects of the patient’s care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it easier to give patients more control over their data, including the right to revoke consent. These characteristics challenge the traditional paper-based, single-organisation-led consent process. The Dovetail digital consent application uses a mobile application and blockchain based infrastructure to offer this capability, as part of a pilot allowing patients to have their data shared amongst digital tools, empowering patients to manage their condition within an integrated care setting.

Objective

To evaluate patient perceptions towards existing consent processes, and the Dovetail blockchain based digital consent application as a means to manage data sharing in the context of diabetes care.

Method

Patients with diabetes at a General Practitioner practice were recruited. Data were collected using focus groups and questionnaires. Thematic analysis of the focus group transcripts and descriptive statistics of the questionnaires was performed.

Results

There was a lack of understanding of existing consent processes in place, and many patients did not have any recollection of having previously given consent. The digital consent application received favourable feedback, with patients recognising the value of the capability offered by the application. Patients overwhelmingly favoured the digital consent application over existing practice.

Conclusions

Digital consent was received favourably, with patients recognising that it addresses the main limitations of the current process. Feedback on potential improvements was received. Future work includes confirmation of results in a broader demographic sample and across multiple conditions.

Health Information Systems in the Digital Health Ecosystem-Problems and Solutions for Ethics, Trust and Privacy

Digital health information systems (DHIS) are increasingly members of ecosystems, collecting, using and sharing a huge amount of personal health information (PHI), frequently without control and authorization through the data subject. From the data subject's perspective, there is frequently no guarantee and therefore no trust that PHI is processed ethically in Digital Health Ecosystems. This results in new ethical, privacy and trust challenges to be solved. The authors' objective is to find a combination of ethical principles, privacy and trust models, together enabling design, implementation of DHIS acting ethically, being trustworthy, and supporting the user's privacy needs. Research published in journals, conference proceedings, and standards documents is analyzed from the viewpoint of ethics, privacy and trust. In that context, systems theory and systems engineering approaches together with heuristic analysis are deployed. The ethical model proposed is a combination of consequentialism, professional medical ethics and utilitarianism. Privacy enforcement can be facilitated by defining it as health information specific contextual intellectual property right, where a service user can express their own privacy needs using computer-understandable policies. Thereby, privacy as a dynamic, indeterminate concept, and computational trust, deploys linguistic values and fuzzy mathematics. The proposed solution, combining ethical principles, privacy as intellectual property and computational trust models, shows a new way to achieve ethically acceptable, trustworthy and privacy-enabling DHIS and Digital Health Ecosystems.

Sustainable Accessibility: A Mobile App for Helping People with Disabilities to Search Accessible Shops

People with motor disabilities must face many barriers and obstacles in their daily lives, making it difficult to perform everyday tasks. The purpose of this work is to improve their living conditions by providing an app with accessibility information in an updated, reliable and friendly form. The development of the system integrates national and regional accessibility regulations, architectural aspects, with an extensive field work, and a sustainable software process. The levels of accessibility and the requirements of the application are defined in the first phases of the project. The field work included the evaluation of 357 commercial establishments in the city of Murcia, Spain, showing that only 25% have a good accessibility, 40% are practicable with help, and 35% are inaccessible shops. The proposed system achieves its objectives of being sustainable and helping in the accessibility. Besides, the system can be a great incentive for businesses to improve their accessibility conditions. In conclusion, new technologies must have a much more active role in the promotion of universal accessibility. These tools must also consider the necessary requirements of sustainable development.