Towards building a Self-Sovereign Identity Framework for Healthcare

Drifted by the hype of new and efficient machine learning and artificial intelligence models aiming to unlock the information wealth hidden inside heterogeneous datasets across different markets and disciplines, healthcare data are in the center of novel technological advancements in predictive health diagnostics, remote healthcare, assistive leaving and wellbeing. Nevertheless, this emerging market has underlined the necessity of developing new methods and updating existing ones for preserving the privacy of the data and their owners, as well as, ensuring confidentiality and trust throughout the health care data processing pipelines. This paper presents one of the key innovations of a Horizon Europe funded project named "TRUSTEE", which focuses on building a trust and privacy framework for cross-European data exchange by employing a secure and private federated framework to empower companies, organizations, and individuals to securely access data across different disciplines, use and re-use data and metadata to extract knowledge with trust. In particular we present our work on implementing strong authentication and continuous authorization schemes based on the duality of eIDAS trust framework and Self Sovereign Identity (SSI) management to ensure security and trust over authentication, authorization and accounting processes for healthcare.

Mathematical Modeling Evaluates How Vaccinations Affected the Course of COVID-19 Disease Progression

The regulation policies implemented, the characteristics of vaccines, and the evolution of the virus continue to play a significant role in the progression of the SARS-CoV-2 pandemic. Numerous research articles have proposed using mathematical models to predict the outcomes of different scenarios, with the aim of improving awareness and informing policy-making. In this work, we propose an expansion to the classical SEIR epidemiological model that is designed to fit the complex epidemiological data of COVID-19. The model includes compartments for vaccinated, asymptomatic, hospitalized, and deceased individuals, splitting the population into two branches based on the severity of progression. In order to investigate the impact of the vaccination program on the spread of COVID-19 in Greece, this study takes into account the realistic vaccination program implemented in Greece, which includes various vaccination rates, different dosages, and the administration of booster shots. It also examines for the first time policy scenarios at crucial time-intervention points for Greece. In particular, we explore how alterations in the vaccination rate, immunity loss, and relaxation of measures regarding the vaccinated individuals affect the dynamics of COVID-19 spread. The modeling parameters revealed an alarming increase in the death rate during the dominance of the delta variant and before the initiation of the booster shot program in Greece. The existing probability of vaccinated people becoming infected and transmitting the virus sets them as catalytic players in COVID-19 progression. Overall, the modeling observations showcase how the criticism of different intervention measures, the vaccination program, and the virus evolution has been present throughout the various stages of the pandemic. As long as immunity declines, new variants emerge, and vaccine protection in reducing transmission remains incompetent; monitoring the complex vaccine and virus evolution is critical to respond proactively in the future.

PANACEA resilient and secure toolkit for healthcare infrastructures

Healthcare organizations are frequently subject to cybersecurity incidents. The outbreak of a pandemic such as COVID-19 has shown the need for specific operational and organizational measures to be in place in order to reduce the risk of successful cyberattacks. Time will be key: preparation is needed to ensure quick secure set-up of additional resources (IT, staff, medical devices) when the next emergency will hit. The PANACEA Solution Toolkit is a suite of complementary tools to provide Health Care Organizations (HCO) with assessment, guidance, technical and organizational "infrastructure" to address the cybersecurity challenges. It provides support for fortifying health organizations against cyber threats on multiple different levels (technical, behavioral, organizational, strategical) and across a diverse set of workflows and scenarios. In order to determine whether the toolkit satisfies the specific business and users' requirements in the selected use cases, a detailed validation plan and execution roadmap is established taking into account the constraints of the current emergent situation.

Cuff-less blood pressure estimation using wrist photoplethysmography

One of the most promising and at the same time rapidly growing sectors in healthcare is that of wearable medical devices. Population ageing constantly shifts towards a higher number of senior and elderly people with increased prevalence of chronic diseases often requiring long-term care and a need to decrease hospitalization time and cost. However, today most of the devices entering the market are not standardized nor medically approved, and they are highly inaccurate. In this work we present a system and a method to provide accurate measurement of systolic and diastolic blood pressure (BP) based solely on wrist photoplethysmography. We map morphological features to BP values using machine learning and propose ways to select high quality signals leading to an accuracy improvement of up to 33.5%, if compared against no signal selection, a mean absolute error of 1.1mmHg in a personalized scenario and 8.7mmHg in an uncalibrated leave-one-out scenario.

Emerging and Established Trends to Support Secure Health Information Exchange

This work aims to provide information, guidelines, established practices and standards, and an extensive evaluation on new and promising technologies for the implementation of a secure information sharing platform for health-related data. We focus strictly on the technical aspects and specifically on the sharing of health information, studying innovative techniques for secure information sharing within the health-care domain, and we describe our solution and evaluate the use of blockchain methodologically for integrating within our implementation. To do so, we analyze health information sharing within the concept of the PANACEA project that facilitates the design, implementation, and deployment of a relevant platform. The research presented in this paper provides evidence and argumentation toward advanced and novel implementation strategies for a state-of-the-art information sharing environment; a description of high-level requirements for the transfer of data between different health-care organizations or cross-border; technologies to support the secure interconnectivity and trust between information technology (IT) systems participating in a sharing-data "community"; standards, guidelines, and interoperability specifications for implementing a common understanding and integration in the sharing of clinical information; and the use of cloud computing and prospectively more advanced technologies such as blockchain. The technologies described and the possible implementation approaches are presented in the design of an innovative secure information sharing platform in the health-care domain.

Cyber-attacks and threats for healthcare - a multi-layer thread analysis

Due to the advent of novel technologies and digital opportunities allowing to simplify user lives, healthcare is increasingly evolving towards digitalization. This represent a great opportunity on one side but it also exposes healthcare organizations to multiple threats (both digital and not) that may lead an attacker to compromise the security of medial processes and potentially patients' safety. Today technical cybersecurity countermeasures are used to protect the confidentiality, integrity and availability of data and information systems - especially in the healthcare domain. This paper will report on the current state of the art about cyber security in the Healthcare domain with particular emphasis on current threats and methodologies to analyze and manage them. In addition, it will introduce a multi-layer attack model providing a new perspective for attack and threat identification and analysis.

PharmActa: Personalized pharmaceutical care eHealth platform for patients and pharmacists

Community pharmacists are critically placed in the patient care chain being an extended frontline within primary healthcare networks across Europe. They are trained to ensure safe and effective medication use, a crucial and responsible role, extending beyond the common misconception limited to just providing timely access to medicines for the population. Technology-wise, eHealth being committed to an effective, networked, patient-centered and accessible healthcare would prove a real asset in this direction by achieving improved therapy adherence with better outcomes and direct contribution to a cost-effective healthcare system. In this work, we present PharmActa, a personalized eHealth platform that addresses key features of pharmaceutical care and enhances communication of pharmacists with patients for optimizing pharmacotherapy. PharmActa empowers patients by providing pharmaceutical care services, such as drug interactions tools, reminders for assisting adhesion and compliance, information regarding adverse drug reactions, as well as pharmacovigilance along with related tools for healthcare management. In addition, it allows the pharmacists to review the medication history in order to provide personalized pharmaceutical care services; thus enhancing their role as healthcare providers. Finally, a mechanism allowing such a system to be interconnected with a developed medical repository following European and International interoperability standards, is also presented. Thus far, the evaluation results presented in this work indicate that PharmActa can be of great benefit to healthcare professionals, especially pharmacists and patients.

Congestive Heart Failure Risk Assessment Monitoring through Internet of things and mobile Personal Health Systems

Congestive heart failure (CHF) occurs when the heart cannot provide the necessary cardiac output for the metabolic needs of the human body. The most prominent symptoms are increased venous pressure, abnormal heart and breathing rate, tiredness and leg swelling. Most important pathogenesis influence are: age, gender, high blood pressure, alcohol and smoking, sedentary lifestyle and diet, genetic predisposition and family history, diabetes, and atherosclerosis. Common causes are considered to be valvular heart disease, coronary heart disease and hypertension. CHF diagnosis can be achieved through physical examination (i.e., blood pressure, body mass index, blood tests) and echocardiography. In this work, we present a smart mobile application and internet of things capable of the early detection and real-time monitoring of CHF exacerbations, enforcing prevention on a daily basis. We refer to the architectural elements of our approach accounting for the integration of a secure access scheme, following GDPR regulation, as a novel biometric solution to increase security and access. A first validation of the system is also presented.

PharmActa: Empowering Patients to Avoid Clinical Significant Drug⁻Herb Interactions

Herbal medicinal products (HMPs) are the subject of increasing interest regarding their benefits for health. However, a serious concern is the potential appearance of clinically significant drug⁻herb interactions in patients. This work provides an overview of drug⁻herb interactions and an evaluation of their clinical significance. We discuss how personalized health services and mobile health applications can utilize tools that provide essential information to patients to avoid drug⁻HMP interactions. There is a specific mention to PharmActa, a dedicated mobile app for personalized pharmaceutical care with information regarding drug⁻HMPs interactions. Several studies over the years have shown that for some HMPs, the potential to present clinically significant interactions is evident, especially for many of the top selling HMPs. Towards that, PharmActa presents how we can improve the way that information regarding potential drug⁻herb interactions can be disseminated to the public. The utilization of technologies focusing on medical information and context awareness introduce a new era in healthcare. The exploitation of eHealth tools and pervasive mobile monitoring technologies in the case of HMPs will allow the citizens to be informed and avoid potential drug⁻HMPs interactions enhancing the effectiveness and ensuring safety for HMPs.

Digital patient: Personalized and translational data management through the MyHealthAvatar EU project

The advancements in healthcare practice have brought to the fore the need for flexible access to health-related information and created an ever-growing demand for the design and the development of data management infrastructures for translational and personalized medicine. In this paper, we present the data management solution implemented for the MyHealthAvatar EU research project, a project that attempts to create a digital representation of a patient's health status. The platform is capable of aggregating several knowledge sources relevant for the provision of individualized personal services. To this end, state of the art technologies are exploited, such as ontologies to model all available information, semantic integration to enable data and query translation and a variety of linking services to allow connecting to external sources. All original information is stored in a NoSQL database for reasons of efficiency and fault tolerance. Then it is semantically uplifted through a semantic warehouse which enables efficient access to it. All different technologies are combined to create a novel web-based platform allowing seamless user interaction through APIs that support personalized, granular and secure access to the relevant information.

Addressing drug-drug and drug-food interactions through personalized empowerment services for healthcare

Personalized healthcare systems support the provision of timely and appropriate information regarding healthcare options and treatment alternatives. Especially for patients that receive multi-drug treatments a key issue is the minimization of the risk of adverse effects due to drug-drug interactions (DDIs). DDIs may be the result of doctor prescribed drugs but also due to self-medication of conventional drugs, alternative medicines, food habits, alcohol or smoking. It is therefore crucial for personalized health systems, apart from assisting physicians for optimal prescription practices, to also provide appropriate information for individual users for drug-drug interactions or similar information regarding risks for modulation of the ensuing treatment. In this manuscript we describe a DDI service including drug-food, drug-herb and other lifestyle-related factors, developed in the context of a personalized patient empowerment platform. The solution enables guidance to patients for their medication on how to reduce the risk of unwanted drug interactions and side effects in a seamless and transparent way. We present and analyze the implemented services and provide examples on using an alerting service to identify potential DDIs in two different chronic diseases, congestive heart failure and osteoarthritis.

Secure access to patient's health records using SpeechXRays a mutli-channel biometrics platform for user authentication

The most commonly used method for user authentication in ICT services or systems is the application of identification tools such as passwords or personal identification numbers (PINs). The rapid development in ICT technology regarding smart devices (laptops, tablets and smartphones) has allowed also the advance of hardware components that capture several biometric traits such as fingerprints and voice. These components are aiming among others to overcome weaknesses and flaws of password usage under the prism of improved user authentication with higher level of security, privacy and usability. To this respect, the potential application of biometrics for secure user authentication regarding access in systems with sensitive data (i.e. patient's data from electronic health records) shows great potentials. SpeechXRays aims to provide a user recognition platform based on biometrics of voice acoustics analysis and audio-visual identity verification. Among others, the platform aims to be applied as an authentication tool for medical personnel in order to gain specific access to patient's electronic health records. In this work a short description of SpeechXrays implementation tool regarding eHealth is provided and analyzed. This study explores security and privacy issues, and offers a comprehensive overview of biometrics technology applications in addressing the e-Health security challenges. We present and describe the necessary requirement for an eHealth platform concerning biometric security.

Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review

BACKGROUND

New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance, enabling people to control and self-regulate their health and wellness and make better health- and lifestyle-related decisions. Mobile sensing technology and health systems responsive to individual profiles combined with cloud computing can expand innovation for new types of interoperable services that are consumer-oriented and community-based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while lessening the burden on exhausted health and social care systems.

OBJECTIVE

Our goal is to identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders.

METHODS

We review the state-of-the-art relevant to the development and implementation of eHealth and mHealth services in critical domains. We identify and discuss scientific, engineering, and implementation-related challenges that need to be overcome to move research, development, and the market forward.

RESULTS

Several important advances have been identified in the fields of systems for personalized health monitoring, such as smartphone platforms and intelligent ubiquitous services. Sensors embedded in smartphones and clothes are making the unobtrusive recognition of physical activity, behavior, and lifestyle possible, and thus the deployment of platforms for health assistance and citizen empowerment. Similarly, significant advances are observed in the domain of infrastructure supporting services. Still, many technical problems remain to be solved, combined with no less challenging issues related to security, privacy, trust, and organizational dynamics.

CONCLUSIONS

Delivering innovative ubiquitous eHealth and mHealth services, including citizen-centered wellness and lifestyle management services, goes well beyond the development of technical solutions. For the large-scale information and communication technology-supported adoption of healthier lifestyles to take place, crucial innovations are needed in the process of making and deploying usable empowering end-user services that are trusted and user-acceptable. Such innovations require multidomain, multilevel, transdisciplinary work, grounded in theory but driven by citizens' and health care professionals' needs, expectations, and capabilities and matched by business ability to bring innovation to the market.

Diabetes management using modern information and communication technologies and new care models

BACKGROUND

Diabetes, a metabolic disorder, has reached epidemic proportions in developed countries. The disease has two main forms: type 1 and type 2. Disease management entails administration of insulin in combination with careful blood glucose monitoring (type 1) or involves the adjustment of diet and exercise level, the use of oral anti-diabetic drugs, and insulin administration to control blood sugar (type 2).

OBJECTIVE

State-of-the-art technologies have the potential to assist healthcare professionals, patients, and informal carers to better manage diabetes insulin therapy, help patients understand their disease, support self-management, and provide a safe environment by monitoring adverse and potentially life-threatening situations with appropriate crisis management.

METHODS

New care models incorporating advanced information and communication technologies have the potential to provide service platforms able to improve health care, personalization, inclusion, and empowerment of the patient, and to support diverse user preferences and needs in different countries. The REACTION project proposes to create a service-oriented architectural platform based on numerous individual services and implementing novel care models that can be deployed in different settings to perform patient monitoring, distributed decision support, health care workflow management, and clinical feedback provision.

RESULTS

This paper presents the work performed in the context of the REACTION project focusing on the development of a health care service platform able to support diabetes management in different healthcare regimes, through clinical applications, such as monitoring of vital signs, feedback provision to the point of care, integrative risk assessment, and event and alarm handling. While moving towards the full implementation of the platform, three major areas of research and development have been identified and consequently approached: the first one is related to the glucose sensor technology and wearability, the second is related to the platform architecture, and the third to the implementation of the end-user services. The Glucose Management System, already developed within the REACTION project, is able to monitor a range of parameters from various sources including glucose levels, nutritional intakes, administered drugs, and patient's insulin sensitivity, offering decision support for insulin dosing to professional caregivers on a mobile tablet platform that fulfills the need of the users and supports medical workflow procedures in compliance with the Medical Device Directive requirements.

CONCLUSIONS

Good control of diabetes, as well as increased emphasis on control of lifestyle factors, may reduce the risk profile of most complications and contribute to health improvement. The REACTION project aims to respond to these challenges by providing integrated, professional, management, and therapy services to diabetic patients in different health care regimes across Europe in an interoperable communication platform.