Integrating digital Health services : the role of the government and the challenge of cost allocation

eHealth, mHealth and eCare services are growing in numbers at a fast pace. This is mainly driven by technology and the societal challenges of an aging and more chronically burdened population while pressure on both human and financial resources increases. Though the adoption of these digital health services is challenging and experience difficulties. This work focusses on the main barriers that cause a 'gap' in the value network. Via case research following barriers are identified: 1) low willingness to pay, 2) unbalanced cost/benefit ratios of the actors or unfair cost allocation and 3) negative impacted business models. Furthermore the several roles of the government within the value network of digital health services are discussed and reflections and guidelines for digital health service developers are foreseen

Toward a framework for data quality in cloud-based health information system

This Cloud computing is a promising platform for health information systems in order to reduce costs and improve accessibility. Cloud computing represents a shift away from computing being purchased as a product to be a service delivered over the Internet to customers. Cloud computing paradigm is becoming one of the popular IT infrastructures for facilitating Electronic Health Record (EHR) integration and sharing. EHR is defined as a repository of patient data in digital form. This record is stored and exchanged securely and accessible by different levels of authorized users. Its key purpose is to support the continuity of care, and allow the exchange and integration of medical information for a patient. However, this would not be achieved without ensuring the quality of data populated in the healthcare clouds as the data quality can have a great impact on the overall effectiveness of any system. The assurance of the quality of data used in healthcare systems is a pressing need to help the continuity and quality of care. Identification of data quality dimensions in healthcare clouds is a challenging issue as data quality of cloud-based health information systems arise some issues such as the appropriateness of use, and provenance. Some research proposed frameworks of the data quality dimensions without taking into consideration the nature of cloud-based healthcare systems. In this paper, we proposed an initial framework that fits the data quality attributes. This framework reflects the main elements of the cloud-based healthcare systems and the functionality of EHR

Initiatives in the Romanian eHealth Landscape

Even if the foundation in the field of eHealth was set almost half century ago, the current achievements’ status does not place Romania on a good position in a European ranking. The efforts made during the last years are promising, but they still cannot surpass the enormous gaps in many eHealth indicators. This is not a surprising fact because the eHealth level must be sustained by a healthy and stable sanitary system and infrastructure, which, in our country, is almost in collapse, especially now in the context of global economic and financial crisis. We consider being guilty for these circumstances the lack of a clear and solid mid-term strategy developed at the level of the Ministry of Health (MoH), harmonized in a global legal and regulatory framework as well, and also the non-correlated researcher groups interests. The good attitude of practitioners regarding the challenges of new technologies and the political will can still give a chance to the Romanian healthcare system and to its modern faces

Developing a National-Level Concept Dictionary for EHR Implementations in Kenya

The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL) / Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings

Reporting an Experience on Design and Implementation of e-Health Systems on Azure Cloud

Electronic Health (e-Health) technology has brought the world with significant transformation from traditional paper-based medical practice to Information and Communication Technologies (ICT)-based systems for automatic management (storage, processing, and archiving) of information. Traditionally e-Health systems have been designed to operate within stovepipes on dedicated networks, physical computers, and locally managed software platforms that make it susceptible to many serious limitations including: 1) lack of on-demand scalability during critical situations; 2) high administrative overheads and costs; and 3) in-efficient resource utilization and energy consumption due to lack of automation. In this paper, we present an approach to migrate the ICT systems in the e-Health sector from traditional in-house Client/Server (C/S) architecture to the virtualised cloud computing environment. To this end, we developed two cloud-based e-Health applications (Medical Practice Management System and Telemedicine Practice System) for demonstrating how cloud services can be leveraged for developing and deploying such applications. The Windows Azure cloud computing platform is selected as an example public cloud platform for our study. We conducted several performance evaluation experiments to understand the Quality Service (QoS) tradeoffs of our applications under variable workload on Azure.Comment: Submitted to third IEEE International Conference on Cloud and Green Computing (CGC 2013

Design science research towards resilient cyber-physical eHealth systems

Most eHealth systems are cyber-physical systems (CPSs) making safety-critical decisions based on information from other systems not known during development. In this design science research, a conceptual resilience governance framework for eHealth CPSs is built utilizing 1) cybersecurity initiatives, standards and frameworks, 2) science of design for software-intensive systems and 3) empowering cyber trust and resilience. According to our study, a resilient CPS consists of two sub-systems: the proper resilient system and the situational awareness system. In a system of CPSs, three networks are composed: platform, software and social network. The resilient platform network is the basis on which information sharing between stakeholders could be created via software layers. However, the trust inside social networks quantifies the pieces of information that will be shared - and with whom. From citizens’ point of view, eHealth is wholeness in which requirements of information security hold true. Present procedures emphasize confidentiality at the expense of integrity and availability, and regulations/instructions are used as an excuse not to change even vital information. The mental-picture of cybersecurity should turn from “threat, crime, attack” to “trust” and “resilience”. Creating confidence in safe digital future is truly needed in the integration of the digital and physical world’s leading to a new digital revolution. The precondition for the exchange of information “trust” must be systematically built at every CPS’ level. In health sector, increasingly interconnected social, technical and economic networks create large complex CPSs, and risk assessment of many individual components becomes cost and time prohibitive. When no-one can control all aspects of CPSs, protection-based risk management is not enough to help prepare for and prevent consequences of foreseeable events, but resilience must be built into systems to help them quickly recover and adapt when adverse events do occur.Most eHealth systems are cyber-physical systems (CPSs) making safety-critical decisions based on information from other systems not known during development. In this design science research, a conceptual resilience governance framework for eHealth CPSs is built utilizing 1) cybersecurity initiatives, standards and frameworks, 2) science of design for software-intensive systems and 3) empowering cyber trust and resilience. According to our study, a resilient CPS consists of two sub-systems: the proper resilient system and the situational awareness system. In a system of CPSs, three networks are composed: platform, software and social network. The resilient platform network is the basis on which information sharing between stakeholders could be created via software layers. However, the trust inside social networks quantifies the pieces of information that will be shared - and with whom. From citizens’ point of view, eHealth is wholeness in which requirements of information security hold true. Present procedures emphasize confidentiality at the expense of integrity and availability, and regulations/instructions are used as an excuse not to change even vital information. The mental-picture of cybersecurity should turn from “threat, crime, attack” to “trust” and “resilience”. Creating confidence in safe digital future is truly needed in the integration of the digital and physical world’s leading to a new digital revolution. The precondition for the exchange of information “trust” must be systematically built at every CPS’ level. In health sector, increasingly interconnected social, technical and economic networks create large complex CPSs, and risk assessment of many individual components becomes cost and time prohibitive. When no-one can control all aspects of CPSs, protection-based risk management is not enough to help prepare for and prevent consequences of foreseeable events, but resilience must be built into systems to help them quickly recover and adapt when adverse events do occur

Mobile Personal Health Application for Empowering Diabetic Patients

In this paper we present the functional features of a mobile Personal Health Application that aims to empower Type 1 and Type 2 diabetic patients by facilitating self-management of their disease. The application supports the collection of observations of daily living i.e. vital signs, diet, quality and quantity of sleep, physical parameters such as weight, mental parameters such as self-assessment of quality of life, level of mood and stress, and physical activity related information. The application can operate in stand-alone mode as a consumer health app running in smartphones and tablets. However, the full range of its functionality is available when integrated with a server-based patient empowerment framework that further facilitates diabetes management with the active involvement of healthcare professionals, the exploitation of inclusive knowledge from clinical guidelines, and the incorporation of comprehensive information material

Blockchain: The Next Breakthrough in the Rapid Progress of AI

Blockchain technologies, once used exclusively for buying and selling bitcoins, have entered the mainstream of computer applications, fundamentally changing the way Internet transactions can be implemented by ascertaining trust between unknown parties. In addition, they ensure immutability (once information is entered it cannot be modified) and enable disintermediation (as trust is assured, no third party is required to verify transactions). These advantages can produce disruptive changes when properly exploited, inspiring a large number of applications. These applications are forming the backbone of what can be called the Internet of Value, bound to bring as significant changes as those brought over the last 20 years by the traditional Internet. This chapter investigates blockchain and the technologies behind it and explains their technological might and outstanding potential, not only for transactions but also as distributed databases. It also discusses its future prospects and the disruptive changes it promises to bring, while also considering the challenges that would need to be overcome for its widespread adoption. Finally, the chapter considers combining blockchain with Artificial Intelligence (AI) and discusses the revolutionary changes that would result by rapidly advancing the AI field

Performance assessment of security mechanisms for cooperative mobile health applications

Mobile health (m-Health) applications aim to deliver healthcare services through mobile applications regardless of time and place. An mHealth application makes use of wireless communications to sustain its health services and often providing a patient-doctor interaction. Therefore, m-Health applications present several challenging issues and constraints, such as, mobile devices battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, network delays, and of most importance, privacy and security concerns. In a typical m-Health system, information transmitted through wireless channels may contain sensitive information such as patient’s clinic history, patient’s personal diseases information (e.g. infectious disease as HIV - human immunodeficiency virus). Carrying such type of information presents many issues related to its privacy and protection. In this work, a cryptographic solution for m-Health applications under a cooperative environment is proposed in order to approach two common drawbacks in mobile health systems: the data privacy and protection. Two different approaches were proposed: i) DE4MHA that aims to guarantee the best confidentiality, integrity, and authenticity of mhealth systems users data and ii) eC4MHA that also focuses on assuring and guarantying the m-Health application data confidentiality, integrity, and authenticity, although with a different paradigm. While DE4MHA considers a peer-to-peer node message forward, with encryption/decryption tasks on each node, eC4MHA focuses on simply encrypting data at the requester node and decrypting it when it reaches the Web service. It relays information through cooperative mobile nodes, giving them the only strictly required information, in order to be able to forward a request, until it reaches the Web service responsible to manage the request, and possibly answer to that same request. In this sense, the referred solutions aim any mobile health application with cooperation mechanism embedded. For test purposes a specific mobile health application, namely SapoFit, was used. Cryptographic mechanisms were created and integrated in SapoFit application with built in cooperation mechanisms. A performance evaluation of both approaches in a real scenario with different mobile devices is performed and presented in this work. A comparison with the performance evaluations of both solutions is also presented.Fundação para a Ciência e a Tecnologia (FCT)European Community Fund FEDER through COMPETE – Programa Operacional Factores de Competitividad