Journal:Emerging and established trends to support secure health information exchange

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Full article title Emerging and established trends to support secure health information exchange
Journal Frontiers in Digital Health
Author(s) Spanakis, Emmanouil G.; Sfakianakis, Stelios; Bonomi, Silvia; Ciccotelli, Claudio; Magalini, Sabina; Sakkalis, Vangelis
Author affiliation(s) Foundation for Research and Technology, Sapienza Università di Roma, Fondazione Policlinico Universitario Agostino Gemelli
Primary contact Email: spanakis at ics dot forth dot gr
Editors Pattichis, Constantinos S.
Year published 2021
Volume and issue 3
Article # 636082
DOI 10.3389/fdgth.2021.636082
ISSN 2673-253X
Distribution license Creative Commons Attribution 4.0 International
Website https://www.frontiersin.org/articles/10.3389/fdgth.2021.636082/full
Download https://www.frontiersin.org/articles/10.3389/fdgth.2021.636082/pdf (PDF)
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Abstract

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 healthcare 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, which 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 national and cross-border transfer of data between different healthcare organizations; technologies to support the secure interconnectivity and trust between information technology (IT) systems participating in a data-sharing “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 healthcare domain.

Introduction

Information technology (IT) has long been identified as a cornerstone for efficient, cost-saving, timely, and reliable healthcare delivery.[1][2] The availability of healthcare information and patient records in digital form facilitates the persistence and posterity of valuable information and greatly supports the decision-making process, and even the extraction of new knowledge at both the individual and population levels. In our previous work, we have emphasized the current state of the art about cybersecurity in the healthcare domain, with emphasis on current threats and methodologies.[3] Paraphrasing the famous words of John Donne, “no IT system is an island, entire of itself.” Today, in a highly connected world where geographic boundaries have been largely eliminated and people can freely move between cities, states, countries, or continents, the requirement for two different information management systems to exchange a person's clinical data or medical history becomes vital and persistent. Sharing health information (e.g., via health information exchange [HIE]) through electronic means greatly improves the cost, quality, and patient experience of healthcare delivery.

To better secure the IT system's potential for interconnectivity and cooperation with other systems, the use of interoperable technologies and standards is needed. Depending on the extent and scope of the envisaged shared information spaces, there may be different levels of interoperability. Figure 1 shows a proposed “maturity” model for interoperability in eHealth.[4] The model consists of five levels that, incrementally, describe a more mature version of an interoperable infrastructure, starting from Level 1 for non-connected eHealth applications; Level 2 where a single eHealth application is directly linked to another application for simple data exchange[5]; Level 3 for distributed systems that agree on protocols used, data formats, message exchange patterns, etc.[6]; Level 4, where eHealth applications from different suppliers that serve a common goal are linked but the applications do not need to have common objectives[7]; and finally, at the “universal” Level 5, where diverse eHealth applications connect to an open, interoperable infrastructure possibly spanning multiple countries.[8][9]


Fig1 Spanakis FrontDigHlth2021 3.jpg

Figure 1. A maturity model for interoperability in eHealth, adapted from Van Velsen et al. 2016[4].

References

  1. ↑ U.S. Congress, Office of Technology Assessment (September 1995). "Bringing Health Care Online: The Role of Information Technologies" (PDF). U.S. Government Printing Office. https://ota.fas.org/reports/9507.pdf. 
  2. ↑ Kolodner, R.M.; Cohn, S.P.; Freidman, C.P. (2008). "Health Information Technology: Strategic Initiatives, Real Progress". Health Affairs 27 (Supp. 1): w391–5. doi:10.1377/hlthaff.27.5.w391. 
  3. ↑ Spanakis, E.G.; Bonomi, S.; Sfakianakis, S. (2020). "Cyber-attacks and threats for healthcare - A multi-layer thread analysis". Proceedings of the 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society: 5705–08. doi:10.1109/EMBC44109.2020.9176698. PMID 33019270. 
  4. ↑ 4.0 4.1 Van Velsen, L.; Hermens, H.; d'Hollosy, O.-N. (2016). "A maturity model for interoperability in eHealth". Proceedings of the IEEE 18th International Conference on e-Health Networking, Applications and Services: 1–6. doi:10.1109/HealthCom.2016.7749533. 
  5. ↑ Chronaki, C.E.; Chiarugi, F.; Mavrogiannaki, E. et al. (2003). "An eHealth platform for instant interaction among health professionals". Proceedings of the Computers in Cardiology 2003: 101–4. doi:10.1109/CIC.2003.1291100. 
  6. ↑ Spanakis, M; Lelis, P.; Chiarugi, F. et al. (2005). "R&D Challenges in Developing an Ambient Intelligence eHealth Platform". IFMBE Proceedings 11 (1): 1727–983. http://139.91.210.27/CBML/PROCEEDINGS/2005_EMBEC/Embec%202005/Abstracts/Abstract791.html. 
  7. ↑ Tsiknakis, M.; Spanakis, M. (2010). "Adoption of innovative eHealth services in prehospital emergency management: A case study". Proceedings of the 10th IEEE International Conference on Information Technology and Applications in Biomedicine: 1–5. doi:10.1109/ITAB.2010.5687752. 
  8. ↑ Spanakis, E.G.; Psaraki, M.; Sakkalis, V. (2018). "Congestive Heart Failure Risk Assessment Monitoring through Internet of things and mobile Personal Health Systems". Proceedings of the 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society: 2925-28. doi:10.1109/EMBC.2018.8513024. PMID 30441013. 
  9. ↑ Spanakis, M.; Sfakianakas, S.; Sakkalis, V. et al. (2019). "PharmActa: Empowering Patients to Avoid Clinical Significant Drug⁻Herb Interactions". Medicines 6 (1): 26. doi:10.3390/medicines6010026. PMC PMC6473432. PMID 30781500. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473432. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation, though grammar and word usage was substantially updated for improved readability. In some cases important information was missing from the references, and that information was added.

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