Skip to main content

How Can We Trust in IoT? The Role of Engineers in Ensuring Trust in the Clinical IoT Ecosystem

Part of the Women in Engineering and Science book series (WES)

Abstract

Engineers play an important role in ensuring the trustworthiness of the clinical enterprise and in the ecosystem of clinical IoT development and implementation. This chapter considers (1) what trust is and why it matters; (2) ethical frameworks that can be used to evaluate one’s own work and professional development; (3) key use cases in trust, ethics, and engineering; and (4) leadership. We outline several frameworks for engineers to think about what trust means, how it applies to their work, and how ethics plays a role in the scope and impact of their work. We encourage engineers to consider how they can engage the wider ecosystem necessary for the effective development of trustworthy clinical IoT—including engagement with management, clinicians, and patients.

Keywords

  • Trust
  • Ethics
  • Professionalism
  • Ecosystem
  • Quality
  • Evidence
  • Reliability
  • Principles
  • Systems
  • Leadership
  • Policy
  • Clinical IoT

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-93592-4_5
  • Chapter length: 31 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   74.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-93592-4
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   94.99
Price excludes VAT (USA)
Fig. 5.1
Fig. 5.2
Fig. 5.3

References

  1. Fernández-Caramés TM, Froiz-Míguez I, Blanco-Novoa O, Fraga-Lamas P. Enabling the internet of mobile crowdsourcing health things: A mobile fog computing, blockchain and IoT based continuous glucose monitoring system for diabetes mellitus research and care. Sensors. 2019;19(15):3319. doi: https://doi.org/10.3390/s19153319

    CrossRef  Google Scholar 

  2. Gowrishankar S, Prachita M, Prakash A. IoT based heart attack detection, heart rate and temperature monitor. Int. J. Comput. Appl. 2017;170(5): 26–30.

    Google Scholar 

  3. Serdaroglu K, Uslu G, Baydere S. Medication intake adherence with real time activity recognition on IoT. In: 2015 IEEE 11th International Conference on Wireless and Mobile Computing, Networking and Communications (WiMob), Abu Dhabi. 2015; 230-237. doi: https://doi.org/10.1109/WiMOB.2015.7347966.

  4. Bates DW, Landman A, Levine DM. Health apps and health policy: what is needed? JAMA. 2018; 320:1975–1976

    CrossRef  Google Scholar 

  5. Lagan S, Sandler L, Torous J. Evaluating evaluation frameworks: a scoping review of frameworks for assessing health apps. BMJ open. 2021 Mar 1;11(3):e047001.

    CrossRef  Google Scholar 

  6. Medtronic recalls MiniMed insulin pumps for incorrect insulin dosing [Internet]. U.S. Food and Drug Administration. 2020 Feb 12 [cited 2021 July 20]. Available from https://www.fda.gov/medical-devices/medical-device-recalls/medtronic-recalls-minimed-insulin-pumps-incorrect-insulin-dosing

  7. Burke LE, Ma J, Azar KM, Bennett GG, Peterson ED, Zheng Y et al. Current science on consumer use of mobile health for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2015 Sep 22;132(12):1157-213. https://doi.org/10.1161/CIR.0000000000000232

    CrossRef  Google Scholar 

  8. Giddens A. The Consequences of Modernity. 1st ed. John Wiley & Sons; 2013

    Google Scholar 

  9. Luhmann N. Familiarity, confidence, trust: problems and alternatives. In: D. Gambetto (Ed.) [Internet]. Trust: Making and Breaking Cooperative Relations (Electronic edition), University of Oxford. 2000; 94-107. Available from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.23.8075&rep=rep1&type=pdf

    Google Scholar 

  10. Mechanic D. The functions and limitations of trust in the provision of medical care. J. Health Polit. Policy Law. 1998; 23 (4): 661e686. https://doi.org/10.1215/03616878-23-4-661.

    CrossRef  Google Scholar 

  11. Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc. Sci. Med. 2000; 51 (5):657e668. https://doi.org/10.1016/S0277-9536(00)00014-9

    CrossRef  Google Scholar 

  12. Maxwell K, Streetly A, Bevan D. Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study. Br. Med. J. 1999;318(7198):1585e1590. https://doi.org/10.1136/bmj.318.7198.1585.

    CrossRef  Google Scholar 

  13. Rogers WA. Is there a moral duty for doctors to trust patients? J. Med. Ethics. 2002;28 (2):77e80. https://doi.org/10.1136/jme.28.2.77.

    CrossRef  Google Scholar 

  14. Thom DH, Wong ST, Guzman D, Wu A, Penko J, Miaskowski C, et al. Physician trust in the patient: development and validation of a new measure. Ann. Fam. Med. 2011 Mar; 9 (2): 148–154. doi: https://doi.org/10.1370/afm.1224

    CrossRef  Google Scholar 

  15. Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the medical profession: conceptual and measurement issues. Health Serv Res. 2002 Oct;37(5):1419-39.

    CrossRef  Google Scholar 

  16. U.S. Department of Health & Human Services - Office for Civil Rights. Accessed April 6, 2022. https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

  17. Richardson JE, Middleton B, Platt JE, Blumenfeld BH. Building and maintaining trust in clinical decision support: Recommendations from the patient centered CDC learning network. 2020 Apr; 4(2):e10208. https://doi.org/10.1002/lrh2.10208

  18. IEEE advancing technology for humanity, code of ethics [Internet]. IEEE. 2020 [cited 2021 August 16]. Available from https://www.ieee.org/about/corporate/governance/p7-8.html.

  19. NSPE Codes of practice for engineers [Internet]. National Society of Professional Engineers. 2019 [cited 2021, July 15]. Available from https://www.nspe.org/resources/ethics/code-ethics.

  20. National Academy of Engineering Center for Engineering Ethics and Society (CEES) [Internet]. 2020 [cited 2021 January 5]. Available from https://www.nae.edu/26187/CEES.

  21. Association of Practical and Professional Ethics (APPE) [Internet]. [Cited 2021, January 5]. Available from https://www.appe-ethics.org

  22. A Framework for ethical decision-making [Internet]. Santa Clara University Markulla Center for Applied Ethics. 2015 [updated 2020, cited 2021, January 10]. Available from https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/.

  23. Wise G, Keat W, Balmer R, Kosky P. Systematic approach to ethical decision making using matrices. In: 2008 38th Annual Frontiers in Education Conference [Internet]. IEEE. 2008 November [cited 2021 January 10]. Available from https://doi.org/10.1109/FIE.2008.4720292.

  24. Ward A. Lean design in healthcare: a journey to improve quality and process of care. New York: Routledge Taylor and Francis Group; 2019.

    Google Scholar 

  25. Friedman M. The business of business is to increase profits. New York Times. 1970 Sept 13:SM7.

    Google Scholar 

  26. Laplume AO, Sonpar K, List RA. Stakeholder theory: reviewing a theory that moves us. J Manage. 2008; 34(6):1152-1189. https://doi.org/10.1177/0149206308324322

    CrossRef  Google Scholar 

  27. Werhane PH. Business ethics, stakeholder theory, and the ethics of healthcare organizations. Camb Q Healthc Ethics; 2000 Spring; 9 (2):169-181. doi: https://doi.org/10.1017/s0963180100902044

  28. Beauchamp T, Childress JF. Principles of biomedical ethics. 8th ed. Oxford University Press; 2019.

    Google Scholar 

  29. Elwyn G, Frosch D, Thomson R et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012; 27(10):1361-7. https://doi.org/10.1007/s11606-012-2077-6

    CrossRef  Google Scholar 

  30. The U.S. public health service syphilis study at Tuskegee [Internet]. U.S. Center for Disease Control. 2021 April 22 [cited 2021 July 20]. Available from https://www.cdc.gov/tuskegee/timeline.htm

  31. Krugman S. The Willowbrook hepatitis studies revisited: ethical aspects. Rev Infect Dis. 1986; 8(1):157-62. https://doi.org/10.1093/clinids/8.1.157.

    CrossRef  Google Scholar 

  32. The Belmont report: Ethical principles and guidelines for the protection of human subjects of research [Internet]. Bethesda, Md. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Department of Health, Education and Welfare. 1979, April [cited 2021 July 15]. Available from https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

  33. Public health code of ethics [Internet]. American Public Health Association. 2019[cited 2021 Jan]. Available from https://www.apha.org/-/media/files/pdf/membergroups/ethics/code_of_ethics

  34. Wilkinson M, Dumontier M, Aalbersberg I, et al. The FAIR guiding principles for scientific data management and stewardship. Sci Data. 2016; 3:160018. https://doi.org/10.1038/sdata.2016.18

    CrossRef  Google Scholar 

  35. Lin D, Crabtree J, Dillo I, et al. The TRUST principles for digital repositories. Sci Data. 2020; 7:144. https://doi.org/10.1038/s41597-020-0486-7

    CrossRef  Google Scholar 

  36. Care principles for indigenous data governance [Internet]. Global Indigenous Data Alliance, 2019 [cited 2021 Jan]. Available from https://www.gida-global.org/care

  37. U.S. Congress House Committee on Transportation and Infrastructure, Final committee report: The design, development, and certification of the Boeing 737 Max [Internet]; 2020 Sept. Available from https://transportation.house.gov/imo/media/doc/2020.09.15%20FINAL%20737%20MAX%20Report%20for%20Public%20Release.pdf

  38. Herkert J, Borenstein J, Miller K. The Boeing 737 MAX: Lessons for engineering ethics. Sci Eng Ethics. 2020; 26(6):2957-2974. https://doi.org/10.1007/s11948-020-00252-y

    CrossRef  Google Scholar 

  39. Sengupta J, Storey K, Casey S, et al. Outcomes before and after the recall of a heart failure pacemaker. JAMA Intern Med. 2020;180(2):198–205. https://doi.org/10.1001/jamainternmed.2019.5171

    CrossRef  Google Scholar 

  40. What to do if your cardiac device is recalled [Internet]. University of Michigan Health System. 2020 [cited 2021 Jan 18]. Available from https://www.uofmhealth.org/health-library/abk4204.

  41. Heart device and pacemaker recalls: what you need to know [Internet]. Cleveland Clinic. 2018 [cited 2021, June 10]. Available from https://health.clevelandclinic.org/heart-device-and-pacemaker-recalls-what-you-need-to-know/

  42. Thomson JJ. Killing, letting die, and the trolley problem. The Monist. 1976; 59(2):204-217.

    CrossRef  Google Scholar 

  43. Bonnefon JF, Shariff A, Rahwan I. The social dilemma of autonomous vehicles. Science. 2016;352(6293):1573-6. https://doi.org/10.1126/science.aaf2654.

    CrossRef  Google Scholar 

  44. Lin P. Robot cars and fake ethical dilemmas. Forbes [Internet]. 2017 April 3 [cited 2021 July 18]. Available from https://www.forbes.com/sites/patricklin/2017/04/03/robot-cars-and-fake-ethical-dilemmas/?sh=2e51d99213a2

  45. The moral machine [Internet]. Massachusetts Institute of Technology (MIT). 2016 [cited 2021 June 10]. Available from https://www.moralmachine.net/

  46. Maxmen A. Self-driving car dilemmas reveal that moral choices are not universal. Nature. 2018 Oct 24.469-470. https://doi.org/10.1038/d41586-018-07135-0

  47. Lester C. A study on driverless car ethics offers a troubling look into our values. New Yorker. 2019 Jan 24[cited 2021 Jan 24]. Available from https://www.newyorker.com/science/elements/a-study-on-driverless-car-ethics-offers-a-troubling-look-into-our-values

  48. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Target ranges of oxygenation saturation in extremely pre-term infants. N Engl J Med 2010; 362:1959-1969. https://doi.org/10.1056/NEJMoa0911781.

  49. U.S. National Library of Medicine. Surfactant positive airway pressure and pulse Oximetry trial (SUPPORT) [Internet]. 2020 [cited 2021 Aug 10]. Available from https://clinicaltrials.gov/ct2/show/NCT00233324

  50. The Office for Human Research Protections’ evaluation of the Surfactant, Positive Pressure, and Oxygenation Randomized Trial [Internet]. U.S. Department of Health and Human Services, Office of Inspector General. 2014 Report (OEI-01-14-00560). 2014 Sep 15 [cited 2021 Jun 15]. Available from https://oig.hhs.gov/oei/reports/oei-01-14-00560.asp

  51. Hudson KL, Guttmacher AE, Collins FS. In support of SUPPORT: The View from the NIH. N Engl J Med. 2013; 368:2349-2351. https://doi.org/10.1056/NEJMp1306986.

    CrossRef  Google Scholar 

  52. Magnus D, Caplan AL. Risk, consent, and support. N Engl J Med. 2013; 368:1864-1865. https://doi.org/10.1056/NEJMp1305086.

    CrossRef  Google Scholar 

  53. Merz JF, King N. Rapid response to U.S. Study criticized for experimentation on premature infants. BMJ. 2013; 347:f4198. https://doi.org/10.1136/bmj.f4198

    CrossRef  Google Scholar 

  54. Shepherd L. The SUPPORT study and the standard of care [Internet]. Hastings Center Bioethics Forum. 2013; May 17 [cited 2021 August 14]. Available from http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=6358&blogid=140.

  55. Shermer M. Ethical issues in deep brain simulation. Front. Integr. Neurosci. 2011 May 9; 5:17. https://doi.org/10.3389/fnint.2011.00017

    CrossRef  Google Scholar 

  56. Harmon A. Indian tribe wins right to limit research on its DNA [Internet]. New York Times. 2010 Apr 21 [cited 2021 June 5]. Available from https://www.nytimes.com/2010/04/22/us/22dna.html

  57. Advocacy-led research [Internet]. Genetic Alliance. [cited 2020 Dec 10]. Available from http://www.geneticalliance.org/programs/advocacy-led-research.

  58. Terry S, Horn E, Scott J. Genetic Alliance Registry and Biobank: a novel disease-advocacy driven research solution. Per Med. 2011; 8(2). https://doi.org/10.2217/pme.11.1.

  59. Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019; 366(6464):447-453. https://doi.org/10.1126/science.aax2342.

    CrossRef  Google Scholar 

  60. Ledford H. Millions of black people affected by racial bias in health-care algorithms. Nature 2017 Oct; 574: 608-609.

    CrossRef  Google Scholar 

  61. Ralston W. The untold story of a cyberattack, a hospital, and a dying woman [Internet]. Wired. 2020 Nov 11[cited 2021 Dec 10]. Available from https://www.wired.co.uk/article/ransomware-hospital-death-germany.

  62. Volz D, McMillan R. Hackers hit hospitals in disruptive ransomware attack [Internet]. Wall Street Journal. 2020 Nov 11 [cited 2021 Jul 13]. Available from https://www.wsj.com/articles/hackers-hit-hospitals-in-disruptive-ransomware-attack-11603992735.

  63. Boudko S, Abie H. Adaptive cybersecurity framework for healthcare internet of things. In: 2009 13th International Symposium on Medical Information and Communication Technology (ISMICT) [Internet] 2019 [cited 2021 June 10]. pp. 1-6. https://doi.org/10.1109/ISMICT.2019.8743905.

  64. Hern A. Hacking risk leads to recall of 500,000 pacemakers due to patient death fears [Internet]. The Guardian. 2017 Aug 31 [cited 2021 Jul 18]. Available from https://www.theguardian.com/technology/2017/aug/31/hacking-risk-recall-pacemakers-patient-death-fears-fda-firmware-update.

  65. Stephenson J. FDA warns that some GE healthcare telemetry servers, health information stations are vulnerable to cyberattack. JAMA Health Forum. 2020;1(2): e200161. https://doi.org/10.1001/jamahealthforum.2020.0161.

    CrossRef  Google Scholar 

  66. Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018 Jul 26;13(1):98. doi: https://doi.org/10.1186/s13012-018-0784-z.

    CrossRef  Google Scholar 

  67. Salari S, Klapman S, Fry B, Hamel S. Interprofessional education: in silo, ineffective. Med. Sci. Educ. 2017 Dec;27(4):831-3.

    CrossRef  Google Scholar 

  68. Edwards PN, Jackson SJ, Bowker GC, Knobel CP. Understanding infrastructure: Dynamics, tensions, and design. Report of a workshop on “History & Theory of Infrastructure: Lessons for New Scientific Cyberinfrastructures” [internet]. 2007 Jan. [cited 2021, July 18]. Available from. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/49353/UnderstandingInfrastr?sequence=3

  69. Buse K, Mays N, Walt G. Making health policy. McGraw-hill education (UK); 2012 May 1

    Google Scholar 

  70. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behavioral sciences. 2018 Nov;8(11):98.

    CrossRef  Google Scholar 

  71. Baker DW. Trust in Health Care in the Time of COVID-19. JAMA. 2020 Dec 15;324(23):2373-5.

    CrossRef  Google Scholar 

  72. Meyer SB, Ward PR. Differentiating between trust and dependence of patients with coronary heart disease: furthering the sociology of trust. Health Risk Soc. 2013;15 (3):279e293. https://doi.org/10.1080/13698575.2013.776017

    CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sherri Douville .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Platt, J., Douville, S., Mongoven, A. (2022). How Can We Trust in IoT? The Role of Engineers in Ensuring Trust in the Clinical IoT Ecosystem. In: Hudson, F.D. (eds) Women Securing the Future with TIPPSS for Connected Healthcare. Women in Engineering and Science. Springer, Cham. https://doi.org/10.1007/978-3-030-93592-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-93592-4_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-93591-7

  • Online ISBN: 978-3-030-93592-4

  • eBook Packages: EngineeringEngineering (R0)