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On protecting & preserving personal privacy in interoperable global healthcare venues

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Abstract

Worldwide, Information Technology (IT) use in healthcare systems is rapidly increasing for the purposes of realizing higher quality, and reducing overall costs. This escalation in healthcare IT use is simultaneously fueling a brisk rise in institutional demands for more Information. Associatedly, with IT proliferation and the escalation of informational demands within healthcare Systems, is an ever-present loss risk of Patient’s Privacy. Therefore, all efforts undertaken to protect Privacy must effectively identify conceivable threat trajectories - against which - pathways to assure protections need exist, and to which, knowledge and resources must be mustered in a timely manner. More fundamentally, however, to identify, prevent, and safeguard against encroachments upon Privacy in healthcare, there is a need for an a priori comprehension by all in healthcare that nothing can be protected adequately if the value of that which is to be protected, and/or the consequences related to the loss - are not well understood. Yet, that which is eminently clear is, in the field of healthcare, many Medical Staff have neither the understanding, an appreciation for the importance, nor the worth of Privacy of those Patients in their care. Even with the threat of official/legal action looming, Privacy violations and compromises of Protected Health Information (PHI) by Medical Staff occur routinely. How could Medical Staff make perverse errors in judgement regarding Patient“s Privacy so often? The aim of this article is to provide a reasonable familiarization to fundamental activities and correlated behaviors that compel risks, which are responsible for Information and Privacy Compromises. Furthermore, by way of such familiarization, necessary actions to be undertaken - to prevent the loss of Personal Privacy in Interoperable global healthcare venues can be suitably employed.

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Notes

  1. Emphasis is provided by the Author, and does not appear in the original

  2. [Resources Provided For Background Reading] Chapter 3: “Privacy and Security Concerns Regarding Electronic Health Information,” In, “For the Record Protecting Electronic Health Information,” Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, Computer Science and Telecommunications Board, National Research Council, National Academy Press, Washington, D.C., 1997; Tolkoff, Marcy [JD]; “Patients Keeping Secrets From You?; EHR Graph Mistakes; More,” Medscape Business of Medicine, June 18, 2015 http://www.medscape.com/viewarticle/845791 AND McCann, Erin; “Deaths by medical mistakes hit records,” HealthcareIT News, Washington, D.C., July 18, 2014 http://www.healthcareitnews.com/news/deaths-by-medical-mistakes-hit-records AND Schuman, Evan; “CDC on EHR errors: Enough’s enough,“ HealthcareIT News Washington, D.C., July 8, 2014 http://www.healthcareitnews.com/news/cdc-ehr-errors-enoughs-enough

  3. Part of an Information Life Cycle Management (ILcM) System

  4. ”The Toxic Terabyte: How Data-Dumping Threatens Business Efficiency,“ IBM - Global Technology Services,

    London, UK., July 2006

  5. The Digital Universe

  6. “The Digital Universe Opportunities: Rich Data and Increasing Value of The Internet things” [White Paper], IDC Research, Framingham, MA, 2014

  7. 1 ExaByte = 1018 Bytes of Data.

  8. 1.1 ZettaBytes/Year, or 88.4 ExaBytes (~1 Billion GB/Month)

  9. “The Zettabyte Era: Trends and Analysis,” CISCO White Paper, San Jose, California, May 2015.

  10. ”The Toxic Terabyte: How Data-Dumping Threatens Business Efficiency,“ IBM - Global Technology Services, London, UK., July 2006

  11. Ibid

  12. “Interoperability” is defined as that capability by which, all operating elements of interdependent and interconnected systems are able to operate and perform synchronously and optimally, to achieve objectives, or mission success. Synchronous operations here infers to an operational requirement for all components/sub-systems of interconnected and interdependent systems, to be properly oriented, skillfully aligned, and reliably available – across geographic and organizational boundaries - to achieve mission objectives. See In: Mathews, R; “Uninteroperability at The United Nations: The Case of a Runaway World Body (On Overcoming Leadership Vacuum, Structural Failures & High Risks to Human Development)” J. Health & Technology, Vol. 4, No. 2, 2014

  13. The statement is often attributed to Computer Scientist, Clifford Stoll. However, it represents a condensation of his writing on the matter. “Data isn’t information… Information, unlike data, is useful. While there’s a gulf between data and information, there’s a wide ocean between information and knowledge. What turns the gears in our brains isn’t information, but ideas, inventions, and inspiration. Knowledge—not information—implies understanding. And beyond knowledge lies what we should be seeking: wisdom.” — Clifford Stoll, In, High-Tech Heretic: Reflections of a Computer Contrarian, Anchor Books, New York, NY (2000), 185–186.

  14. The notion of competition is framed around more than mere economic trajectories. Public and Private institutions that collect data may very well be governed by different legal authorities. Just the same, the collectors of information find value in letting it, or selling it entirely. The laws covering collections, and the sale of information collected - may vary for Public and Private entities. Regardless, the end-result in terms of Privacy is the same; the public is largely unaware of those ways in which the data is collected and used, and that both Public and Private Information sellers stem revenue streams from such sales.

  15. “Report of the National Task Force on Privacy, Technology, and Criminal Justice Information -- Law and policy Change drivers Recommendations,” Office of Justice Programs - Bureau of Justice Statistics, U.S. Department of Justice (SEARCH Group, Incorporated, The National Consortium for Justice Information and Statistics, under CA# 96-BJ-CX-K010), Sacramento, CA, August 2001.

  16. OECD Member States Participating in the Global Privacy Enforcement Network (GPEN)

  17. “Children’s Privacy: insufficient protection on the websites“ – CNIL (National Commission on Informatics and Liberties – the French National Data Protection Authority), September 2, 2015 [audit of 1494 websites and Applications. http://www.cnil.fr/linstitution/actualite/article/article/vie-privee-des-enfants-une-protection-insuffisante-sur-les-sites-internet/

  18. Digital Universe

  19. See “The Digital Universe Opportunities” 2013, Supra, note 6

  20. “The Big Data Refinery: distilling intelligence from Big Data,” Database and Network Journal, Vol. 42, No.4, August 2012

  21. “Disruptive Impact of IoT on Business” (The Gartner Symposium/ITxpo 2014), Barcelona, Spain, November 11, 2014. [https://www.gartner.com/newsroom/id/2905717

  22. Ibid

  23. ISACA identifies itself as “the world’s leading independent, nonprofit association in governing, managing and assuring trust in an evolving digital world.”

  24. “Keeping a Lock on Privacy: How Enterprises Are Managing Their Privacy Function,” ISACA, Rolling Meadows, IL, September 2015

  25. Ibid

  26. “The State of Data Sharing For Healthcare Analytics 2015–2016: Change, Challenges and Choice,” Privacy Analytics, Ottawa - Ontario, Canada, November 2015.

  27. “Identity Thief Sentenced for Filing Tax Returns in the Names of the Attorney General and Others,” FBI Atlanta Division/U.S. Attorney’s Office - Northern District of Georgia, March 12, 2014 https://www.fbi.gov/atlanta/press-releases/2014/identity-thief-sentenced-for-filing-tax-returns-in-the-names-of-the-attorney-general-and-others AND Williams, Pete and Black, Jeff; ‘“Sophisticated’ ID thieves swipe info on Michelle Obama, Beyonce’, Ashton Kutcher and others,” NBC News (US-News), Tuesday Mar 12, 2013 http://usnews.nbcnews.com/_news/2013/03/12/17287204-sophisticated-id-thieves-swipe-info-on-michelle-obama-beyonce-ashton-kutcher-and-others

  28. Vaas, Lisa; “Data-stealing botnets found in major data brokers’ servers,” Naked-Security By SOPHOS (Computer Security News), 26 Sep 2013 https://nakedsecurity.sophos.com/2013/09/26/data-stealing-botnets-found-in-major-public-record-holders-servers/ and Krebs, Brian; “Data Broker Giants Hacked by ID Theft Service,” Krebs on Security, September 13, 2013 http://krebsonsecurity.com/2013/09/data-broker-giants-hacked-by-id-theft-service/

  29. “ChoicePoint Settles Data Security Breach Charges; to Pay $10 Million in Civil Penalties, $5 Million for Consumer Redress,” The Federal Trade Commission (FTC), Washington, D.C., January 26, 2006 https://www.ftc.gov/news-events/press-releases/2006/01/choicepoint-settles-data-security-breach-charges-pay-10-million

  30. “Consumer Data Broker ChoicePoint Failed to Protect Consumers’ Personal Data, Left Key Electronic Monitoring Tool Turned Off for Four Months New Settlement Imposes Stricter Compliance Regimen,“ The Federal Trade Commission (FTC), Washington, D.C., October 19, 2009 https://www.ftc.gov/news-events/press-releases/2009/10/consumer-data-broker-choicepoint-failed-protect-consumers

  31. References a “Fort Knox“ for Information

  32. “Holman v. Experian Information Solutions Inc., et al.,” Case No. 4:11-cv-00180, in the U.S. District Court for The Northern District of California, USA, January 12, 2011

  33. “Patton et al. v. Experian Data Corp.,” Case No. 8:15-cv-01142, in the U.S. District Court for the Central District of California, July 17, 2015

  34. “LifeLock Will Pay $12 Million to Settle Charges by the FTC and 35 States That Identity Theft Prevention and Data Security Claims Were False,” Federal Trade Commission, Washington, D.C., March 9, 2010 https://www.ftc.gov/news-events/press-releases/2010/03/lifelock-will-pay-12-million-settle-charges-ftc-35-states

  35. “FTC Takes Action Against LifeLock for Alleged Violations of 2010 Order: FTC Asserts LifeLock Failed to Institute Security

    Program And Misled Consumers About Its Identity Protection Services,” Federal Trade Commission, Washington, D.C., July

    21, 2015 https://www.ftc.gov/news-events/press-releases/2015/07/ftc-takes-action-against-lifelock-alleged-violations-2010-order

  36. “Above All, Do No Harm” has also appeared in texts in different ways.

  37. Hereafter referred to herein, as “The Oath”

  38. The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. The Johns Hopkins University Press, Baltimore, MD, USA, 1943 http://guides.library.jhu.edu/c.php?g=202502&p=1335752 AND “The Hippocratic Oath,” Translated by Michael North, US National Library of Medicine, Bethesda, MD, USA, 2002 https://www.nlm.nih.gov/hmd/greek/greek_oath.html [presented as a secondary reference to clarify modifications from original]

  39. Hereafter referred to as “The Principle”

  40. See reference to Adverse Drug Events (ADEs) under: “Preservation of Personal Privacy in Healthcare Practice – A Sector Primer”

  41. In his address, Holmes’ announced that he had “firmly” believed in the need to offer the rebuke

  42. The author has chosen to refer to “Regular Medicine” as it was presented exactly, in the original text. However, adjacently and contextually presented here is Thomas Kuhn’s idea of “Normal Science.” Kuhn’s expressions on “Normal Science” is not presented here as a 1:1 meaning for “Regular Medicine.” The reference is to demonstrate the proclivity to prefer a “persistent” practice, in terms of Kuhn and “Normal Science,” nothing more. Kuhn, Thomas S; “The Structure of Scientific Revolutions” [Third Edition], University of Chicago Press, Chicago, IL, USA, 1996 Additionally, see: “Kuhn describes normal science as ‘puzzle-solving’ (1962/1970a, 35–42). While this term suggests that normal science is not dramatic, its main purpose is to convey the idea that like someone doing a crossword puzzle or a chess problem or a jigsaw, the puzzle-solver expects to have a reasonable chance of solving the puzzle, that his doing so will depend mainly on his own ability, and that the puzzle itself and its methods of solution will have a high degree of familiarity. A puzzle-solver is not entering completely uncharted territory. Because its puzzles and their solutions are familiar and relatively straightforward, normal science can expect to accumulate a growing stock of puzzle-solutions.” -- Thomas Kuhn In: “2. The Development of Science,” Stanford Encyclopedia of Philosophy, Stanford, CA, First published August 13 2004; Substantive Revision - August 11, 2011 http://plato.stanford.edu/entries/thomas-kuhn/

  43. Just so that we are clear, ‘a’ Trillion has, 12 zeros – following a 1.

  44. “National Health Expenditure Projections 2008–2018,” Office of the Actuary - U.S. Centers for Medicare and Medicaid Services, Department of Health & Human Services, Washington, D.C., February 19, 2009

  45. The article in question, pre-dates the Information Age; the rise of The Internet, and all Social-Media applications and platforms.

  46. The subject of “Confidentiality,” as Siegler has discussed in his article - is relationally discussed herein as equal to - the requirement to extend, assure and maintain “Personal Privacy” of Patients in, and surrounding all medical encounters

  47. Online Privacy Alliance [http://www.privacyalliance.org/]

  48. Sprenger, Polly; “Sun on Privacy: ‘Get Over It,’ WIRED Magazine, January 26 1999 http://archive.wired.com/politics/law/news/1999/01/17538

  49. See Siegler, Mark, Supra, ref. [22]

  50. Emphasis not in the original

  51. The act of conveying Healthcare Patient information to persons (Medical or Non-Medical personnel)

    that do not have a ‘Professional Need-To-Know’

  52. Emphasis not in the original

  53. Emphasis not in the original

  54. Alan Davidson - Director of Digital Economy; “Commerce Department Digital Economy Agenda 2015,” U.S. Department of Commerce, Washington, D.C., June 25, 2015

  55. Background Reading: Two-Thirds of OECD Member participants surveyed stated they were more concerned about their online privacy than a year ago. More than half feared monitoring by government agencies. -- “OECD Digital Economy Outlook 2015,” OECD Publishing, Paris, France, July 2015 http://dx.doi.org/10.1787/9789264232440-en and 54 % of Millennials surveyed in the UK & US expressed that failure of companies and governments to adequately protect identities, and data, would result in public distrust of goods and services. 70 % expressed belief that the risk to online safety will increase, and 31 % were of the opinion that the risk will increase dramatically. 80 % of those surveyed stated that it either very important or vital that their PII, financial, and/or medical data be shared only with authorized parties. -- Privacy Survey of Millennials, Intercede/Atomik Research, October 2015 https://www.intercede.com/latest-news-from-intercede/millennials-protest-against-ineffective-security-practices/ and 90 % of all Top World industries have suffered Protected Health Information Breaches. -- Widup, Suzanne; Bassett, Gabriel; Hylender, Dave; Rudis, Bob; Spitler, Marc; “2015 Protected Health Information Data Breach Report,” Verizon Enterprise Solutions, Basking Ridge, NJ, December 2015 http://www.verizonenterprise.com/resources/reports/rp_2015-protected-health-information-data-breach-report_en_xg.pdf

  56. One of the first foreign policy actions that U.S. President Barak Obama undertook after inauguration was to “reset” U.S. relations with Russia. The task would fall to the U.S. Secretary of State, as the Chief U.S. Diplomatic Officer, and Senior Cabinet Official. The U.S. Secretary of State sits at the helm of a Government Department that is highly specialized in the art of Statecraft. Additionally, in terms of National Security, the U.S. Department of State is the most important U.S. Government Department, next only to the Department of Defense, whose operations c/would be severely impacted or curtailed - when dealing with foreign nations, if language proficiency was not present or exercised. For this purpose, both Departments are highly resourced to meet mission requirements and challenges pertaining to languages. Yet, remarkably, shameful events result, as the example below amply demonstrates. Instead of canned proprieties, gauche and tactless statements, and fabricated chuckles being end products, the 'Joint Policy' purposes of two nations (a “reset” in this case) could have been better fulfilled, if required competencies were duly asserted, when it was warranted. -- “U.S. Gift to Russia Lost in Translation,” The Associated Press, March 6, 2009 https://www.youtube.com/watch?v=0GdLClHAMB0

  57. Online Trust Audit – 2016 Presidential Candidates, Online Trust Alliance, Bellevue, WA, September 2015.

  58. “2015 Protected Health Information Data Breach Report,” Verizon Enterprise Solutions, Basking Ridge, NJ, December 2015

  59. See section on: “Rise of Information Demand, & Its Effect Upon Privacy”

  60. Author attributes the term to Brenton C. Greene, Former DoD Select Commissioner to the President’s Commission on Critical Infrastructure Protection (PCCIP). By the term “Cyber-Fluency,” Captain Greene (Ret.) proposed a personal/institutional expression in the degrees of expertise, dexterity, talent and skill to exert efficiency, and effectiveness in one’s interactions with information technologies, and in the directing or controlling of its use to effect impact as desired. The author extends Cyber-Fluency to include such personal qualities as Critical Observation, Inquiry, Analysis, and Application, all of which drives Cognitive Presence. The Author defines Cognitive Presence in relation to Cyber-Fluency, as that ability which a person who interacts with Information Technologies possesses, enabling that person to structure relevance, meaning and emphasis among other things.

  61. Ibid

  62. “Where Are The Ethics? Surgeon Posts Pictures of Patient’s Internal Organs on Facebook,’ FirstPost - India, March 30 2015 http://www.firstpost.com/india/ethics-surgeon-posts-pictures-patients-internal-organs-facebook-2179891.html

  63. Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs. Research in Action, Issue 1, AHRQ Publication Number 01–0020, U.S. Agency for Healthcare Research and Quality, Rockville, MD., March 2001 http://archive.ahrq.gov/research/findings/factsheets/errors-safety/aderia/ade.html

  64. Facebook Reports - Third Quarter (2015), Menlo Park, CA, November 4, 2015 [Data as of September 30, 2015] http://investor.fb.com/releasedetail.cfm?ReleaseID=940609

  65. “Has Big Data Made Anonymity Impossible?” In: “Big Data Gets Personal,” MIT Technology Review - Business Report, Cambridge, MA, June 2013

  66. See Sidebar in Introduction.

  67. Ibid

  68. Fundamentally, this implies, a combination of literacy and numeracy skills composite (ability to determine relevance, make comparisons, evaluations, justifications etc.) that aid one in thought processes associated with problem solving and decision-making. Background reading: Wheeler, Patricia and Haertel, Geneva D; “Resource Handbook on Performance Assessment and Measurement,” The Owl Press, Berkeley, CA., 1993

  69. Former University of Louisville (Kentucky, US) Nursing Student Nina Yoder’s Post on her MySpace.com Blog with the title: “How I Witnessed the Miracle of Life,” February 2, 2009

  70. Memorandum Opinion. Yoder v. University of Louisville [Nina Yoder, Plaintiff, v. University of Louisville, et al., Defendants.], Civil Action No. 3:09-CV-00205, United States District Court, W.D. Kentucky, Louisville, KY., USA, March 30, 2012

  71. “Facebook Nurse Banned For Inappropriate Postings,” [Katie Grant, Ed.] The Telegraph (UK), 04 Sep 2013 http://www.telegraph.co.uk/news/health/10285422/Facebook-nurse-banned-for-inappropriate-postings.html AND Keogh, Kat; “Nurses Warned of Disciplinary Risk Over Improper Facebook Postings,” Nursing Standard, Vol. 27, No. 52, August 28 2013

  72. “Nursing Students Kicked out for Placenta Photos,” CBS-News/AP, January 3, 2011 http://www.cbsnews.com/news/nursing-students-kicked-out-for-placenta-photos/

  73. “You’re so vain: Study links social media use and narcissism,” ScienceDaily, June 11, 2013 http://www.sciencedaily.com/releases/2013/06/130611122111.htm

  74. Buffardi, Laura E and Campbell, Keith W; “Narcissism and Social Networking Web Sites,” Personality & Social Psychology Bulletin, Vol. 34, No. 10, October 2008 [First Published - July 3, 2008] AND Mehdizadeh, Soraya; ‘Self-Presentation 2.0: Narcissism and Self-Esteem on Facebook,’ Cyberpsychology, Behavior, and Social Networking, Volume 13, Number 4, 2010

  75. Not to be confused with ‘laws of nature’

  76. “The Chief Enemy of Privacy In Modern Life is That Interest In Other People and Their Affairs Known As Curiosity, Which In The Days Before Newspapers, Created Personal Gossip.” -- E. L. Godkin, in: “The Rights of The Citizen: IV - To His Own Reputation,” Scribners, July 1890

  77. Ibid

  78. Rubberneck: To look about or stare with great curiosity, as by craning the neck or turning the head. As in: “The tieup was due to drivers rubbernecking an accident.” http://dictionary.reference.com/browse/rubberneck

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Authors and Affiliations

  1. Distinguished Senior Research Scholar - National Security Affairs & U.S. Industrial Preparedness, Office of Scientific Inquiry & Applications (OSIA), University of Hawai’i, Honolulu, HI, USA

    Robert Mathews

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Correspondence to Robert Mathews.

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This article is part of the Topical Collection on Social Implications of Technologies

Editor’s Note

This treatise is a truncated exposition of a wider-angled deliberation of "Privacy," and of those required abilities to assure and maintain, safe and secure healthcare transactions everywhere. To comprehend the importance of Privacy, and to apply that comprehension to the creation of safer healthcare Privacy practices, a proper relating and interpreting of Privacy influencers causing confusion for those protecting the Personal Privacy of others must first occur. Therefore, this article is aimed at providing readers with greater clarity into the subject of Privacy by inspecting various Safety and Security significations in Healthcare.

Additionally, the views expressed in this monograph are solely that of the author, and do not reflect the official policy or position of the University of Hawai'i, the Office of Scientific Inquiry & Applications (OSIA), or the United States Government.

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Mathews, R. On protecting & preserving personal privacy in interoperable global healthcare venues. Health Technol. 6, 53–73 (2016). https://doi.org/10.1007/s12553-016-0126-6

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  • DOI: https://doi.org/10.1007/s12553-016-0126-6

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