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Georeferenced and Secure Mobile Health System for Large Scale Data Collection in Primary Care
University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
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2016 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 94, p. 91-99Article in journal (Refereed) Published
Abstract [en]

Introduction - Mobile health consists in applying mobile devices and communication capabilities for expanding the coverage and improving the effectiveness of health care programs. The technology is particularly promising for developing countries, in which health authorities can take advantage of the flourishing mobile market to provide adequate health care to underprivileged communities, especially primary care. In Brazil, the Primary Care Information System (SIAB) receives primary health care data from all regions of the country, creating a rich database for health-related action planning. Family Health Teams (FHTs) collect this data in periodic visits to families enrolled in governmental programs, following an acquisition procedure that involves filling in paper forms. This procedure compromises the quality of the data provided to health care authorities and slows down the decision-making process.

Objectives - To develop a mobile system (GeoHealth) that should address and overcome the aforementioned problems and deploy the proposed solution in a wide underprivileged metropolitan area of a major city in Brazil.

Methods - The proposed solution comprises three main components: (a) an Application Server, with a database containing family health conditions; and two clients, (b) a Web Browser running visualization tools for management tasks, and (c) a data-gathering device (smartphone) to register and to georeference the family health data. A data security framework was designed to ensure the security of data, which was stored locally and transmitted over public networks.

Results - The system was successfully deployed at six primary care units in the city of Sao Paulo, where a total of 28,324 families/96,061 inhabitants are regularly followed up by government health policies. The health conditions observed from the population covered were: diabetes in 3.40%, hypertension (age > 40) in 23.87% and tuberculosis in 0.06%. This estimated prevalence has enabled FHTs to set clinical appointments proactively, with the aim of confirming or detecting cases of non-communicable diseases more efficiently, based on real-time information.

Conclusion - The proposed system has the potential to improve the efficiency of primary care data collection and analysis. In terms of direct costs, it can be considered a low-cost solution, with an estimated additional monthly cost of U$ 0.040 per inhabitant of the region covered, or approximately U$ 0.106 per person, considering only those currently enrolled in the system.

Place, publisher, year, edition, pages
Elsevier, 2016. Vol. 94, p. 91-99
Keywords [en]
Data collection, mobile health, data quality, georeference, primary care, security
National Category
Computer and Information Sciences
Research subject
Computer Science
Identifiers
URN: urn:nbn:se:kau:diva-44392DOI: 10.1016/j.ijmedinf.2016.06.013ISI: 000382511500011OAI: oai:DiVA.org:kau-44392DiVA, id: diva2:946708
Available from: 2016-07-05 Created: 2016-07-05 Last updated: 2018-11-27Bibliographically approved
In thesis
1. Secure and Privacy-aware Data Collection and Processing in Mobile Health Systems
Open this publication in new window or tab >>Secure and Privacy-aware Data Collection and Processing in Mobile Health Systems
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare systems have assimilated information and communication technologies in order to improve the quality of healthcare and patient's experience at reduced costs. The increasing digitalization of people's health information raises however new threats regarding information security and privacy. Accidental or deliberate data breaches of health data may lead to societal pressures, embarrassment and discrimination. Information security and privacy are paramount to achieve high quality healthcare services, and further, to not harm individuals when providing care. With that in mind, we give special attention to the category of Mobile Health (mHealth) systems. That is, the use of mobile devices (e.g., mobile phones, sensors, PDAs) to support medical and public health. Such systems, have been particularly successful in developing countries, taking advantage of the flourishing mobile market and the need to expand the coverage of primary healthcare programs. Many mHealth initiatives, however, fail to address security and privacy issues. This, coupled with the lack of specific legislation for privacy and data protection in these countries, increases the risk of harm to individuals. The overall objective of this thesis is to enhance knowledge regarding the design of security and privacy technologies for mHealth systems. In particular, we deal with mHealth Data Collection Systems (MDCSs), which consists of mobile devices for collecting and reporting health-related data, replacing paper-based approaches for health surveys and surveillance. This thesis consists of publications contributing to mHealth security and privacy in various ways: with a comprehensive literature review about mHealth in Brazil; with the design of a security framework for MDCSs (SecourHealth); with the design of a MDCS (GeoHealth); with the design of Privacy Impact Assessment template for MDCSs; and with the study of ontology-based obfuscation and anonymisation functions for health data.

Abstract [en]

Information security and privacy are paramount to achieve high quality healthcare services, and further, to not harm individuals when providing care. With that in mind, we give special attention to the category of Mobile Health (mHealth) systems. That is, the use of mobile devices (e.g., mobile phones, sensors, PDAs) to support medical and public health. Such systems, have been particularly successful in developing countries, taking advantage of the flourishing mobile market and the need to expand the coverage of primary healthcare programs. Many mHealth initiatives, however, fail to address security and privacy issues. This, coupled with the lack of specific legislation for privacy and data protection in these countries, increases the risk of harm to individuals. The overall objective of this thesis is to enhance knowledge regarding the design of security and privacy technologies for mHealth systems. In particular, we deal with mHealth Data Collection Systems (MDCSs), which consists of mobile devices for collecting and reporting health-related data, replacing paper-based approaches for health surveys and surveillance.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2016. p. 28
Series
Karlstad University Studies, ISSN 1403-8099 ; 2016:47
Keywords
Mobile health, information security, data privacy, data collection, personal health data
National Category
Computer and Information Sciences Telecommunications Computer Sciences
Research subject
Computer Science; Computer Science
Identifiers
urn:nbn:se:kau:diva-46982 (URN)978-91-7063-730-8 (ISBN)
Presentation
2016-12-13, 21A342 - Eva Erikssonsalen, Karlstads universitet, 651 88, Karlstad, 15:15 (English)
Opponent
Supervisors
Available from: 2016-11-22 Created: 2016-10-31 Last updated: 2018-08-07Bibliographically approved
2. Engineering Privacy for Mobile Health Data Collection Systems in the Primary Care
Open this publication in new window or tab >>Engineering Privacy for Mobile Health Data Collection Systems in the Primary Care
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mobile health (mHealth) systems empower Community Health Workers (CHWs) around the world, by supporting the provisioning of Community-Based Primary Health Care (CBPHC) – primary care outside the health facility into people’s homes. In particular, Mobile Health Data Collection Systems (MDCSs) are used by CHWs to collect health-related data about the families that they treat, replacing paper-based approaches for health surveys. Although MDCSs significantly improve the overall efficiency of CBPHC, existing and proposed solutions lack adequate privacy and security safeguards. In order to bridge this knowledge gap between the research areas of mHealth and privacy, the main research question of this thesis is: How to design secure and privacy-preserving systems for Mobile Health Data Collection Systems? To answer this question, the Design Method is chosen as an engineering approach to analyse and design privacy and security mechanisms for MDCSs. Among the main contributions, a comprehensive literature review of the Brazilian mHealth ecosystem is presented. This review led us to focus on MDCSs due to their impact on Brazil’s CBPHC, the Family Health Strategy programme. On the privacy engineering side, the contributions are a Privacy Impact Assessment (PIA) for the GeoHealth MDCS and three mechanisms: (a) SecourHealth, a security framework for data encryption and user authentication; (b) an Ontology-based Data Sharing System (O-DSS) that provides obfuscation and anonymisation functions; and, (c) an electronic consent (e-Consent) tool for obtaining and handling informed consent. Additionally, practical experience is shared about designing a MDCS, GeoHealth, and deploying it in a large-scale experimental study. In conclusion, the contributions of this thesis offer guidance to mHealth practitioners, encouraging them to adopt the principles of privacy by design and by default in their projects.

Abstract [en]

Mobile health (mHealth) systems empower Community Health Workers (CHWs) around the world, by supporting the provisioning of Community-Based Primary Health Care (CBPHC). In particular, Mobile Health Data Collection Systems (MDCSs) are used by CHWs to collect health-related data about the families that they treat, replacing paper-based approaches. Although MDCSs improve the efficiency of CBPHC, existing solutions lack adequate privacy and security safeguards.

To bridge this knowledge gap between the research areas of mHealth and privacy, we start by asking: How to design secure and privacy-preserving systems for Mobile Health Data Collection Systems? To answer this question, an engineering approach is chosen to analyse and design privacy and security mechanisms for MDCSs.

Among the main contributions, a comprehensive literature review of the Brazilian mHealth ecosystem is presented. On the privacy engineering side, the contributions are a Privacy Impact Assessment (PIA) for the GeoHealth MDCS and three mechanisms: SecourHealth, a security framework for data encryption and user authentication; an Ontology-based Data Sharing System (O-DSS) that provides obfuscation and anonymisation functions; and, an electronic consent (e-Consent) tool for obtaining and handling informed consent.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2019. p. 55
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:1
Keywords
Privacy, data protection, information security, mobile health, community-based primary care, privacy impact assessment, consent management, anonymisation
National Category
Computer and Information Sciences
Research subject
Computer Science
Identifiers
urn:nbn:se:kau:diva-70216 (URN)978-91-7063-900-5 (ISBN)978-91-7063-995-1 (ISBN)
Public defence
2019-01-31, 1A305, Lagerlöfsalen, Karlstad, 10:00 (English)
Opponent
Supervisors
Available from: 2019-01-08 Created: 2018-11-27 Last updated: 2019-01-08Bibliographically approved

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Iwaya, Leonardo H

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