Concept for Sharing Distributed Personal Health Records with Blockchains.

The characteristics of the "blockchain" technology and especially its decentralized nature lead to the notion of neutrality, censorship resistance, and absolute truths, which makes the concept interesting for many different domains, such as finance, supply chain management, or the energy sector - of course also for the healthcare area (eHealth). Blockchains also offer the possibility for well-known access points for a distributed system with easy to use and simple to integrate programming interfaces, which makes it interesting as a central point for electronic healthcare data exchange in a distributed environment. This paper presents a concept for integrating and sharing distributed personal healthcare records based on smart contracts implemented on an Ethereum blockchain.

Evaluation of Standards for Access Control Enabling PHR-S Federation.

The adoption of the Internet of Things (IoT) and mobile applications in the healthcare may transform the healthcare industry by offering better disease tracking and management as well as patient empowerment. Unfortunately, almost all of these new systems set up their own ecosystem and to be really valuable for the care process they need to be integrated or federated with user managed access control services based on international standards and profiles to enable interoperability. Thus, this work presents the results of an evaluation of available specifications for federated authorization, based on a set of basic requirements.

Propose of Standards Based IT Architecture to Enrich the Value of Allergy Data by Telemonitoring Data.

Interoperability is a key requirement for any IT-System to be future proof and cost efficient, due to the increasing interaction of IT-Systems in Healthcare. This feasibility study is part of a larger project focusing on the conceptualization and evaluation of interoperable and modular IT-Framework components for exchanging big data information sets. Hence, this project investigates the applicability of a standard based IT-Architecture for the integration of Personal Health Devices data and open data sources. As a proof of concept use case, pollen forecast data from the Medical University of Vienna were combined with Personal Health Device data and a data correlation was investigated. The standards were identified as well as selected in expert's reviewed and the Architecture was designed based on a literature research. Subsequently the prototype was implemented and successfully tested in interoperability tests. The study shows that the architecture meets the requirements. It can be flexibly extended according to further requirements due to its generic setup. However, further extensions of the Interoperability-Connector and a full test setup needs to be realized in future.

Biosignals, Standards and FHIR - The Way to Go?

BACKGROUND: Standards have become available to share semantically encoded vital parameters from medical devices, as required for example by personal healthcare records. Standardised sharing of biosignal data largely remains open. OBJECTIVES: The goal of this work is to explore available biosignal file format and data exchange standards and profiles, and to conceptualise end-to-end solutions. METHODS: The authors reviewed and discussed available biosignal file format standards with other members of international standards development organisations (SDOs). RESULTS: A raw concept for standards based acquisition, storage, archiving and sharing of biosignals was developed. The GDF format may serve for storing biosignals. Signals can then be shared using FHIR resources and may be stored on FHIR servers or in DICOM archives, with DICOM waveforms as one possible format. CONCLUSION: Currently a group of international SDOs (e.g. HL7, IHE, DICOM, IEEE) is engaged in intensive discussions. This discussion extends existing work that already was adopted by large implementer communities. The concept presented here only reports the current status of the discussion in Austria. The discussion will continue internationally, with results to be expected over the coming years.

Analyzing Privacy Risks of mHealth Applications.

Mobile health applications are expected to play a major role for the management of personal health in the future. For this purpose, the apps collect a lot of sensitive data from sensors or direct user input, combine it with automatic data such as GPS location data, store it locally and pass it on to web-platforms (often running in a public cloud), where the information can be managed and often shared with others in social networks. However, it is usually not transparent for the user how this sensitive information is handled and where it goes to. This paper shows the result of the analysis of mobile health applications regarding the handling of sensitive data especially with respect to transmission to third-parties.

Development of a virtual lab for practical eLearning in eHealth.

In recent years an ongoing development in educational offers for professionals working in the field of eHealth has been observed. This education is increasingly offered in the form of eLearning courses. Furthermore, it can be seen that simulations are a valuable part to support the knowledge transfer. Based on the knowledge profiles defined for eHealth courses a virtual lab should be developed. For this purpose, a subset of skills and a use case is determined. After searching and evaluating appropriate simulating and testing tools six tools were chosen to implement the use case practically. Within an UML use case diagram the interaction between the tools and the user is represented. Initially tests have shown good results of the tools' feasibility. After an extensive testing phase the tools should be integrated in the eHealth eLearning courses.

Development of Knowledge Profiles for International eHealth eLearning Courses.

Professionals working in the multidisciplinary field of eHealth vary in their educational background. However, knowledge in the areas of medicine, engineering and management is required to fulfil the tasks associated with eHealth sufficiently. Based on the results of an analysis of national and international educational offers a survey gathering user requirements for the development of knowledge profiles in eHealth was conducted (n=75) by professionals and students. During a workshop the first results were presented and discussed together with the network partners and the attendees. The resulting knowledge profiles contain knowledge areas of all three thematic content categories including fundamentals of medical terminology, standards and interoperability and usability as well as basics of all three content categories. The knowledge profiles are currently applied in a master's degree programme at the UAS Technikum Wien and will be developed further.

Applicability of IHE/Continua components for PHR systems: learning from experiences.

Capturing personal health data using smartphones, PCs or other devices, and the reuse of the data in personal health records (PHR) is becoming more and more attractive for modern health-conscious populations. This paper analyses interoperability specifications targeting standards-based communication of computer systems and personal health devices (e.g. blood pressure monitor) in healthcare from initiatives like Integrating the Healthcare Enterprise (IHE) and Continua Health Alliance driven by industry and healthcare professionals. Furthermore it identifies certain contradictions and gaps in the specifications and suggests possible solutions. Despite these shortcomings, the specifications allow fully functional implementations of PHR systems. Henceforth, both big business and small and medium-sized enterprises (SMEs) can actively contribute to the widespread use of large-scale interoperable PHR systems.

End-to-End Encryption for Personal Telehealth Systems.

Data from personal health devices is expected to be an important part of personalized care in future, but communication frameworks for such data create new challenges for security and privacy. Continua Health Alliance has been very active and successful in defining guidelines and a reference architecture for transmitting personal health device data based on well-known international standards. But looking at the security definitions, the concepts are still facing open issues and weaknesses like identity management or missing end-2end (E2E) encryption. This paper presents an approach for an E2E encryption framework based on Continua's reference architecture and the underlying base standards. It introduces the basic process and proposes necessary extensions to the architecture as well as to the standardized protocols of ISO/IEEE 11073 and HL7 version 2.

Security challenges in integration of a PHR-S into a standards based national EHR.

Health related data provided by patients themselves is expected to play a major role in future healthcare. Data from personal health devices, vaccination records, health diaries or observations of daily living, for instance, is stored in personal health records (PHR) which are maintained by personal health record systems (PHR-S). Combining this information with medical records provided by healthcare providers in electronic health records (EHR) is one of the next steps towards "personal care". Austria currently sets up a nationwide EHR system that incorporates all healthcare providers and is technically based on international standards (IHE, HL7, OASIS, ...). Looking at the expected potential of merging PHR and EHR data it is worth to analyse integration approaches. Although knowing that an integration requires the coordination of processes, information models and technical architectures, this paper specifically focuses on security issues by evaluating general security requirements for a PHR-S (based on HL7 PHR-S FM), comparing them with the information security specifications for the Austrian's national EHR (based on ISO/IES 27000 series) and identifying the main challenges as well as possible approaches.

Concepts for a standard based cross-organisational information security management system in the context of a nationwide EHR.

Working with health related data necessitates appropriate levels of security and privacy. Information security, meaning ensuring confidentiality, integrity, and availability, is more organizational, than technical in nature. It includes many organizational and management measures, is based on well-defined security roles, processes, and documents, and needs permanent adaption of security policies, continuously monitoring, and measures assessment. This big challenge for any organization leads to implementation of an information security management system (ISMS). In the context of establishing a regional or national electronic health record for integrated care (ICEHR), the situation is worse. Changing the medical information exchange from on-demand peer-to-peer connections to health information networks requires all organizations participating in the EHR system to have consistent security levels and to follow the same security guidelines and rules. Also, the implementation must be monitored and audited, establishing cross-organizational information security management systems (ISMS) based on international standards. This paper evaluates requirements and defines basic concepts for an ISO 27000 series-based cross-organizational ISMS in the healthcare domain and especially for the implementation of the nationwide electronic health record in Austria (ELGA).