RESUMO
The digitization of mental health enables significant shifts in clinical practice by harnessing vast amounts of data derived from the use of apps and wearables to enhance medical research, patient care, and health system efficiency. However, this process brings forth pertinent ethical and legal risks. Ethically, concerns primarily revolve around safeguarding the privacy and confidentiality of sensitive data, alongside the transformation of the doctor-patient relationship through technological interaction. Within the regulatory realm, issues encompass the classification of these tools as medical products, ensuring normative assurance of effective protection of mental health data, and addressing potential legal risks within this domain. This article aims to provide an overarching view of this landscape, serving as a catalyst for the technological, ethical, and legal discourse necessitated by digital mental health.
Assuntos
Confidencialidade , Saúde Mental , Aplicativos Móveis , Humanos , Confidencialidade/legislação & jurisprudência , Confidencialidade/ética , Aplicativos Móveis/ética , Aplicativos Móveis/legislação & jurisprudência , Relações Médico-Paciente/ética , Telemedicina/ética , Telemedicina/legislação & jurisprudência , Dispositivos Eletrônicos Vestíveis/ética , Segurança Computacional/legislação & jurisprudênciaRESUMO
BACKGROUND: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. OBJECTIVE: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. METHODS: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. RESULTS: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). CONCLUSIONS: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages.
Assuntos
Aplicativos Móveis , China , Humanos , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos , Aplicativos Móveis/legislação & jurisprudência , Segurança Computacional/normas , Segurança Computacional/legislação & jurisprudência , COVID-19/prevenção & controle , COVID-19/epidemiologia , Confidencialidade/normas , Confidencialidade/legislação & jurisprudência , Internet , Pandemias/prevenção & controleRESUMO
Introducción: En tiempos de COVID-19 constituye una necesidad utilizar dispositivos y aplicaciones móviles para el desarrollo del proceso docente-educativo en la Universidad de Ciencias Médicas de Sancti Spíritus, sin descuidar elementos de seguridad que permiten garantizar la preservación de la confidencialidad de los datos personales de estudiantes y profesores. Objetivo: Identificar el estado de preparación inicial de estudiantes y profesores de la carrera Licenciatura en Sistemas de Información en Salud, en temas orientados a la seguridad de dispositivos y aplicaciones móviles en función de la educación. Métodos: Estudio exploratorio realizado en los cursos académicos 2019-2020 y 2020-2021. Se trabajó con una muestra probabilística de 50 estudiantes y profesores. Se emplearon métodos teóricos, empíricos y estadístico-matemático. Se estructuró la variable dependiente en tres dimensiones y seis indicadores, y se definieron las fuentes de información y los principios éticos. Resultados: Se identificaron los conocimientos teórico-prácticos de estudiantes y profesores en seguridad de dispositivos y aplicaciones móviles en función de la educación; adicionalmente, la actitud y motivación que manifestaron en cuanto al uso de métodos técnicos de seguridad y superación. Conclusiones: Existen insuficientes métodos de seguridad técnica en dispositivos y aplicaciones móviles, y falta de cultura tecnológica orientada al uso de las redes de la Empresa de Telecomunicaciones de Cuba para el acceso a internet; de ahí la importancia de proteger los datos personales almacenados en dispositivos y aplicaciones móviles. Asimismo, desconocimiento de avisos y políticas de privacidad de las aplicaciones móviles, e insuficientes acciones formativas orientadas al uso correcto de las aplicaciones y la protección de los datos personales(AU)
Introduction: In times of COVID-19 it constitutes a necessity to use mobile devices and applications for the development of the teaching-educational process at the University of Medical Sciences of Sancti Spíritus, without neglecting security elements that allow guaranteeing the preservation of the confidentiality of personal data of students and teachers. Objective: To identify the state of initial preparation of students and teachers of the Bachelor's Degree in Health Information Systems, in topics oriented to the security of mobile devices and applications in terms of education. Methods: Exploratory study conducted in the academic years 2019-2020 and 2020-2021. We worked with a probability sample of 50 students and teachers. Theoretical, empirical and statistical-mathematical methods were used. The dependent variable was structured in three dimensions and six indicators, and the sources of information and ethical principles were defined. Results: Theoretical-practical knowledge of students and teachers in security of mobile devices and applications as a function of education was identified; additionally, the attitude and motivation they manifested regarding the use of technical methods of security and self-improvement. Conclusions: There are insufficient technical security methods in mobile devices and applications, and lack of technological culture oriented to the use of the networks of the Cuban Telecommunications Company for Internet access; hence the importance of protecting personal data stored in mobile devices and applications. Likewise, lack of knowledge of privacy notices and policies of mobile applications, and insufficient training actions oriented to the correct use of applications and the protection of personal data(AU)
Assuntos
Humanos , Ensino/educação , Docentes/educação , Aplicativos Móveis/legislação & jurisprudência , Educação a Distância/ética , Telefone Celular , COVID-19/prevenção & controleRESUMO
Resumo Este artigo descreve como o aplicativo WhatsApp é utilizado na relação entre pacientes e médicos do ambulatório de pediatria e obstetrícia da Fundação Santa Casa de Misericórdia do Pará, Brasil, e discute suas implicações éticas. Dados foram levantados em pesquisa de campo qualitativa por meio de questionário semiestruturado aplicado a oito médicos. Como resultado, observou-se que entre as situações de uso preferencial do WhatsApp citadas pelos respondentes está o esclarecimento de dúvidas (62,5%). Entre as desvantagens mencionadas pelos participantes está a banalização do uso desse tipo de serviço por parte dos pacientes (37,5%), e 62,5% acham que a utilização do aplicativo seja ética. Conclui-se que faltam pesquisas sobre o assunto e regulamentação do uso do aplicativo na área da saúde.
Abstract This article describes how the WhatsApp application is used in the physician-patient relationship at the pediatrics and obstetrics outpatient clinic of the Santa Casa de Misericórdia Foundation in the State of Pará, Brazil, and discusses its ethical implications. Data was collected in qualitative field research using a semi-structured questionnaire applied to eight physicians. As a result, it was observed that among the situations of preferential use of WhatsApp mentioned by the respondents is the clarification of doubts (62.5%). Among the disadvantages mentioned by the interviewees is the trivialization of the use of this type of service by patients (37.5%), and 62.5% consider the use of the application ethical. We conclude that there is a lack of research on the subject addressed and of regulation of the use of the application in the health area.
Resumen Este artículo describe cómo se utiliza la aplicación WhatsApp en la relación entre médicos y pacientes del ambulatorio de pediatría y obstetricia de la Fundación Santa Casa de Misericordia del Pará, Brasil, y discute sus implicancias éticas. Los datos fueron recogidos en una investigación de campo cualitativa, por medio de un cuestionario semiestructurado aplicado a ocho médicos. Como resultado, se observó que entre las situaciones de uso preferencial del WhatsApp citadas por los médicos entrevistados aparece el esclarecimiento de dudas (62,5%). Entre las desventajas mencionadas por los participantes está la banalización del uso de este servicio por parte de los pacientes (37,5%), y el 62,5% no creen que sea ético el uso de la aplicación. Se concluye que faltan investigaciones sobre el tema y una regulación del uso de la aplicación en el área de la salud.