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Conceptual Privacy Framework for Health Information on Wearable Device

Article (PDF Available) inPLoS ONE 9(12):e114306 · December 2014with217 Reads
DOI: 10.1371/journal.pone.0114306
Abstract
Wearable health tech provides doctors with the ability to remotely supervise their patients' wellness. It also makes it much easier to authorize someone else to take appropriate actions to ensure the person's wellness than ever before. Information Technology may soon change the way medicine is practiced, improving the performance, while reducing the price of healthcare. We analyzed the secrecy demands of wearable devices, including Smartphone, smart watch and their computing techniques, that can soon change the way healthcare is provided. However, before this is adopted in practice, all devices must be equipped with sufficient privacy capabilities related to healthcare service. In this paper, we formulated a new improved conceptual framework for wearable healthcare systems. This framework consists of ten principles and nine checklists, capable of providing complete privacy protection package to wearable device owners. We constructed this framework based on the analysis of existing mobile technology,
RESEARCH ARTICLE
Conceptual Privacy Framework for Health
Information on Wearable Device
Seyedmostafa Safavi*, Zarina Shukur
Unit of Cyber Security, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia,
43600, Bangi, Malaysia
*Safavi@takhosting.info
Abstract
Wearable health tech provides doctors with the ability to remotely supervise their
patients’ wellness. It also makes it much easier to authorize someone else to take
appropriate actions to ensure the person’s wellness than ever before. Information
Technology may soon change the way medicine is practiced, improving the
performance, while reducing the price of healthcare. We analyzed the secrecy
demands of wearable devices, including Smartphone, smart watch and their
computing techniques, that can soon change the way healthcare is provided.
However, before this is adopted in practice, all devices must be equipped with
sufficient privacy capabilities related to healthcare service. In this paper, we
formulated a new improved conceptual framework for wearable healthcare
systems. This framework consists of ten principles and nine checklists, capable of
providing complete privacy protection package to wearable device owners. We
constructed this framework based on the analysis of existing mobile technology, the
results of which are combined with the existing security standards. The approach
also incorporates the market share percentage level of every app and its respective
OS. This framework is evaluated based on the stringent CIA and HIPAA principles
for information security. This evaluation is followed by testing the capability to
revoke rights of subjects to access objects and ability to determine the set of
available permissions for a particular subject for all models Finally, as the last step,
we examine the complexity of the required initial setup.
Introduction
Given that healthcare is one of the most important aspects of not only our lives,
but also economy, it is not surprising that it is gaining attention in wearable
technology. Healthcare provision via wearable devices brought changes in
OPEN ACCESS
Citation: Safavi S, Shukur Z (2014) Conceptual
Privacy Framework for Health Information on
Wearable Device. PLoS ONE 9(12): e114306.
doi:10.1371/journal.pone.0114306
Editor: Muhammad Khurram Khan, King Saud
University, Kingdom of Saudi Arabia, Saudi Arabia
Received: August 17, 2014
Accepted: November 8, 2014
Published: December 5, 2014
Copyright: ß2014 Safavi, Shukur. This is an
open-access article distributed under the terms of
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and repro-
duction in any medium, provided the original author
and source are credited.
Data Availability: The authors confirm that all data
underlying the findings are fully available without
restriction. All relevant data are within the paper.
Funding: This research was supported by The
National University of Malaysia (UKM) grant
ERGS/1/2013/ICT04/UKM/01/1. The funder had no
role in study design, data collection and analysis,
decision to publish, or preparation of the manu-
script.
Competing Interests: The authors have declared
that no competing interests exist.
PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 1/16
treatment and examination of patients, as well as research and development in
different areas. Given that the advanced communications technology has ensured
that most individuals own Smartphones, which are capable of using 3rd party
applications and many more devices connected to it, it was logical to find the ways
for healthcare to benefit from this trend. This prompted the emergence of a new
field called Mobile Health that, according to World Health Organization (WHO),
has enabled health checkups to be conducted via Smartphone or some other type
of wearable device. It is envisaged that, soon, health management and supervision
will be conducted with the help of functions like sound, SMS and MMS,
Bluetooth and other services [1](Figure 1). On the other hand, Google has
already made significant progress in this field, by introducing wearable OS called
Android Wear and the new types of wearable devices, such as Android watches
and Google Glasses (the glasses that can provide their wearer with information
and collect it at the same time). Google developers have proposed the idea of
inbuilt technology that can use sensors to provide all kinds of information about
the user’s health [2]. The applications recently announced by Apple (HealthKit),
Google (Google Fit) and Samsung (S Health) facilitate health monitoring through
sensors that measure a user’s heart rate and a gyroscope that calculates a user’s
movement. This technology and API along it may help providers to collect the
most relevant data, because the glasses are something most individuals are used to
wearing. Producing devices with such capability could bring much more
innovation to the healthcare system. Rapid growth in the number of subscribers to
technology, such as cell phone, can ensure connectivity and usability throughout
the healthcare system.
According to the report by Wu et al. [3], usage of cellular technology,
Smartphones in particular, in the medical field is increasing, since the devices can
be used to record patient’s medical history, symptoms and details about lifestyle.
This information can assist physicians in providing treatment and diagnosis in a
safe and effective way. Findings of similar research studies indicate that, with more
widespread health IT adoption, we can have an effective means to improve the
quality and safety of healthcare [4].
However, this innovation also poses an issue of ensuring that protected health
information (PHI) is not misused, (protected health information (PHI) is any
information about health status, provision of health care, or payment for health
care that can be linked to a specific individual). A study recently published by
comScore suggests that the number of cell phone subscribers in the US increased
from 49 to 76.8 million between 2010 and 2011 [5], [6]. As shown in Figure 2, the
demand for portable devices like Smartphone can ensure that they are widely
available in healthcare. It is important to note that, if mobile healthcare
technology is to be widely utilized, it must be ensured that the client is given full
control of the data, even if a different party owns the applications. Thus, issues are
likely to rise when one party decides to share information with different
companies for profit. Hence, in the context of the healthcare system, it is necessary
to apply privacy and safety rules [7].
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While wearable healthcare provision devices could bring us better lifestyle and
remove the need to regularly visit clinics, it may introduce greater security and
privacy issues to our society [8], [9]. Healthcare technology gadgets have to be
designed with the aim of improving health, as well as keeping the client out of
privacy and secrecy difficulties. Clearly, there is a potential for misuse of health
information, which must be addressed.
In this paper, we propose a concise, improved and effective privacy framework
for wearable device manufacturers, as well as application developers, capable of
Figure 1. Mobile sensors and area of coverage.
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Figure 2. Adoption of mobile health initiatives and phases, globally [1].
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providing greater privacy and security to the wearable device owners. The
framework consists of two parts—the principles and the checklists. Since the
framework is related to the privacy of health information on a wearable device,
several critical aspects are considered when constructing the framework.
For creating the checklists, we propose:
NWearable technology that includes the device technology and its operating
system,
NFunctionalities of health apps,
NSystem architecture based on PHR standard.
For formulating the principles, we offer:
NExpanding the existing privacy and security framework related to health
information,
NConducting a healthcare system projects case study.
The proposed framework is subsequently compared with other frameworks
based on six CIA and HIPAA principles pertaining to Information Security,
namely Confidentiality, Integrity, Availability, Authenticity, Non-repudiation and
Information security analysis.
This paper is organized as follows: Section 2 presents a review of the
aforementioned aspects, while the proposed framework is described in Section 3.
In Section 4, we evaluate the framework, and Section 5 concludes the work.
Review on Technology and Health Application
1. Popular PHR Architectures
Wearable technology, and especially mobile health, can bring advanced super-
vision to any place at any time without the need for the patient to visit the clinic.
As a result, the cost of healthcare can be substantially reduced. To record medical
history, two standard formats, Personal Health Record (PHR) and Electronic
Health Record (EHR), are used. While PHR is designed by the patient, EHR is
designed and supported by the healthcare supplier, such as a clinic or hospital
system. Since PHRs contain significant amount of data and must be subjected to
stringent privacy rules and controls, they are the main focus of this paper.
Presently, Google [10] healthcare service and Microsoft [11], are the two main
PHR providers, as shown in Figure 3. Both companies offer applications that
permit the users to control their own PHI with the help of Internet. This enables
collation of PHI from different sources pertaining to the same person. Moreover,
the user can change the elements in the existing record, as well as share the
content with family or healthcare providers. Once they have created a Microsoft
account, users can control and handle their own or family member’s PHR, as well
as authorize others to handle their own PHRs at any time and level. As mentioned
earlier, as clients can share their own data with whomever they choose, they are
effectively accepting the risks associated with the process. PHRs with different
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types of protection designs [12] indicate that it is likely that how service providers
handle the sensitive data and protect the health information will change in the
future.
Via Internet, the clients can check the submitted information and visit
schedules at anytime, as well as choose a specific doctor to visit. This method
involves client sharing the PHI across the PHR model, which may also include
receiving data associated with financial claims and lab results by multiple
suppliers. Similarly, physicians will receive all the necessary information about the
patient across the system.
As the PHR model is based on users holding their data on a central repository,
the client must keep and share the entire PHI data via Internet or portable devices.
Presently, this includes flash memory or Smartphone, but the number of options
is likely to expand in the future. It is essential, however, that these allow the user
to add and change fields of database records using the device or a dedicated
Internet website.
This model authorizes suitable devices to run processes on user PHR
information with specific technology. In case of different vendors providing PHR,
a set of standards must be imposed. For example, if a Smartphone health gadget
seller supplies a specific application that can record the information received by
the same device, it must be recognizable by all other devices involved in the
healthcare system and allow the patient to access data with the help of seller’s
Internet site. In addition, privacy in mobile health in organizations should be
using the same client-centric PHRs. Presently, many service providers can provide
cellular connectivity. While this reduces the price of technology and expands its
usage, it poses much greater risk to security and privacy.
Figure 3. PHR model provided by Microsoft [13].
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2. Operating System Main Features
The most popular platforms are largely similar in terms of allowing the users to
receive useful applications. However, their operating systems are typically
incompatible. As shown in Figure 4, ideally the platform should be able handle all
types of health care devices, with the focus on wearable gadgets that always stay
with the user.
The Android Operating System designer and developer (Google company) is
focusing on health system since many users use the device and would like to
benefit from it in terms of improving their health and fitness.
As shown inFigure 4, the operating system needs to support features that can help
applications to connect to the wearable device and have hardware that can receive
and store data in real time. In case of any issues or noticeable changes in the user’s
health, the wearable device should automatically start working in emergency mode.
Among the three most widely used operating systems available in the market,
only Android has included built-in connectivity to Bluetooth Health Device
Profile (HDP) system [15].
3. Brief Review on Popular Wearable Devices
As of April 2014, the Unit of Cyber Security in Faculty of Information Science and
Technology, Universiti Kebangsaan Malaysia (UKM) has completed analysis of
some wearable devices that are still not available to public worldwide, namely
Google Glass from Google Company and Galaxy Gear Fit designed and developed
for wearable system from Samsung.
As an appointed explorer (the first author) for the latest wearable devices, we
found that, with the sensors available in these wearable devices and help of API,
healthcare providers can record data and protect the device owner. Presently, they
can use the technology to find out the position of the user and record the number
of steps taken, along with other fitness measurements, including heart rate
measured by the built-in sensor, these devices are incapable of recording and
transmitting data, such as location, without connection to a Wi-Fi network or a
specific smartphone (Figure 5). This scenario may change with the recently
announced Android Wear devices (e.g. Galaxy Live, LG G-Watch R, Moto 360), as
well as the Apple Watch, which has a Healthkit system, and the Samsung Gear S,
which includes 3G, GPS, and a heart rate monitor.
After proper analysis of devices, we concluded that the mechanism that ensures
data security is presently lacking, which must be changed in later versions. Data
protection is crucial for widespread use of these devices as a means of keeping daily
checks of user’s health and lifestyle. Thus, this point is added to our checklist.
4. Review of Health Apps
We analyzed the applications made for different Operating Systems in Table 1,
based on the platform, functionality and targeted audience of the specified
application. In this study, the strategy of selecting applications follows three main
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criteria: (1) category, which refers to the listed applications categorized under the
patients’ section, (2) download per application, or the popularity of the
application that can lead users to find more useful applications under the first
criteria, and (3) the mobile operating system covered by the selected application.
After conducting an extensive analysis of applications, we conclude that proper
transparency in application, ease of User Interface (UI) use, customer interaction
with the system and having moderator and privacy settings are the most
important aspects of wearable healthcare applications. Hence, these elements are
included into the newly proposed framework.
The Proposed Framework
The proposed framework considers the client control across the healthcare
information, implying the power to share data with a specific organization or a
particular person relevant to the subject. At the same time, it is essential to
Figure 4. Comparison of Market share percentage and main healthcare features supported by three
mobile OS platforms [14].
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Figure 5. Google Glass design (front view) [1].
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differentiate between level of responses. We expect that the portable and wearable
devices, like Smartphone and smart watch, with the help of Internet and
application developers, will help rapidly expand the use of healthcare technology
[16]. The patient should have the option to share the data monitored and stored
by these devices with family members [17], [18], [19], or with 3rd parties. For
example, doctors can use the data for diagnosis [20], the insurance system can
Table 1. Applications that we have reviewed.
Application Platforms Functions Main Audience
S Health by Samsung Android It can help you achieve your fitness goals by monitoring your
fitness levels during workouts and throughout the day. The
application will be connected to wearable devices to monitor
your health at all times
Patient
Davis’s Laboratory and
Diagnostic Tests
Android, BlackBerry, iOS,
Palm OS, Windows Mobile.
User will receive care before, during, and after the test; RSS
receives feeds of clinical lab-product news.
Patient
Pocket Guide to Diagnostic
Tests
Android, BlackBerry, iOS,
Palm OS, Windows Mobile.
Clinical settings laboratory procedures; diagnostic imaging tests;
complex algorithms flowcharts will be ready at all times;
laboratory tests; images are color images; and cloud support app.
Patient/Clinics
Labs 360 Android, BlackBerry, iOS,
Palm OS, Windows Mobile.
Providing values; cross-reference available; up to date Healthcare provi-
ders
5MCC Android, BlackBerry, iOS,
Palm OS, Windows Mobile
Diagnostic information, algorithms and flowcharts available;
drug therapy in every case available.
Doctor/Patient
5MIDC Android, BlackBerry, iOS,
Palm OS, Windows Mobile
Alphabetically listed topics of interest Patient/Healthcare
providers/Doctor
ID Notes Palm OS Organs, illnesses and related treatments, different types of indexing. Doctor/Patient
P.M.I.D Palm OS, Windows Mobile Guideline and therapy suggestion; users will be categorized by
physical history and therapy specify to the same user.
Patient/Healthcare
providers
S.G Antimicrobial Therapy Palm OS, Windows Mobile,
iOS, BlackBerry.
Facility to search; categories available; organized diseases &
historical conditions; organized drug info; very efficient navigation.
Doctor/Patient
ePocrates ID Palm OS, Windows Mobile,
iOS, BlackBerry, Android
900 infections, pathogens and drugs recorded in its database;
anatomic location and price details by alphabetical categories;
ability to record personal notes and information in the database.
Doctor
Mobipocket Reader BlackBerry, Windows Mobile,
Symbian OS, Palm OS
eBooks library; search in the dictionary; customizable display. Doctor/Patient
J.H.A.Guide iOS, Android, Palm OS,
Windows Mobile, BlackBerry
Includes expert noted information about illnesses; drug lists and
interactions; Info on anti-microbial agents;
Doctor
Palm LabDX Palm OS, Windows CE Alphabetical tests listed; includes test info; mostly info about
testing.
Doctor/Patient
UpToDate iOS, web-enabled smart-
phone
Includes 14000 physicians, drug topics and related information;
provides search filters to find the information in three categories:
adult, pediatric, patient.
Doctor/Patient
EyeChart iOS Complete eye charts used by professionals. Doctor/Patient
Lab Unit Converter iOS Conversions and tests, ability to search lab results. Doctor
Normal Lab Values iOS Search reference visualizes labs alphabetically. Doctor/Patient
DizzyFIX iOS Assists treatment of BPPVc Doctor/Patient
Video Laser Level iOS The oculoplastic surgeons can check alignment of canthal
position at the time of surgical planning and after the job.
Doctor
eRoentgen Radiology Dx iOS Identifies best radiology test for the user; can be searched via
diagnosis/symptoms.
Doctor
Antibiotic Dosage Calculator iOS Calculation of drug dosages and adjustments based on patient’s
data t.
Doctor/Patient
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access the information to provide cover for the user, and researchers can access
the records in order to conduct analyses and tests [21]. It is also envisaged that
other authorized persons may use this information to design diet, health plan or a
training program for the client [22].
The framework depicted in Figure 6 is designed with the aim of improving
security and privacy level for the healthcare system owner and it may help device
manufacturers to improve privacy checklist. Privacy rules in this framework are
sourced from major popular frameworks that have been available since 1999 (ONC,
the Markle Foundation, HPP, and CCHIT) [23] and various healthcare system
projects (CDT, CF) [24]. In Connecting for Health (CF) project, every device
should be capable of transferring data, from forms to the data architecture. In CDT,
which is based on using policy scenes of the CF, the focus is on policy papers [25].
1. The Principles
We recommend several improvements to both ONC and CF, which are
formulated and programmed by various groups of professionals. Since we have
Figure 6. Conceptual framework in Wearable Healthcare System.
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focused on information privacy on wearable devices, the CF framework is deemed
a more objective framework and, as it is user-centric, it will be covered in the
following sections.
The new framework is based on ten essential principles shown in Figure 6.
NPr1. The user-collected information should be treated as private data and only
be available to a specific list of authorized persons or companies.
NPr2. The purpose of collecting data should be clearly stated and adhered to.
NPr3. The wearable device should have safeguards to protect the content from
unauthorized access or misuse.
NPr4. The device should have monitoring service that can gather information
about the application’s data collection protocol and the data owner should have
the right to monitor, review and stop specific application.
NPr5. Wearable devices should have a component that controls the information
stored in the database, as well as allow the data owner to edit or delete content
at any time.
NPr6. The technology used to gather the data should be transparent at all times.
NPr7. The device user, or other trusted entities, can insert the personal data from
the device to an application specified to collect the data from the owner of the
wearable device, while adhering to respected policies.
NPr8. The device should collect data in a transparent way mentioned in a
relevant policy and the aim of the collection of information must be completely
visible.
NPr9. The ownership of data collection has to be fully transparent and granted
solely to the device owner.
NPr10. The systematically distributed PHR database should be involved and the
wearable device owner should be able to modify the content at any time.
We acknowledge that wearable healthcare system may provide protection
through many different aspects, and the attributes noted above may used by other
sectors, not only those related to portable or wearable healthcare system. Since
wearable healthcare system is the most likely one to be used, it is a vulnerable
service; thus, we may have to adjust remote supervision to control the device. In
addition, applications should have the capability to disable remote monitoring
and even shut down the device to protect the user’s complete PHI package.
2. The Checklist for Privacy
This checklist was created after an extensive analysis of the currently available
devices capable of supporting the healthcare monitoring system. It is divided to
two parts, one pertaining to device protection and the other to data privacy and
security.
I. Proper device healthcare Application checklist:
NCL1. Communication line to transfer information.
NCL2. Direct connection between the user and the support center.
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NCL3. Designed secure port to exchange relevant information between the
system and the user.
NCL4. Secure access control method for authentication of the healthcare user.
For example, PIN authentication process, or some system based on biometrics,
including an eye focus to open the lock, a retinal scan, voice scan, and so on,
could ensure that only the authorized individual can access the data.
II. Checklist for privacy protected applications:
NCLP1. Full transparency in application.
NCLP2. Internet connected application for Smartphone and easy to use User
Interface (UI) for the customer interaction with the system.
NCLP3. The user-manageable application to receive data.
NCLP4. Restrictions on information privacy and unity.
NCLP5. Inclusion of moderator and privacy guard.
3. The Improved PHR Model
Once the new improved framework was determined, we designed a new and
improved PHR model (Figure 7) that would be more secure as well as flexible.
Thus, in our view, it can be used to protect the user, while being responsive at all
times.
4. Framework Evaluation Based on CIA and HIPAA Principles
The evaluation presented here is based on the CIA and HIPAA principles for
information security and tried to cover all aspect of privacy and security as well as
usability of the model via proper analysis.
As the first step, we tested the ten principles noted above with respect to
ensuring better security, as well as providing a user-friendly interface. Thus, we
started with flexibility that brings the ability to support frequent changes in policy,
and continued with granularity of the process, with respect to the permission
levels that can be applied to different objects.
In the second step, we assessed the access control model performance, whereby
we tested the authorization complexity of the proposed model. Next, we moved
onto analysis that involved modifying access privileges to check if the model is
flexible enough. Finally, we tested whether the privileged data is modifiable and, at
the same time, attempted to modify the rights of subjects to access objects.
After finishing the analyses noted above, we moved onto testing the capability
to revoke rights of subjects to access objects, followed by the ability to determine
the set of available permissions for a particular subject for the proposed model. In
the final step, we examined the complexity of the required initial setup.
As shown in Figure 7, the requests from different parts of system will be
checked by the new framework, which will use the priority settings in order to
respond correctly.
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5. Comparison with major frameworks
This comparison is based on the CIA principles for information security and tries
to cover all aspect of the wearable device privacy framework in Table 2. We have
divided the table into six principles recommended by CIA, with corresponding
keys to the existing and new frameworks. We compare our new framework with
Office of the National Coordinator for Health Information Technology
Framework (ONC) [23], Health Privacy Project Framework (HPP) [26], Best
Practices Framework (BP) [27], Markle Common Framework (CF) [28], The
Certification Commission for Healthcare Information Technology Framework
(CCHIT) [29].
6. Case Study
We illustrate and evaluate this framework with a wearable privacy awareness
system designed for a clinic. For this evaluation, we conduct a case study on a
user—a heart surgery patient—to effectively manage his or her situation,
including significant variations in his or her blood stress level, frequently elevated
blood pressure, and step counts. The doctor advises the patient to subscribe to a
health management program designed by the clinic. The patient is also advised to
wear a Samsung Wear device that will continuously monitor his activities. The
device and application are designed as a wristwatch to prevent any kind of loss or
misuse. In the first attempt, the wearable device features pulse waveform and pair-
Figure 7. New improved PHR model.
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to-pair connection to the patient’s mobile system for the authentication of an
actual patient. Moreover, if the patient has to move away from the mobile device,
he or she has to enter a code in the device to initiate its operation in stand-alone
mode (Pr3 and CL4).
During its installation in a smartphone, the application shows the permissions
that must be accepted to send information from the mobile and to allow the
sensors to continuously provide a report to the installed application (CLP1). After
installation, the patient is notified of a carefully designed privacy policy list that is
clear, concise, easily understandable, and not too long so as to discourage the
patient from simply accepting it without reading it (CLP2, Pr2, Pr8, and Pr6).
This privacy policy clearly indicates how information is collected and with whom
it will be shared (Pr1). After the patient reads and accepts the privacy policy, the
application proceeds to the setup for information collection. This process allows
the patient to specify and choose with whom and at what time to share the
collected information (Pr9 and CLP4). This selected setting can be changed at any
time and is flexible enough to conceal data location when the patient chooses the
secrecy option (Pr5). More choices are available for sharing data that can facilitate
the level of access to PHI; for example, doctor information and insurance
company are not be the same (Pr1). The patient or an authorized person may
change the settings and preferences for the specific ID (Pr10 and Pr4) through the
mobile, watch, and website interfaces (with username and password).
The device continuously monitors a patient’s health and activity and sends
encrypted information to the smartphone if paired with a mobile device (CL3).
The application in the smartphone is capable of sending information with a set of
certified cryptographic keys to a clinic server with a configurable setting of the
same application (CL1). It is also capable of verifying that the patient’s wearable
Table 2. Comparison with major frameworks.
CIA Principles Proposed Framework Frameworks related to features
Confidentiality Accountability, Access control, Disclosure of data,
Treatment Pr9/CL4/CL1
ONC1, ONC2, HPP3, BP3, CF1, CF6, CCHIT4, CCHIT 5,
CCHIT 6, CCHIT 7, BP9, CF9, ONC5, HPP2, BP4, BP6,
CF4, CF7
Integrity Data quality/integrity, Informed consent Pr2/Pr5 ONC6, ONC7, BP7, BP8, CF6, CF7, ONC4, HPP4, HPP6,
BP5, CF1, CF3, CCHIT1, CCHIT3
Availability Access control, Disclosure of data Pr2/Pr1/Pr7/
CL2/CL4/CLP2
ONC1, ONC2, HPP3, BP3, CF1, CF6, CCHIT4, CCHIT 5,
CCHIT 6, CCHIT 7, ONC5, HPP2, BP4, BP6, CF4, CF7
Authenticity Data quality/integrity, Informed consent,
Transparency Pr1/Pr6/Pr4/CL3
ONC6, ONC7, BP7, BP8, CF6, CF7, ONC4, HPP4, HPP6,
BP5, CF1, CF3, CCHIT1, CCHIT3, ONC1, ONC 3, ONC 4,
HPP 4, HPP 6, BP1, CF2
Protection safe guard CL4/CLP5/Pr4/Pr10 This feature is not available in any of them
Non-repudiation Transparency, Informed consent, Disclosure of
data Pr1/Pr8/Pr2/CLP1
ONC1, ONC 3, ONC 4, HPP4, HPP 6, BP1, CF1, CF2,
CCHIT3, ONC4, HPP4, HPP 6, BP5, CF3, CCHIT1,
CCHIT3, ONC5, HPP2, BP4, BP6, CF4, CF7
Information security
analysis
Informed consent, Access control, Accountability
CL4/CLP3/CLP4
ONC4, HPP4, HPP 6, BP5, CF1, CF3, CCHIT1, CCHIT3,
ONC1, ONC2, HPP3, BP3, CF1, CF6, CCHIT4, CCHIT 5,
CCHIT 6, CCHIT 7
Protection safe guard Pr3/CLP5 This feature is currently not available
doi:10.1371/journal.pone.0114306.t002
Conceptual Privacy Framework for Health Information on Wearable Device
PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 13 / 16
device is calibrated at all times. The information received by the application in the
smartphone is equipped with mobile device capabilities, such as a sensor that
determines location (GPS), Wi-Fi address (MAC and localization address), and
calendar schedule, to facilitate the effective planning of the patient’s health
program (Pr4). The application in the wearable device alerts the user to engage in
some activity when he or she has free time, such as a notification to exercise by
waking or slow jogging.
The wearable device enables the patient to send diet information to the
application and the server connected to the device using voice command and
camera (Pr7). The device’s smart notification reminds the patient to take his or
her medicine or sends him or her motivational messages to control his or her diet
and activity, but only when the patent’s calendar registers free time.
The application in the wearable device, smartphone, and secure website
interface with username and password provides the patient information about
activities that can help prevent illness (CLP3). The patient’s doctor may also
monitor and analyze the patient’s improvement. However, insurance companies
may have access to particular information to keep the patient under insurance
rules and regulations (Pr1). In case of device loss or theft, the device is
automatically disconnected and wiped remotely after the patient reports loss or
the back-end server audit log flags a report. The log is reported to both patient
and clinic for further investigation (CLP5).
The same back-end server reports the name of the patient and the time and
location collected by the wearable device (CL2). In addition, the updates of the
application on the wearable device and smartphone are automatically applied to
ensure the security of the device and the remote protection of privacy (CL4 and
CLP5).
Conclusion
In this paper, we improved privacy and security of wearable devices intended for
use in healthcare provision by designing a new framework that can work on every
wearable operating system. After an extensive analysis of data and frameworks
related to the healthcare system, we proposed a different framework that can
support new wearable devices, such as Google Glass, Galaxy Gear Fit or Galaxy
Wear. The suggested framework incorporates ten essential principles for wearable
healthcare systems. In addition, we have proposed a comprehensive checklist that
can help both developers and manufacturers to improve the quality of privacy
safeguards in their products. We believe that our conceptual framework is one of
the most comprehensive concepts available at the time of publishing this paper.
However, we are fully aware that these frameworks cannot be implemented
without law enforcement that combines the security and privacy with regulation.
Such collaborative effort between technology developers, service providers and
law professionals will ensure that healthcare not only becomes cheaper, but also
Conceptual Privacy Framework for Health Information on Wearable Device
PLOS ONE | DOI:10.1371/journal.pone.0114306 December 5, 2014 14 / 16
more accessible to all. We hope that this work has contributed to the better
understanding of the security protocols.
Acknowledgments
This research was supported by The National University of Malaysia (UKM) grant
ERGS/1/2013/ICT04/UKM/01/1. We are very thankful to anonymous reviewers
for their comments, reply and suggestions for Conceptual Privacy Framework for
Health Information on Wearable Device, which helps and improve the future
researchers.
Author Contributions
Conceived and designed the experiments: SS ZS. Performed the experiments: SS
ZS. Analyzed the data: SS ZS. Contributed reagents/materials/analysis tools: SS ZS.
Wrote the paper: SS ZS.
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