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Group Research report on Health Information Privacy: Implications of using Wearable Devices in Healthcare
We all live in a world where our societies or communities are filled with information and as of today, we are living in a world where information technology is taking over and shaping the way people work and live. Because of Information technology (IT), it has allowed free time of people to be increased and today’s culture to be greatly improved in a lot of areas such as making it easier for individuals to perform tasks in the workplace. One example is the use of wearable devices in healthcare. Wearable healthcare technologies are smart electronic products designed as accessories that attaches to a user.
Smart wearable device has been significantly improved thanks to the development of advanced technology and the use of big data. Few examples are Wearable Fitness Trackers, Smart Health Watches, Wearable ECG Monitors, Wearable Blood Pressure Monitors and Biosensors. Big companies such as Apple, Samsung, Fitbit, iHealth, Microsoft, Xiaomi and Google are heavily invested in these devices. Users and Companies both benefits from gathered big data and data analyzation. For users, smart wearables can help improve lifestyle by monitoring health and through analysed data gives health related suggestion. Companies can use data accumulated for better decision making. However, ethical issues arise with the development of smart wearables. All systems are vulnerable which leads to unwanted information leakage that threatens users, or companies misusing gathered data. Both parties must take initiative to implement ethical guidelines and take responsibility based on their roles. Users needs to be proactive and gain knowledge to protect their personal data. And Companies must strictly follow rules and regulations in handling gathered data.
Wearable healthcare technology devices have many potential benefits in the Medical field. For example, Personal Health monitoring technologies improves the accuracy of information people get regarding their healthiness, inviting users to live more healthier, which ultimately reduces their healthcare cost (M. Kalantari, 2017). An instance where wearable technology benefits both doctors and patients by connecting them through the internet to exchange information. Few other examples include Remote diagnosis, Remote treatment and Remote patient monitoring.
Even with the promising potential of Personal Health monitoring device, an unwavering doubt comes across users as to whether it is safe enough to put on every day and incorporate them in our lives (A. Marakhimov, 2017). Consequently, if security imperfections are neglected, it could have a major impact in our lives and could use to monopoly piece by dishonest people. This paper provides a summary of Wearable monitoring system risks and big data analytics on wearables. As well as highlighting 3 major ethical concerns. Concluding with a suggestion based on the ethical issues discussed.
A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:
· Give a new interpretation of old material or combine new with old interpretations,
· Trace the intellectual progression of the field, including major debates,
· Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
· Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.
The purpose of a literature review is to:
· Place each work in the context of its contribution to understanding the research problem being studied.
· Describe the relationship of each work to the others under consideration.
· Identify new ways to interpret prior research.
· Reveal any gaps that exist in the literature.
· Resolve conflicts amongst seemingly contradictory previous studies.
· Identify areas of prior scholarship to prevent duplication of effort.
· Point the way in fulfilling a need for additional research.
· Locate your own research within the context of existing literature [very important].
Key Area 1: Ethics and Laws Page
Medical practitioners can use technology speedup the exchange of information to their patients. Enabling them to update patents in real time without having to schedule a check-up meeting every week. As an effect, increasing their productivity and efficiency at work. With the advancement of wearable devices, the use of big data and cloud computing incorporates with it. However, big data poses a major risk to customers and medical practitioners alike (Fugini et al 2009). Thus, increasing the security risk as well as other concerns regarding the use of collected information. In this research article, we scope in to 3 related ethical issues concerning the use of wearables into our healthcare system. Privacy and security concerns of users about their private information. In addition to integrity and Good faith of companies involved.
Privacy and security
Medical Doctors could get ask for an access of information from their patients to analyse health and well being. Storing These information to a database generating big data. Big data always comes with a concern of data leakage. Commercial companies and Banks also experience security breaches, even with informed users experience security breach. Wearables database inventory consist of user’s health indexes. Thus, leakage of information has a varied level of harmfulness to users. Enabling Wearables to be always connected creates a potential security breach for hackers and scammers. Acquiring important private information along with petition information, private photos/videos, bank information and text messages (A. Razaque et al., 2016). Smart watches huge storage capacity invites hackers to get into your personal device according to Hewlett-Packard software company (2015), A study done by HP showed few possible vulnerabilities of smart watches “insufficient authentication, lack of encryption, and privacy concerns”.
A research paper published by Song, C. G., Liu, J. W., Wu, Q. H., and Guan, Z. Y. (2015) reveals PIN code can be detected by motion sensors of wearables. Hackers only need to get access to the device’s gyroscope sensor and know the user’s keyboard layout to be able to unlock vulnerable devices. Furthermore, Wang et al. (2016) identified two common hacker methodology. Packet sniffing where hackers can intersect the data user sends through wireless connection. And Internal attack where they insert an unnoticeable malware app to gather data without the user knowing it. Both methods can mine personal data such as passwords, recorded voice calls, e-mails and location history. Breaching Section 2 of NZ’s Privacy Act 1993 excerpt “Purpose of collection of personal information”.
Competition from the major wearable device companies might benefit users at first glance. But unfortunately, because of such competition they tend to invest heavily on functions to attract customers’ attention. In turn, ignoring security patches releasing new functions without testing if they could be exploited by hackers and scammers.
Smart glasses like Google glass could be used by customers to spy on other people breaching an ethical code of wearables users and troubled by the legality of their actions. According to Google’s official terms and services for using their smart ware “bans apps that takes photos or record video while the device’s display is off”. In turn, creates a relentless concerns to customers .Since Google glass does not have a function to prevent application developers to get access to camera and recording audio system of the device (Delail and Yeun, 2016).
Companies have boasted a Risk management system in on their wearables to ensure that users do not have to micromanage security concerns. The goal of this system is to disappear and become part of each individual users as an accessory, improving ease of use (Fugini et al., 2009). Implementation of this system poses a potential manufacturer integrity issues. Ethical code of ITP in New Zealand states that “IT practitioners must act in the execution of their profession with integrity, dignity and honour to merit the trust of the community and the profession, and apply honesty, skill, judgement and initiative to contribute positively to the well-being of society”. In addition to ethical issues, dishonest companies could get caught up with the NZ Privacy Act 1993 section 4 line 1 “ Companies shall establish and maintain detailed technical standards to govern the operation of the programme”. Manufactures could exploit the fact that they do not have to give details of ‘background processes happening within the device. Giving them an opportunity to data mine users’ private information. If customers get informed about the effect of Risk management to Wearable devices, they could develop trust issues to developers and manufacturers.
Information data of individuals have great business value to companies. Data valuation provide an in depth guide on how data can be capitalized to make profit (W. T. Lin, 2009). According to a report done by the US Federal Trade Commission (2014), few dishonest companies recorded browsing history records of users, in addition to information about their geographical location (GPS). Data gathers can be marketed for commercial profit as stated by W. Lin (2009) in her report. Evidently, these companies breached one of ethical codes of IT Professionals “Giving informed consent to parties involved”. Data stored in wearable devices generally consist of health and medical information, which are important data for companies in the fields of Cosmetics, Medicine, Robotics and Fitness. Profiting from users’ personal information without consent violates customers’ privacy.
Case Study Example
In today’s digital information age, the issue of confidentiality of medical information and health data has attracted the attention of many people. After many medical institutions collect and record people’s health information electronically, some data leakage incidents have confirmed that people have Worry. According to the research: “A few years ago, a woman asked her health agency for her medical record, but the agency sent it to the wrong address. When an error was found, a staff member visited the sending address and was told that no parcel was received. Not long ago, the woman asked for a copy of her medical file again. During the browsing, she found that her medical notes were sent to the wrong address.” 
These ethical issues are included in this case.
• The counselor did not check and confirm the address of the woman.
• The file is not safe during the process.
• When the error was discovered, the health agency did not inform the woman in time, causing the woman to learn about the incident after a certain period of time.
• The health agency concealed the accidents caused by their mistakes.
• The health agency does not securely store women’s medical files.
• The health agency did not retrieve the file that was sent by mistake, which may result in the disclosure of the woman’s medical file.
• The health agency did not take action after losing the customer’s medical file.
In this case, the woman should be most worried that her medical file is in danger of being leaked. Because the health agency did not properly protect and protect the woman’s medical file, the woman’s privacy was infringed. Once the records in the medical file are discovered, it may lead to paralysis, humiliation or discrimination. In severe cases, if the file is illegally used, the patient may lose health insurance or work. The patient’s medical file requires the health agency to properly keep it and dispose of the file in a safe situation, as this is very important for the patient’s privacy. The disclosure of medical information also means the disclosure of privacy, and the consequences are very serious. This also confirms that privacy is a key issue for health information.
According to the ethical principles provided by the American Association for Health Information Management (AHIMA) 
1. “Advocate, uphold, and defend the consumer’s right to privacy and the doctrine of confidentiality in the use and disclosure of information.
2. Preserve, protect, and secure personal health information in any form or medium and hold in the highest regard health information and other information of a confidential nature obtained in an official capacity, taking into account the applicable statutes and regulations.”
By investigating these two principles, we can find that all of them have extremely strict requirements for the protection of privacy by health information managers. First, health information managers must respect and protect consumers’ privacy as much as possible. Second, when disclosing any health information, consider the relevant and necessary information for the purpose and ensure that the necessary information is the minimum standard. In the preservation and protection of information, information professionals must take reasonable measures to store health information securely, and access to any information needs to be authorized. Precautions should also be taken to prevent theft and transmission of information in unexpected situations. It is necessary to inform consumers in advance about the limitations of the service provided by the risk. Understanding and strictly adhering to the guidelines for the privacy of health information helps to protect the privacy of each consumer and prevent the bad effects of privacy breaches.
On the other hand, in this incident, we can learn from the moral aspect that after the accident involving personal information, the responsible agency should promptly inform the person whose information was lost or leaked. Remedial measures should be taken in a timely manner. After discovering the wrong mailing address, you should go through the original documents. For the protection of health information, preventive measures should be implemented to protect the relevant data.
In this case, according to the provisions of Article 5 of the “Health Information Privacy Code 1994” issued by the New Zealand Government: “A health agency that holds health information must ensure:
(a) that the information is protected, by such security safeguards as it is reasonable in the circumstances to take, against:
(i) loss;” 
This provision clearly states that health authorities holding health information must ensure that information is protected by security measures and must not be lost. In this case, the health institution did not choose to take countermeasures when the patient’s medical file was lost but concealed the matter. From the incident of losing the medical file, the health institution violated the regulations.
At the same time, through this legal policy, we can also learn that in any case, professionals must ensure the safety of health information, understand the professional mission and ethical principles, and promote the obligation to respect privacy. Responsible for protecting health information in a legal sense, responding to requests from legal persons. Understanding how the law protects its privacy interests is a key purpose in learning the laws governing health information.
In this case, the ethical behavior of the health institution is judged by means of power and obligation. We believe that it is morally wrong for the health agency to inform the woman that the medical file was sent to the wrong address because the health agency is obligated to be safe. Keep the customer’s medical information and obligated to let the customer know about it after any unexpected situation. This is also the customer’s right in this health facility, but the health agency did not accurately inform, but the woman found this thing. Health agencies do not respect the rights of customers.
On the other hand, looking at this case in terms of virtue, health institutions have not chosen excellent solutions and protection measures that do not strictly enforce information security. First, the health agency did not carefully confirm the woman’s address and sent the wrong address. Second, health agencies have chosen to deceive rather than honestly inform customers of the process. From the perspective of virtue, health institutions are equally immoral.
Key Area 2: The Technological Aspect
Information Technology and Information System is increasingly becoming a critical part in health sustainability. Medical technology, Digital Health and Medical/Health informatics are few terms describing the integration between technology and health. We will focus on the machinery implemented and the analyzation of data collected. Medical Technology is a broad term but for the purpose of this research, defined as devices or mechanical technologies that helps doctors and patients. Medical technology may broadly include biotechnology, medical devices, information technology and healthcare devices/services. Focusing mainly on wearable devices such as google glasses, iWatch, smart bands and smart earphones.
Medical/Health informatics (database)
Big data (SELinux security policies)
Database (Microsoft Access)
Patient satisfaction systems
Billing and payment processing
c. Key Area 3: Integrating ethics and law, on one hand, and the technology, on the other hand
i. The link between (a) and (b) in your research problem, e.g., supporting the NZ PA 1993 and HIPC 1994 at the database level using MySQL (but not limited to these); and
ii. What your investigation seeks to establish or create, e.g., framework and method for the above example in (i).
• FRAMEWORK AND DIAGRAM
Framework for addressing ethical issues of wearable devices in Healthcare
In this report, a framework will be presented for identifying the ethical issues of implementing information technology to the domain of healthcare. This part will start with an explanation of the framework. Then, the adjustment of this framework to the healthcare domain will be described along with the ethical issues involved. Lastly, a guideline will be presented which will show the process of using the framework.
Composition and content of the Framework
How to use the Framework for Health IT
As this framework will be used as an instruction to the Health Information Technology, the steps of using the framework will be shown below.
Identifying the Ethical Issue
When addressing the ethical issues of using Wearable Devices in the Health domain, it is very important to firstly identify the ethical issues that may be present in the situation.
Privacy and Security – How is security and privacy affected in using IT in healthcare
Kalantari, M. (2017). Consumers’ adoption of wearable technologies: Literature review, synthesis, and future research agenda. Int. J. Technol. Mark, 12, 274–307.
Marakhimov, A. (2017). Joo, J. Consumer adaptation and infusion of wearable devices for healthcare. Computers in Human Behavior, 76, 135–148.
A. Razaque et al. (2016). Pebble watch security assessment. 2016 IEEE Long Island Systems, Applications and Technology Conference (LISAT).
Hewlett-Packard (HP) (2015) “Internet of Things Security Study: Smartwatches”, Fortify Research HP Available at https://www.ftc.gov/system/files/documents.pdf.
Wang, C., Guo, X., Wang, Y., Chen, Y., & Liu, B. (2016). Friend or foe? your wearable devices reveal your personal pin. AsiaCCS
Song, C. G., Liu, J. W., Wu, Q. H., & Guan, Z. Y. (2015). ‘New Attack Based on Smartwatch Motion Sensors and the Protection Method Research’. Journal on Communications, 36(s1), 235-242.
Fugini, M., Conti, G. M., Rizzo, F., Raibulet, C., & Ubezio, L.. (2009). Wearable Services in Risk Management. IEEE/WIC/ACM International Joint Conference on Web Intelligence & Intelligent Agent Technology. IEEE Computer Society.
Delail, B. A., & Yeun, C. Y. (2016). Recent advances of smart glass application security and privacy. Internet Technology & Secured Transactions. IEEE
Lin, W. T. (2009). The business value of information technology as measured by technical efficiency: Evidence from country-level data, Decision Support Systems, Volume 46, Issue 4,Pages 865-874
US Federal Trade Commission (2014). ‘Spring Privacy Series: Mobile Device Tracking’. Federal Trade Commission. Retrieved from https://www.ftc.gov/news-events/events-calendar/2014/02/spring-privacy-series-mobile-device-tracking
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