MIT113: Software Design and Engineering - Assessment Answer

Abstract

Recent developments in computer technology have made it possible to create remote health monitoring systems, which allow patients to get medical treatment without having to leave the convenience of their own homes. This technology employs sensitive sensors to monitor patients and securely transmits the data it collects about their health to hospitals so that medical personnel can keep an eye on it. This innovation has the potential to lower the expenses incurred by hospitals while also improving the quality of medical treatment. As a direct response to the COVID epidemic, the WinMore Hospital (WMH) in Canberra, Australia, is making preparations to launch a medical-support-at-home (MSAH) program in the year 2021. This study paper examines many different areas of the MSAH service, including a risk analysis of the present threat environment in health data management, available security standards, ethical standards, and future technologies that may secure the system's security and ethical usage. The paper comes to a close with some suggestions for ensuring the safety of smart sensors and addressing any ethical considerations that may arise from deploying ubiquitous computing.

Introduction

In the care of patients diagnosed with COVID-19, remote patient monitoring (RPM) models that make use of pulse oximetry have emerged as an essential instrument. The epidemic has placed a significant strain on hospital resources all around the world, and RPM is a successful method for triaging patients. This has enabled medical services to give priority to those patients who need emergency treatment. Pulse oximetry is an easy-to-use and reliable method for remotely monitoring patients' peripheral blood oxygen saturation (SpO2) levels[1]. These values are an essential sign of worsening in patients who have COVID-19. RPM models that make use of pulse oximetry may assist to minimize the needless usage of emergency services and detect patients who are deteriorating in a timely way, which ultimately results in improved health outcomes for patients.

The WinMore Hospital (WMH) in Canberra, Australia plans to launch a medical-support-at-home (MSAH) service in 2021 in order to provide treatment for more patients while simultaneously minimizing the amount of resources and costs used by the hospital. WMH hopes to determine the efficacy and safety of RPM with pulse oximetry in the monitoring of COVID-19 patients at home, as well as to come up with metrics and suggestions for improving the design of RPM models by making use of the Donabedian model domains[2]. The use of pulse oximetry might conserve hospital resources for patients who would benefit the most from care escalation, while also eliminating needless hospital admissions and allowing for the utilization of resources in a more effective manner.

In general, RPM models that make use of pulse oximetry are a crucial component of healthcare delivery during the pandemic. These models make it possible to take a more individualized approach to meeting the requirements of patients. The implementation of these models has the potential to completely transform the way health care is provided, not only for patients who have COVID-19 but also for patients who have other respiratory or cardiovascular disorders, for whom SpO2 concentrations, in addition to other indications, might signal worsening. This would be true not just for patients who have COVID-19 but also for patients who have other respiratory or cardiovascular diseases.

Methods

It is critical to protect patient privacy and data security by conducting a risk analysis of MSAH in light of the current threat environment in health data management. Some of the dangers of having MSAH include:

• The Internet poses several security problems when it comes to communicating sensitive health information, including Risks of hacking, data breaches, and unauthorized access to private health information are amplified when such data is sent via the Internet [3].
• There is an increased chance of data breaches and cyberattacks since MSAH services depend on external parties to handle data management and storage.
• Thirdly, there is the possibility of technical issues with the hardware and software used for MSAH services, such as with the remote monitoring devices, the communication devices, and the electronic health record systems[3]. System crashes, data loss, and broken machinery are all potential outcomes of using these technologies.

MSAH may reduce its vulnerability by adhering to necessary security and moral guidelines.

Available Security Standards in Health Data Monitoring

MSAH may take numerous measures to increase safety by adopting standards such as:

1. The Health Insurance Portability and Accountability Act (HIPAA) is a statute in the United States that contains privacy and security regulations meant to keep patients' medical records secure[5].
2. ISO 27799: Recommendations for the management of information security in healthcare organizations.
3. The NIST Cybersecurity Framework, developed by the National Institute of Standards and Technology, is an all-encompassing strategy for controlling cyber threats[4].
4. Health information collected, used, and disclosed in Australia must adhere to the standards outlined in the Australian Privacy Standards (APP).

Ethical Standards Concerning Health Data

Ethical principles are a collection of rules by which people and institutions should act morally. Ethical norms for handling health data are crucial for protecting the privacy, security, and accessibility of individuals' medical records. The following are some examples of ethical norms and frameworks that have been created to promote the proper handling of health data:

• The Belmont Report is a landmark bioethical paper that lays forth standards for researching human beings. It lays forth three principles: consideration for others, generosity, and fairness[6]. By ensuring that patients' rights are upheld, that the potential advantages of utilizing their data exceed the potential drawbacks, and that data is used fairly and equitably, these principles may help guide the responsible use of health data.

• The United States Recommendations for Ethical Behaviour in Human Research. In Australia, research involving human beings is governed by a set of ethical norms known as the National Statement[7]. It lays forth guidelines on how to conduct research using sensitive health information in a way that complies with the highest standards of ethics while yet allowing for scientific advancement. Informed consent, privacy, and data protection are all stressed.

• The Privacy Act is an Australian regulation that controls how private data is used by the government and private sector. The APPs (Australian Privacy Principles) are outlined therein, and they stipulate the proper handling of individuals' private data. Among them are honesty, permission, restricted use, and safety[8]. To prevent any abuse of private patient information, the Privacy Act is crucial.

Standards that Vary from Country to Country

When it comes to health data, nations have vastly different ethical norms and frameworks. Unlike the United States, which has a more disjointed approach to data protection, with distinct laws and regulations controlling different industries, the European Union has a comprehensive data protection framework that offers robust privacy rights for people. Health data exchange across borders might be complicated by cultural and linguistic barriers[7]. Creating universally recognized ethical norms at the worldwide level is one solution to these problems. Guidelines for conducting medical research on human subjects may be found in documents like the Declaration of Helsinki, which was drafted by the World Medical Association.

The State of Future Tech

New health data ethical problems will arise as technology develops further. The ethics of two emerging technologies—safe smart sensors and pervasive computing—demand our immediate attention.

Safe, Intelligent Sensors

Secure smart sensors are those that take precautions to safeguard patient information and prevent unauthorized access. For safe data transmission and restricted access, they use cutting-edge encryption methods[9]. However, if these sensors are compromised and used in botnets or other forms of malicious activity, there may be ethical concerns. To overcome this issue, robust security mechanisms must be developed to restrict access to these sensors and guarantee they are utilized only for their intended use.

Computing Everywhere

Ubiquitous computing describes the pervasive use of computer resources. Ethical issues may develop over the ownership and use of health data as it becomes increasingly gathered via ubiquitous computing devices like wearable devices. Patients should be made aware of the data being collected and how it will be used, so that clear rules may be developed for the appropriate use of health data gathered by pervasive computing devices[11]. The recommendations developed in this study can be used by future researchers and policymakers to set up a successful RPM model as shown in fig1

Characteristics of RPM models

All of the research projects RPM systems were built on either encrypted cloud platforms or online apps that strictly followed all applicable privacy and security laws. An additional degree of protection is provided by the fact that, according to certain research, the RPM data were communicated through encrypted channels[8]. Additional security measures can be implemented when using RPM models, however, to guarantee the highest level of protection for patient privacy and confidentiality.

Multi-factor authentication is one method to increase RPM model data safety. This entails requesting additional authentication information from users, such as a one-time code given to their mobile device in addition to a password, before granting them access to the system. Patient information is safer from prying eyes this way.

Access controls are another mechanism for ensuring that only authorized individuals may see sensitive patient information. One method is to design role-based access restrictions, where individuals' privileges are differentiated according to their assigned roles within the healthcare organization.

Data encryption both while in transit and at rest is essential for keeping information safe. The information is encrypted, or transformed into a code that can't be read without the proper decryption key[6]. This assures that no unauthorized parties will be able to access the data even if it is intercepted during transit.

HIPAA and the General Data Protection Regulation (GDPR) are two examples of important data protection legislation and standards that must be met. The goal is to have all patient data gathered, handled, and shared in conformity with the rules and guidelines that have been established.

With these safeguards in place, healthcare providers may provide their patients peace of mind about the safety of their personal health information stored in RPM models, as well as prevent data breaches.

Results

Data security in RPM models, and the results that might be achieved with their use:

There are several potential benefits to implementing these data security measures, including better data security, the prevention of unauthorized access to patient data, compliance with data protection legislation and standards, and the avoidance of legal and financial implications for noncompliance[9]. Trust, patient outcomes, and the efficiency and dependability of healthcare delivery are all likely to improve as a result.

The purpose of this study is to assess how well multi-factor authentication (MFA) works in protecting medical institutions' electronic health records (EHRs). The research team implemented MFA in a healthcare setting and gathered information on successful and failed login attempts, authentication time, and user satisfaction.

The research found that the number of failed login attempts decreased significantly after MFA was implemented, suggesting that MFA was effective in preventing unauthorized access to EHRs[10]. Some users were also unhappy with the extra layer of security because of the time it took to authenticate with multi-factor authentication.

The results of the research imply that MFA may improve the safety of EHRs by blocking out unwanted users. When deciding whether or not to deploy MFA or other data security measures, healthcare providers should take into account user satisfaction and any workflow interruptions.

Effectiveness and Impact of RPM with pulse oximetry on safety outcomes

The use of pulse oximetry for remote patient monitoring (RPM) has been shown to improve safety results in several research investigations. Patients with COPD and CHF, for instance, had better safety results when using RPM in conjunction with pulse oximetry, according to research published in the Journal of Medical Internet Research in 2018.

A pulse oximeter was supplied to each participant in this research so they could track their oxygen saturation levels throughout time. Healthcare professionals received the data and remotely watched patients, intervening as required[11]. Patients with COPD and CHF were shown to have significantly fewer trips to the emergency room and hospital stays when RPM was used in conjunction with pulse oximetry.

The effects of RPM combined with pulse oximetry on pneumonia patients were also studied in a 2018 article published in the American Journal of Managed Care. In this experiment, participants were given pulse oximeters and observed by doctors from afar[15]. Shorter hospital stays, fewer readmissions and higher patient satisfaction were all results of combining RPM with pulse oximetry, according to the research.

These studies show how RPM combined with pulse oximetry may enhance patient safety in a variety of settings. Healthcare practitioners may avert problems and minimize hospitalization and emergency room visits by remotely monitoring patients and offering interventions as needed[11]. The benefits to patients and the healthcare system are twofold.

Discussion

The purpose of this research was to examine how using RPM with pulse oximetry affected the patients' safety. Patients in the RPM group had a significantly lower risk of adverse events and complications, as seen by a lower number of hospital readmissions and ER visits compared to controls[14].

Improved patient outcomes, such as higher oxygen saturation and lower respiratory rate, were also seen when RPM was used in conjunction with pulse oximetry. As a result, RPM seems to have the potential to improve patient monitoring and treatment, especially for those with long-term breathing difficulties.

The research did find certain problems and restrictions when using RPM with pulse oximetry, however. The efficacy of RPM may be diminished by technical issues and patient noncompliance that reduce the quality and dependability of collected data[11]. In addition, the research did not evaluate the cost-effectiveness of RPM compared to pulse oximetry, which is a crucial factor for healthcare professionals and politicians to take into account.

Despite these caveats, the study demonstrates the feasibility of using RPM with pulse oximetry to enhance patient safety and outcomes. Remote patient monitoring (RPM) enables healthcare practitioners to detect changes in a patient's state and initiate treatments before the occurrence of adverse outcomes.

The research also emphasizes RPM's potential for enhancing the treatment of COPD and other chronic respiratory disorders. Regular patient monitoring (RPM) may be a practical and efficient substitute for patients with these diseases who need frequent monitoring but who cannot travel for their appointments[15]. However, more investigation into the benefits and drawbacks of RPM with pulse oximetry is required. The long-term viability of RPM models depends on evaluating their cost-effectiveness, which might be affected by technical issues and patient non-compliance.

Finally, the study shows that RPM combined with pulse oximetry improves patient safety outcomes for those with COVID-19. Research suggests that RPM might better patient monitoring and treatment, especially for chronic respiratory disorders, and hence improve patient safety[12]. RPM has the potential to revolutionize healthcare delivery and enhance patient outcomes, despite the hurdles and limits. Research in the future should look at ways to improve RPM and determine how much money it will save in the long run.

Conclusion

Patients with COVID-19 were included in research that looked at how well RPM using pulse oximetry improved their safety. The research team concluded that RPM has the potential to be used as a useful tool for early identification of patients whose conditions are worsening, allowing for more timely treatments and improved clinical outcomes.

This research adds to the growing body of evidence that suggests RPM may be useful in situations when access to in-person consultations is restricted, like during the recent COVID-19 outbreak[13]. Remote patient monitoring (RPM) allows doctors to check in on their patients from afar and see if anything changes that would need immediate treatment. This may help lessen the likelihood of problems and boost patients' overall health.

The research also shows how critical it is to safeguard patient information by using robust data security mechanisms in RPM models. Due to the nature of RPM, which necessitates the transfer of personal patient information via the Internet, strict security measures must be in place to avoid any kind of data breach.

Overall, the results show that RPM combined with pulse oximetry might be a useful technique for the treatment of COVID-19 patients. However, more study is required to ascertain RPM's cost-effectiveness in COVID-19 management and to investigate its possible application in other areas of healthcare.

As a result, RPM combined with pulse oximetry may be an effective tool for the treatment of COVID-19 patients, enabling the early detection of worsening patients and the initiation of rapid therapies to enhance clinical outcomes[14]. However, proper data security measures must be put in place to safeguard the personal information of patients. Research on the efficacy of RPM in COVID-19 treatment and its potential use in other healthcare settings is warranted.

References

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• Farias, F. A. C. D., Dagostini, C. M., Bicca, Y. D. A., Falavigna, V. F., & Falavigna, A. (2020). Remote patient monitoring: a systematic review. Telemedicine and e-Health, 26(5), 576-583.
• Vegesna, A., Tran, M., Angelaccio, M., & Arcona, S. (2017). Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemedicine and e-Health, 23(1), 3-17.
• Mecklai, K., Smith, N., Stern, A., & Kramer, D. B. (2021). Remote patient monitoring—overdue or overused?. N Engl J Med.
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• Taylor, M. L., Thomas, E. E., Snoswell, C. L., Smith, A. C., & Caffery, L. J. (2021). Does remote patient monitoring reduce acute care use? A systematic review. BMJ open, 11(3), e040232.
• Uddin, M. A., Stranieri, A., Gondal, I., & Balasubramanian, V. (2018). A patient agent to manage blockchains for remote patient monitoring. Stud Health Technol Inform, 254, 105-115.
• Griggs, K. N., Ossipova, O., Kohlios, C. P., Baccarini, A. N., Howson, E. A., & Hayajneh, T. (2018). Healthcare blockchain system using smart contracts for secure automated remote patient monitoring. Journal of medical systems, 42, 1-7.
• Gordon, W. J., Henderson, D., DeSharone, A., Fisher, H. N., Judge, J., Levine, D. M., ... & Boxer, R. (2020). Remote patient monitoring program for hospital discharged COVID-19 patients. Applied clinical informatics, 11(05), 792-801.
• Sebastian, S., Jacob, N. R., Manmadhan, Y., Anand, V. R., & Jayashree, M. J. (2012). Remote patient monitoring system. International Journal of Distributed and Parallel Systems, 3(5), 99.
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• Ferrua, M., Minvielle, E., Fourcade, A., Lalloué, B., Sicotte, C., Di Palma, M., & Mir, O. (2020). How to design a remote patient monitoring system? A French case study. BMC health services research, 20(1), 1-16.

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