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<h2 class="hd hd-2 unit-title">Overview</h2>
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<h4>Introduction</h4>
<p>After the solution is developed, deployment entails implementation of the project, evaluation of its effectiveness and impact, and scaling the project. This again is often distinct across projects, but the general objectives are to refine the solution and progress toward a sustainable health impact. Deployment is particularly challenging in a global health project, since there are several daunting challenges for any solution. Technology is ultimately only a small part of the success of any health informatics project, as any solution needs to be closely integrated within existing workflows, engaging key stakeholders along the entire process.</p>
<h4>Human Resources</h4>
<p>Essential human resources play a hugely significant role in a global health project, as the health care workforce requires abundant amounts of specialty training and unique skillsets. The potential workforce in the target implementation region that meets the criteria is often limited, leading to a “zero-sum game” by creating a competition between global health projects. This could potentially overburden the health care workforce or drastically increase implementation costs.</p>
<p>Another aspect that is often forgotten during implementation is ongoing training costs of the workforce. With any new guideline, protocol, or technology, the workforce will need to be adequately trained in order to ensure effective deployment. Usability plays an important role in end-user adoption; developers must consider baseline technical competence, since not every individual is comfortable with using the latest computer or smartphone technologies.</p>
<h4>Sustainable Quality Improvement</h4>
<p>Ultimately, as previously stated, the goal for a global health informatics project is sustainable impact in improving health outcomes. Ongoing evaluation and monitoring measuring outcomes and health metrics is required to support clinical effectiveness. More importantly, technology solutions must consider methods to “close the loop,” wherein specific interventions are connected to positive outcomes. Too often, projects merely collect data about a patient for research and publication purposes. For many complicated health conditions, in order to drive sustainable impact, the intervention needs to yield a specific benefit to the patients, which often involves follow-up care beyond a software application.</p>
<h4>Maintenance and Scaling</h4>
<p>After implementation, maintenance typically entails minor enhancements, fixing defects, addressing scale or performance issues, and continually evaluating the product’s performance. Incremental improvements and iterations, responsiveness to user feedback, and managing technical debt lead to happier users and increased adoption. These processes require significant costs and resources and must be included in the plan for ongoing projects.</p>
<p>Beyond maintenance is scaling a project to the next step and expanding beyond the original project scope. This can increase the impact of the program by integrating with more services or expand to additional regions to reach a larger population. This necessitates careful considerations of sustainability and business models for all projects, whether they are supported by grants or are intended to be commercial ventures.</p>
<h4>Unique Regulatory Barriers</h4>
<p>The unique regulatory barriers to health technologies are a frequently encountered impediment. Even with clearly identified needs and benefits, politics can still get in the way. For example, most public health initiatives require buy-in from local governments, which are sometimes bureaucratic or have their own focused initiatives for limited resources. Another example is the regulatory environment for medical devices across differing regions: a product that was developed in one region may need to undergo extensive testing and evaluation from other local regulatory bodies.</p>
<p>The sensitive nature of health information and the need for patient privacy and security are an additional aspect to the regulatory environment. With the growing pervasiveness of electronic health data, there is growing concern over the vulnerabilities exposed by these expanding centralized data stores. Immense amounts of sensitive patient information can be exposed due to a software bug, security intrusion, or simple human error. Navigating these intricacies is important to consider throughout the project life cycle to avoid a violation and protect vulnerable populations.</p>
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<h2 class="hd hd-2 unit-title">Privacy and Security</h2>
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<h4>Introduction</h4>
<p>The roles that privacy and confidentiality play in eHealth (which includes “mHealth,” described below, and is also referred to as “digital health”) are inherently linked with hardware and software security. Laws, policies, public health interests, and societal attitudes regarding the expectation of privacy over individual health data dictate how technology addresses security solutions to protect personal data. Often, however, business interests drive how technology addresses data security. These business interests do not necessarily reflect prevailing laws, policies, public health standards, and social attitudes regarding privacy. One of the greatest challenges in the evolution of eHealth is generating a unified approach to privacy so that laws, policies, and public health standards keep pace with the dizzying evolution of technology, while at the same time respecting individual attitudes toward the expectation and “right” of privacy. This section will explore and provide an overview of the concept of privacy in the context of eHealth. It will present interpretations of what eHealth privacy means; identify some of the driving forces warranting examination of how privacy is protected under eHealth systems; and present the current state of how the global community acknowledges and protects privacy in an increasingly digital world.<</p>
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<p>The following videos in this unit are presented by:</p>
<p>Bruce Schneier<br />Chief Technology Officer, Resilient</p>
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<h3 class="hd hd-2">Why do we need privacy?</h3>
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<h4>What does privacy mean and how does it link to security?</h4>
<p><i>“Privacy” with respect to eHealth can be viewed broadly to apply to an individual person, while “confidentiality” applies to data.</i> Privacy generally refers to patients having substantial control over the extent, timing, and circumstances of sharing oneself and information about oneself with others. Confidentiality refers to the treatment of identifiable information that has been disclosed to others in a relationship of trust and with the expectation that it will not be divulged to others except in ways that have been previously agreed upon. For purposes of this section, the term <i>privacy</i> encompasses the concept of confidentiality.</p>
<p>Understanding all the implications connected with privacy, including what society’s reasonable expectations to privacy of personal information ought to be in the rapidly growing world of eHealth, is vital to developing a secure eHealth system. Protecting the privacy of personal health data is particularly critical with sensitive issues such as HIV, sexual preference, and conditions relating to sexual and reproductive health. Safeguarding the privacy of personal health data is also critical when dealing with victims/survivors of sexual violence accessing health services to tend to their injuries. Victims/survivors of sexual violence might not seek help or appropriate health care if they feared personal information connected with the assault would not be kept confidential, exposing them to possible retribution from perpetrators and stigmatization within their communities.</p>
<p>There are many eHealth stakeholders with vested interests in eHealth data. An ideal eHealth information system should incorporate the interests of all these stakeholders:</p>
<ul>
<li>health care professionals who use the data to make decisions regarding the best possible care for their patients</li>
<li>local, regional, national, and international health authorities responsible for ensuring public health, who use the data for making policy decisions and resource allocations to most efficiently protect the public health</li>
<li>individual patients with a <i> right</i> to protecting the privacy of their personal health data so they can receive unfettered access to the best possible healthcare without judgment, stigma or discrimination.</li>
</ul>
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<h3 class="hd hd-2">Privacy vs. practicability</h3>
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Unit Exercise
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<h2 class="hd hd-2 unit-title">Privacy and Security in LMIC</h2>
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<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">While much discourse around eHealth privacy has been occurring in the context of Western, developed economies, there are driving forces and considerations that warrant examining privacy implications for eHealth in the context of LMIC. In particular, an increasingly number of front-line health workers in even the poorest, most remote areas of the world are using mobile phones for health-related activities (“mHealth”), including the collection and management of patient-level health data. Emerging electronic health information systems in LMIC, such as DHIS2 and OpenMRS, that leverage mobile phones and other information and communication technologies (ICT) for the collection of patient-level health data further contribute to the eHealth phenomenon. Using mobile phone applications to collect critical, sensitive, private medical information, and eHealth information management systems to store and manage that data, warrant a special focus on security and privacy features to avoid the potentially harmful consequences that are associated with breaches of privacy.<o:p></o:p></span></p>
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<h4 class="H2HeadingLevel2" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Data for Decision Making: Demand for More Complete, Timely, Accurate, and Reliable Data<o:p></o:p></span></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">A global groundswell of demand in LMIC for better and more health, demographic, and other types of data is driving much of the push toward eHealth information systems. Referred to as “data for decision making,” the public health community views electronic data collection, particularly mobile phones, as a means to obtain more complete, timely, accurate, and reliable health data to better inform appropriate health interventions, prioritizations of activities, and the efficient allocation of resources. While evidence exists that using mobile phones and ICT devices enables front-line health workers to collect more complete, timely, and accurate information, there is also evidence that using mobile phones in particular for collecting and analyzing data in LMIC is not failsafe and leads to accuracy errors comparable to using other traditional data-collection methods. Yet, with an arguably mixed evidence base supporting the accuracy advantages of using mobile phones as the ICT entry point for collecting electronic health data, the trend for using mobile phones and SMS for health data collection moves forward.<o:p></o:p></span></p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Global health stakeholders, including the World Health Organization, are actively promoting eHealth and mHealth solutions for developing harmonized reproductive health registries. Public health experts assert that population-based health registries are essential for monitoring progress in global health and development, particularly Millennium Goals 4 and 5 (reducing child mortality and improving maternal health). Electronically collecting population-based aggregated health data for health registries often starts at the level of the individual patient. Front-line health care workers use mobile phones and ICT (e.g., web-based technology) to collect and record individual health data when they meet with patients at hospitals, local clinics, and patients’ homes. Even though the data will ultimately be aggregated, without failsafe protection that guards against transmitting and misappropriating personally identifiable patient information, electronically collecting data that starts with the entry of patient-level health information potentially exposes that data to vulnerability to breaches of privacy.</span></p>
<h4 class="H2HeadingLevel2" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Data Sharing and the Interoperability of eHealth Information Systems<o:p></o:p></span></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Connected with the drive to electronically collect more health data is the drive toward data sharing and the interoperability between and among information management systems. Electronic health data can be increasingly shared between and among multiple systems, stakeholders, and environments, presenting new and unexplored challenges to individual privacy. eHealth interoperability permits more data sharing between caregiver and patient; caregiver and caregiver; caregiver and administrative entity; administrative entity and national registry or information management system; and national health information management systems and international surveillance bodies. <o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The issues of data sharing and eHealth system interoperability arise in numerous health-related contexts. The biological research community has been working toward establishing a framework for responsible sharing of genomic and health-related data. Communities of patients with common health conditions such as cancer have benefited from online sharing of information. In general, there is a growth of health information exchange, leading to more individual patient records shared across multiple health care settings separate from an individual’s original point of care.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Global focus on supporting the expanding digitalization of national civil registration and vital statistics (CRVS) systems raises significant privacy concerns over personal health data. A CRVS system captures data and statistics on vital events such as births, deaths, marriages, divorces, and fetal deaths. One of the key functions of a CRVS system is to secure all citizens with a legal identity through the issuance of birth certificates, ensuring the right to access public services and social protection.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Many within the global health community assert that vital registries, as part of CRVS systems, are “global public goods”. Electronic registries facilitate the collection, storage, retrieval, and analysis of accurate population and demographic data to inform national policy makers, who use the data for policy planning and efficient resource allocation. The international community also uses the data for monitoring progress against global health and development indicators under the Millennium Development Goals. Promoters for electronically modernizing CRVS systems, which could include linking with mobile data-collection platforms, note the growth of mHealth within LMIC, enabling front-line health workers to use SMS messaging to enter data that will be used by registries.<o:p></o:p></span></p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The interoperability of eHealth information systems with CRVS systems that store personally identifiable data, notwithstanding any security precautions that may be in place, potentially heightens the risk of inadvertent sharing of personal health data (Figure1).<o:p></o:p></span></p>
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<h4>Figure 1. Vision for DHIS2: Linking of Health and CRVS Information Management Systems</h4>
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<p style="font-size: 16px;">The following video in this unit is presented by:</p>
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<h3 class="hd hd-2">Is privacy a luxury the developing world cannot afford?</h3>
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Unit Exercise
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<h2 class="hd hd-2 unit-title">eHealth Privacy</h2>
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<h4>Introduction</h4>
<p>The roles that privacy and confidentiality play in eHealth (which includes “mHealth,” described below, and is also referred to as “digital health”) are inherently linked with hardware and software security. Laws, policies, public health interests, and societal attitudes regarding the expectation of privacy over individual health data dictate how technology addresses security solutions to protect personal data. Often, however, business interests drive how technology addresses data security. These business interests do not necessarily reflect prevailing laws, policies, public health standards, and social attitudes regarding privacy. One of the greatest challenges in the evolution of eHealth is generating a unified approach to privacy so that laws, policies, and public health standards keep pace with the dizzying evolution of technology, while at the same time respecting individual attitudes toward the expectation and “right” of privacy. This section will explore and provide an overview of the concept of privacy in the context of eHealth. It will present interpretations of what eHealth privacy means; identify some of the driving forces warranting examination of how privacy is protected under eHealth systems; and present the current state of how the global community acknowledges and protects privacy in an increasingly digital world.<</p>
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<h4 class="H1HeadingLevel1" style="mso-layout-grid-align: none; text-autospace: none;">The State of Privacy Protection in eHealth</h4>
<p class="H1HeadingLevel1" style="mso-layout-grid-align: none; text-autospace: none;">Protecting the privacy of health and other personal information is dependent upon how privacy is conceptualized and defined. One cannot protect privacy without knowing exactly what privacy is and what sorts of information are deemed private. Accordingly, protecting privacy requires identifying standards that define with specificity the categories of health and personal data warranting privacy protection. Ideally, privacy standards also define the circumstances and conditions under which different kinds of health and personal data can be shared, and with whom. The word “ideally” is used because the challenges in identifying those standards are comparable to the search for the Holy Grail. Subjectivity and context play a large part in ascertaining standards regarding privacy. Different stakeholders have widely varying perspectives on the sorts of information that merit protection from disclosure, the limiting circumstances under which private data may be shared, and with which stakeholders that data can be shared.</p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Numerous initiatives acknowledge and underscore the importance of addressing privacy and security in eHealth and CRVS systems in LMIC. The World Health Organization has reported that governments cite issues related to data privacy and security and the protection of individual health information as two of the top barriers to the expansion of mHealth. A number of jurisdictions are drafting and considering eHealth Action Plans that specifically address data protection and personal privacy. Privacy and data-protection frameworks should be foundational components of the architecture of national eHealth systems (Figure 2).<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Organizations and initiatives including the International Organization for Standards; Health Level 7 International; Integrating the Health Care Enterprise; the World Health Organization; and the International Telecommunications Union are all playing roles and driving an agenda toward establishing interoperability standards (which would include addressing privacy and security). Their efforts include focusing on how to accommodate LMIC needs. While progress is being made, there is still no global consensus on a set of specific, harmonized standards regarding interoperability and protecting the privacy of personal health data.<o:p></o:p></span></p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">With respect to electronic CRVS information systems (which, when interoperable with eHealth systems and registries, have implications for the privacy of personal health data), some global standards do exist. However, many of those standards are buried in dense, highly technical documents that were written over 15 years ago when the technology, systems, and program contexts were different from those of today.<o:p></o:p></span></p>
<h4 class="H2HeadingLevel2" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Laws and Policies<o:p></o:p></span></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">In the absence of an international consensus and a convention enshrining standards specifically addressing eHealth privacy in LMIC contexts, national laws, regulations, and policies generally dictate how eHealth systems handle privacy. Most legal approaches toward protecting privacy are grounded in the recognition of the individual right to privacy. Notwithstanding enshrining the legal right to privacy, those laws, policies, and regulations that have been enacted:<o:p></o:p></span></p>
<p class="LList" style="tab-stops: 12.0pt 24.0pt 48.0pt; mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">•<span style="mso-tab-count: 1;"> </span>are generally ad hoc<o:p></o:p></span></p>
<p class="LList" style="tab-stops: 12.0pt 24.0pt 48.0pt; mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">•<span style="mso-tab-count: 1;"> </span>vary significantly from one nation to another<o:p></o:p></span></p>
<p class="LList" style="tab-stops: 12.0pt 24.0pt 48.0pt; mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">•<span style="mso-tab-count: 1;"> </span>do not always explicitly address the electronic collection, management, and transmission of health data; and/or<o:p></o:p></span></p>
<p class="LList" style="tab-stops: 12.0pt 24.0pt 48.0pt; mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">•<span style="mso-tab-count: 1;"> </span>are vague and ambiguous.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">International law, most notably the Universal Declaration of Human Rights, recognizes the individual right to privacy. Numerous other international and multinational agreements and conventions, such as the International Covenant on Civil and Political Rights and the European Convention on Human Rights and Fundamental Freedoms, also acknowledge the individual right to privacy. Most countries recognize the right to privacy in their constitutions, and when not explicitly recognized constitutionally, many courts have promulgated the right to privacy in their decrees, as they have done in the United States, Ireland, and India.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">A 2013 comprehensive landscaping global review and analysis of current privacy laws and regulations revealed that privacy laws falls into one of three categories: (1) omnibus data-protection regulation in the style of European laws, which regulate all personal information equally; (2) United States–style sectoral privacy laws that address specific privacy issues arising in certain industries and business sectors, so that only certain types of personal information are regulated; and (3) the constitutional approach, whereby certain types of personal information are considered private and inviolate from a basic human rights perspective, but no specific privacy regulation is otherwise in place.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Europe and certain Latin American and Asian countries have enacted and implemented omnibus data-privacy laws. The United States has enacted broad protection over health and medical data, notably through the Health Insurance Portability and Accountability Act, commonly known as HIPAA. Comparatively, most African countries have undeveloped data-privacy legal regulatory frameworks with the exception of a handful of countries, including South Africa, Kenya, Mauritius, and Morocco.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The individual right to privacy is not universally recognized in many LMIC. For example, the African Charter on Human and People’s Rights (Banjul) Charter, which has been adopted by more than 50 countries, fails to articulate the personal right to privacy. A number African countries have, however, addressed privacy by conferring constitutional and other legal obligations, supplemented by ethical codes of practice, upon medical workers and others who typically come into contact with certain kinds of information, such as data relating to HIV/AIDS, DNA, and genetic information.<o:p></o:p></span></p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The recognition of the right to privacy specifically regarding patient information is found in the World Health Organization’s 1994 Declaration on the Promotion of Patients’ Rights in Europe and in the European Commission’s Data Protection Directive 95/46/EC. The 1994 World Health Organization Declaration, however, like many international declarations and conventions, is voluntary and does not have the force of law unless adopted by member states. Extending the right to privacy specifically to personal health data that is electronically collected and stored is gaining momentum, but is not universal, nor harmonized between jurisdictions.<o:p></o:p></span></p>
<h4 class="H2HeadingLevel2" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Culture and Social Norms<o:p></o:p></span></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Obligations conferred by constitutions, legislation, or ethical codes of practice for practitioners do not guarantee against breaches of confidentiality by health care workers in many LMIC where privacy concepts of informed consent are not culturally embraced. Culture and social norms connected with living in communal societies in many LMIC, particularly in Africa, account for the relative absence of formal legislative and regulatory provisions recognizing and protecting the right to privacy over personal health data. The notion of personal privacy rights, including the expectation of confidentiality over personal health data, tends to conflict with traditional African society’s sense of duty to help all who are sick within a community. It is common practice for patients to be accompanied by family or other community members when visiting traditional medicine practitioners. Often a head of the family and other community members will consult among themselves to decide the appropriate course of action for a sick member of the community, with many having access to information regarding the condition of the patient.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Gender norms in many cultures that subordinate the rights of women and girls significantly undermine a woman’s expectation to privacy over her personal information, particularly regarding sexual and reproductive health. Women in some cultures are reluctant to use health services because gender-insensitive health workers do not ensure privacy and confidentiality regarding treatments.<o:p></o:p></span></p>
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<h4>Figure 2. International Organization for Standards (ISO) National eHealth Architecture: Foundation of eHealth Infrastructure</h4>
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<h4 class="H1HeadingLevel1" style="mso-layout-grid-align:none;text-autospace:none"><span style="mso-bidi-font-size:12.0pt;color:windowtext">Emerging Challenges in Addressing Privacy<o:p></o:p></span></h4>
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none"><span style="mso-bidi-font-size:12.0pt;color:windowtext">With the burgeoning growth of eHealth comes the breaking down of country borders. Devices that electronically collect data and the servers that electronically store the data frequently sit in different countries. Cross-border electronic transfers of health information implicate key issues of ownership and access to eHealth data. A key gap in most nations’ legislative approaches toward privacy is how to address cross-border transfers of personal information. Questions about ownership and control rights of national governments, the organizations managing servers, local administrative health authorities, and individual patients over patient-level eHealth data are yet to be resolved by global consensus. However, some governments restrict the transfer of personal data of any citizens, other than aggregate data, outside their borders.<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align:none;text-autospace:none"><span style="mso-bidi-font-size:12.0pt;color:windowtext">As the issues of eHealth privacy are sorted and frameworks for protecting the privacy of personal health data are developed and implemented, questions arise as to who enforces privacy standards and who is accountable for breaches. These questions include: who is accountable as duty bearers for breaches of privacy, and under what circumstances? Will front-line health care workers at rural health clinics be held accountable, and if so, under what circumstances? Will technology companies be held accountable for not putting in place effective security mechanisms into the hardware devices (mobile phones) and software applications? Are district and national health authorities accountable for eHealth information systems that do not possess failsafe security features and lead to inadvertent disclosures of private health information? When a breach of privacy does occur, will a patient living in a rural village in Africa have any realistic recourse to seek redress?<o:p></o:p></span></p>
<p class="TxText" style="mso-layout-grid-align:none;text-autospace:none"><span style="mso-bidi-font-size:12.0pt;color:windowtext">The evolution of “big data” and cloud computing, along with the never-ending introduction of new technologies, create privacy challenges that are yet to be completely identified. The speed of new and emerging technologies and their ecosystems will indubitably outpace eHealth privacy frameworks and standards, making them anachronistic almost as soon as they are developed.<o:p></o:p></span></p>
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<h4 class="H1HeadingLevel1" style="mso-layout-grid-align: none; text-autospace: none;"><font color="#000000">Take Home Messages</font></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">This chapter only scrapes the surface in exploring how privacy of personal health data is conceptualized and protected in an LMIC eHealth environment. The concept of privacy is multifaceted and complex, influenced by many factors. Laws, policies, culture, social norms, and technology all play roles in contributing to standards that impact privacy protection, including the duty to keep personal health data confidential. These factors are often intertwined with social norms regarding expectations of personal privacy influencing laws and policies, or laws and policies impacting how software developers design security features for ensuring the protection of personal health data. Sometimes these factors are incongruous, such as when, for example, laws and policies do not reflect the prevailing social and cultural norms regarding what sorts of personal health information should be afforded privacy protection. Differing attitudes toward privacy between many Western developed nations and LMIC create challenges in developing globally harmonized privacy standards.<o:p></o:p></span></p>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The dizzying pace of development of new eHealth technologies creates constant challenges for addressing eHealth privacy. The framers of privacy laws, policies, and standards cannot always anticipate new innovations in technology that would impact the ability to electronically protect personal health data. The exuberance toward rolling out electronic health information systems and data sharing requires a tempered approach that reflects and addresses the individual right to privacy of personal health information.<o:p></o:p></span></p>
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