Comprehensive user requirements engineering methodology for secure and interoperable health data exchange

• DOI: 10.1186/s12911-018-0664-0
• Publication Date: 2018-10-16T10:47:26Z
• Authors: Pantelis Natsiavas; Janne Rasmussen; Maja Voss-Knude; Κostas Votis; Luigi Coppolino; Paolo Campegiani; Isaac Cano; David Marí; Giuliana Faiella; Fabrizio Clemente; Marco Nalin; Evangelos Grivas; Oana Stan; Erol Gelenbe; Jos Dumortier; Jan Petersen; Dimitrios Tzovaras; Luigi Romano; Ioannis Komnios; Vassilis Koutkias
• Keywords: Cybersecurity; Computer applications to medicine. Medical informatics; R858-859.7; 610; Seguretat informàtica; Internetworking (Telecommunication); Barriers and facilitators for HIT acceptance; Workflow; Gap analysis; 03 medical and health sciences; 0302 clinical medicine; Computer security; Interoperabilitat en xarxes d'ordinadors; 0909 Geomatic Engineering; Humans; Computer Security; User requirements engineering; Digitization; Science & Technology; Cross-border health data exchange; Data Collection; 1103 Clinical Sciences; Interoperability; 004; 3. Good health; Europe; 0806 Information Systems; Digitalització; Health information technologies (HIT); Life Sciences & Biomedicine; Digital health; Medical Informatics; Research Article

Increased digitalization of healthcare comes along with the cost of cybercrime proliferation. This results to patients' and healthcare providers' skepticism to adopt Health Information Technologies (HIT). In Europe, this shortcoming hampers efficient cross-border health data exchange, which requires a holistic, secure and interoperable framework. This study aimed to provide the foundations for designing a secure and interoperable toolkit for cross-border health data exchange within the European Union (EU), conducted in the scope of the KONFIDO project. Particularly, we present our user requirements engineering methodology and the obtained results, driving the technical design of the KONFIDO toolkit.Our methodology relied on four pillars: (a) a gap analysis study, reviewing a range of relevant projects/initiatives, technologies as well as cybersecurity strategies for HIT interoperability and cybersecurity; (b) the definition of user scenarios with major focus on cross-border health data exchange in the three pilot countries of the project; (c) a user requirements elicitation phase containing a threat analysis of the business processes entailed in the user scenarios, and (d) surveying and discussing with key stakeholders, aiming to validate the obtained outcomes and identify barriers and facilitators for HIT adoption linked with cybersecurity and interoperability.According to the gap analysis outcomes, full adherence with information security standards is currently not universally met. Sustainability plans shall be defined for adapting existing/evolving frameworks to the state-of-the-art. Overall, lack of integration in a holistic security approach was clearly identified. For each user scenario, we concluded with a comprehensive workflow, highlighting challenges and open issues for their application in our pilot sites. The threat analysis resulted in a set of 30 user goals in total, documented in detail. Finally, indicative barriers of HIT acceptance include lack of awareness regarding HIT risks and legislations, lack of a security-oriented culture and management commitment, as well as usability constraints, while important facilitators concern the adoption of standards and current efforts for a common EU legislation framework.Our study provides important insights to address secure and interoperable health data exchange, while our methodological framework constitutes a paradigm for investigating diverse cybersecurity-related risks in the health sector.