Privacy and trust management for electronic health records

Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.

Fiduciary Duty and the Atmospheric Trust

This book explores the application of concepts of fiduciary duty or public trust in responding to the policy and governance challenges posed by policy problems that extend over multiple terms of government or even, as in the case of climate change, human generations. The volume brings together a range of perspectives including leading international thinkers on questions of fiduciary duty and public trust, Australia's most prominent judicial advocate for the application of fiduciary duty, top law scholars from several major universities, expert commentary from an influential climate policy think-tank and the views of long-serving highly respected past and present parliamentarians. The book presents a detailed examination of the nature and extent of fiduciary duty, looking at the example of Australia and having regard to developments in comparable jurisdictions. It identifies principles that could improve the accountability of political actors for their responses to major problems that may extend over multiple electoral cycles.

The role of knowledge in the project management office

Both Knowledge Management (KM) and Project Management (PM) are known as crucial factors to develop competitive advantage(CA). PM Office (PMO) is recognized as a strong solution to institutionalize PM practices in organization. However, according to the literature there is a significant gap in addressing KM practices in the PMO. In other words, existing PMO maturity models has not been addressed from KM perceptive. This paper discusses undertaken investigations of both KM and PM as an initial part of PhD research on the role of knowledge in PMO

Modelling contractor's and subcontractor's trust : a system dynamics approach

A general mistrust within the contactor and subcontractor companies has identified one of the significant barriers to derive benefits from true downstream supply chain integration. Using the general theory of trust in inter-organizational relations and conducting interviews, this research discusses factors that influence development of trust and cooperation in contractor– subcontractor relationships in construction projects. System dynamics is the simulation method is selected in this theory-building effort, based on qualitative data collected from two projects of a construction company in Thailand. Performance, permeability and system based trust are found to make significant contributions toward parties’ trust level. Three strategic policies such as best value contracting, management of subcontractors as internal team and semi project partnering approach are recommended to stimulate the trust factors as well as cooperative long term relationship.

Address terms in turn beginnings: Managing disalignment and disaffiliation in telephone counselling

This paper examines use of address terms by counsellors on a telephone counselling service for children and young people. Drawing on conversation analytic findings and methods, we show how personal names are used in the management of structural and interpersonal aspects of counselling interaction. Focusing on address terms in turn-beginnings - where a name is used as, or as part of, a preface - the analysis shows that address terms are used in turns that are not fitted with prior talk in terms of either the activity or affective stance of the client. We discuss two environments in which this practice is observed: in beginning turns that initiate a new action sequence, and in turns that challenge the client’s position. Our focus is on the use of client names in the context of producing disaligning or disaffiliative actions. In disaligned actions, counsellors produced sequentially disjunctive turns that regularly involved a return to a counselling agenda. In disaffiliative actions counsellors presented a stance that did not fit with the affective stance of the client in the prior turn, for instance, in disagreeing with or complimenting the client. The paper discusses how such turns invoke a counselling agenda and how name use is used in the management of rapport and trust in counselling interaction.

An architecture for enhanced assurance in e-health systems

Notwithstanding the obvious potential advantages of information and communications technology (ICT) in the enhanced provision of healthcare services, there are some concerns associated with integration of and access to electronic health records. A security violation in health records, such as an unauthorised disclosure or unauthorised alteration of an individual's health information, can significantly undermine both healthcare providers' and consumers' confidence and trust in e-health systems. A crisis in confidence in any national level e-health system could seriously degrade the realisation of the system's potential benefits. In response to the privacy and security requirements for the protection of health information, this research project investigated national and international e-health development activities to identify the necessary requirements for the creation of a trusted health information system architecture consistent with legislative and regulatory requirements and relevant health informatics standards. The research examined the appropriateness and sustainability of the current approaches for the protection of health information. It then proposed an architecture to facilitate the viable and sustainable enforcement of privacy and security in health information systems under the project title "Open and Trusted Health Information Systems (OTHIS)". OTHIS addresses necessary security controls to protect sensitive health information when such data is at rest, during processing and in transit with three separate and achievable security function-based concepts and modules: a) Health Informatics Application Security (HIAS); b) Health Informatics Access Control (HIAC); and c) Health Informatics Network Security (HINS). The outcome of this research is a roadmap for a viable and sustainable architecture for providing robust protection and security of health information including elucidations of three achievable security control subsystem requirements within the proposed architecture. The successful completion of two proof-of-concept prototypes demonstrated the comprehensibility, feasibility and practicality of the HIAC and HIAS models for the development and assessment of trusted health systems. Meanwhile, the OTHIS architecture has provided guidance for technical and security design appropriate to the development and implementation of trusted health information systems whilst simultaneously offering guidance for ongoing research projects. The socio-economic implications of this research can be summarised in the fact that this research embraces the need for low cost security strategies against economic realities by using open-source technologies for overall test implementation. This allows the proposed architecture to be publicly accessible, providing a platform for interoperability to meet real-world application security demands. On the whole, the OTHIS architecture sets a high level of security standard for the establishment and maintenance of both current and future health information systems. This thereby increases healthcare providers‘ and consumers‘ trust in the adoption of electronic health records to realise the associated benefits.

Collaboration : developing integration in multi-purpose services in rural New South Wales, Australia

Introduction: The Multi-purpose Service (MPS) Program was introduced to rural Australia in 1991 as a solution to poor health outcomes in rural compared with metropolitan populations, difficulty in attracting healthcare staff and a lack of viability and range of health services in rural areas. The aim of this study was to describe the main concerns of participants involved in the development of multi-purpose services in rural New South Wales (NSW). This article is abstracted from a larger study and discusses the extent to which collaboration occurred within the new multi-purpose service. Methods: A constructivist grounded theory methodology was used. Participants were from 13 multi-purpose services in rural NSW and 30 in-depth interviews were conducted with 6 community members, 11 managers and 13 staff members who had been involved in the process of developing a multi-purpose service. Results: The main concern of all participants was their anticipation of risk. This anticipation of risk manifested itself in either trust or suspicion and explained their progression through a phase of collaborating. Participants who had trust in other stakeholders were more likely to embrace an integrated health service identity. Those participants, who were suspicious that they would lose status or power, maintained that the previous hospital services provided a better health service and described a coexistence of services within the multi-purpose service. Conclusions: This study provided an insight into the perceptions of community members, staff members and managers involved in the process of developing a multi-purpose service. It revealed that the anticipation of risk was intrinsic to a process of changing from a traditional hospital service to collaborating in a new model of health care provided at a multi-purpose service.

Risk, trust, and consumer online purchasing behaviour : a Chilean perspective

Purpose: The purpose of this study is to investigate Latin American online purchase behaviour with a specific focus on the influence of perceived risk and trust. While studies of this nature have been conducted quite extensively in developed countries, their application in developing countries, such as Latin America is limited. Our study addresses this gap in the literature with an empirical study conducted in Chile. Design/methodology/approach: The authors develop and test a proposed model of the influence of consumer’s perceptions of risk and trust on their attitudes and intentions to purchase on the Internet. An online survey method is used. The sample consists of 176 Chilean consumers who have made at least one purchase online. The data is analysed using structural equation modelling technique (SEM). Findings: The analysis revealed that of the perceived risk and trust factors examined, trust in third party assurances and a cultural environment of trust had the strongest positive influence on intentions to continuing purchasing online. Perceived risk had an inverse relationship with attitude and consumers’ attitude has a positive influence on intentions to purchase online. Trust in online vendors and a propensity to trust were both insignificant. Practical implications: Practically, these results identity which risk and trust beliefs towards purchasing online have the most effect thereby providing insights into how companies should seek to mitigate perceptions of risk to encourage new and return purchasers. Additionally, this research shows that consumers in a Latin American country, recognised as a collectivist, high risk avoidance culture, are willing to make purchases online despite the risks involved. Originality/value: The study and its results is one of few available that consider a Latin American context. The value of the findings provides insights into the specific risk and trust factors that influence Chilean consumers when considering purchasing online. The tested model adds value not only to the literature on Latin American consumer behaviour but also provides guidance for companies offering online retailing facilities in these less developed countries.

The Wood Royal Commission : a case study in the slippery slope from unethical conduct to criminal acts

Over the last two and a half decades, corruption in the police service in Australia has come under increased official and public scrutiny. Numerous scandals involving police officers has caused concerned about the integrity and ethics within the Police Service. This paper examines the Wood Royal Commission, specifically looking at testimony from Trevor Haken. This paper provides insights into the nature of police corruption as well as the process or ‘slippery slope’ corrupt officers go through. This paper also contributed to the existing literature by providing knowledge into the types of corruption used by police officers in real-life situations, and deepening understanding of how corruption emerges and why. It specifically confirms the literature on slippery slope arguments about police corruption and the role of trust in building a corrupt career. The paper contributes to the existing literature by providing insights into the nature of corruption used by police officers in real-life situations, and deepens the understanding of the process of corruption. The findings also contribute to our understanding that corruption is not just an individual incident but rather a result of reoccurring incidents that are generated by the nature of work, organizational structure and society in relation to corruption.

Overdue choices : how information and role in decision-making influence women's preferences for induction for prolonged pregnancy

Background: Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners’ communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women’s preferences for induction of labor for prolonged pregnancy. Methods: A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman’s involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Results: Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants’ general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Conclusions: Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. (BIRTH 39:3 September 2012)

A comment on "Inherited Trust and Growth"

Algan and Cahuc (2010) argue that “inherited trust” is a key factor in explaining growth rates across countries. They derive a measure of inherited trust by linking respondents’ “home countries: in the United States General Social Survey (1972-2004) and the 2000 wave of the World Values Survey. Algan and Cahuc then estimate trust levels for people born before 1910 (inherited trust in 1935) and afterwards (inherited trust in 2000). They show a strong link between economic growth rates and inherited trust. We do not challenge this result, but we do argue that: (1) The 2000 World Values Survey has many anomalous results; (2) the estimates for inherited trust in 1935 are mostly based upon tiny samples for most ethnic heritage groups in the General Social Survey; and (3) Algan and Cahuc’s findings are based upon two-tailed rather than one-tailed tests. We reestimate their model using the more reliable waves of the World Values Survey and find much weaker relationships between inherited trust in 1935 and trust in the home country. We also suggest caution in the overall measure of inherited trust in 1935.

The role of customer gratitude in strengthening seller-buyer relationships

Despite its emphasis on relationships between buyers and sellers, and the effect of emotion on behaviours, marketing literature has not yet investigated customer gratitude as an element of relational exchange. Gratitude is a significant component of personal relationships and may offer important insights into how perceptions of relationship marketing investments impact customer trust in, satisfaction with and affective commitment to a seller. In addition, customer gratitude may provide a more complete explanation of how marketing investments work. Consequently, this research contributes to marketing literature by investigating customer gratitude as a mediating mechanism in the relationship between customer perceptions of relationship marketing investments and customer trust in, satisfaction with and affective commitment to the seller: all dimensions of relationship quality.

Supermarkets and agro-industrial foods : the strategic manufacturing of consumer trust

There is increasing evidence of a weakened platform of consumer trust in mass produced food products. The resistance shown by consumers to the agro-industrial paradigm is evident in an emergent phase of reflexive consumerism, public reactions to an overly-concentrated retail sector and the rise of alternative food networks such as farmers' markets and organic box schemes. Supermarkets are responding strategically by aiming to manufacture new trust relations with consumers. This paper identifies three key strategies of trust manufacturing: (i) reputational enhancement though the institution of “behind the scenes,” business-to-business private standards; (ii) direct quality claims via private standard certification badges on food products, and ; (iii) discursive claimsmaking through symbolic representations of “authenticity” and “tradition.” Drawing upon the food governance literature and a “visual sociology” of supermarkets and supermarket produce, we highlight how trust is both commoditized and increasingly embedded into the marketing of mass-produced foods.

Literature review : A culture of trust enhances performance

In this environmental scan of research and policy literature, the authors consider various definitions of trust as they seek to address and inform the hypothesis that ‘a culture of trust enhances performance’ in schools. The discussion draws on the work of the Australian Institute for Teaching and School Leadership in school leadership and research by Caldwell and Harris (2008) to consider ways in which trust is linked to performance in schools and organisations. It explores the concept of trust as a form of capital available to schools, and highlights how successful school leaders work to align trust, strategy and passion in implementing effective change. At the heart of the review is the relationship between trust and school improvement. An adapted model of the elements of a culture of trust developed by Bryk and Schneider in their influential study of trust in school reform in Chicago is used to frame this aspect of the review. The authors identify four essential categories of relationships that enable schools to be described as having a culture of trust. The review concludes with a discussion of the relationship between trust and school governance.

Reconnecting theory and practice in a pluralistic organizing context : issues and Aristotelian considerations

The overall purpose of this paper is to contribute to the theory - practice gap debate in organization studies, especially in pluralistic contexts such as project organizing. We briefly outline some of the current debates, i.e. modernist and postmodernist proposals, and the prevalent dichotomous thinking stance assumptions to better move beyond it, anchoring our contribution in the Aristotelian ethical and practical philosophy. We introduce the current state of the debate, part of the broad question of “science that matters”, and the various discourses between practice and academia within social sciences and more specifically organizational studies. We briefly critically summarize some main features of the two main philosophical stances (modernism, postmodernism), before presenting some key aspects, for the purpose of this paper, of the Aristotelian pre-modern practical and ethical philosophy. Then, we build on the foundations above established, discussing propositions to reconnect theory and practice according the Aristotelian ethical and practical philosophy, and some key implications for research notably in the following areas: roles played by practitioners and scholars, emancipatory praxeological style of reasoning, for closing the “phronetic gap” and reconnecting means and ends, facts and values, relation between collective praxis, development of “good practice” (standards), ethics and politics. We conclude highlighting the role of the suggested shift to an Aristotelian emancipatory style of reasoning for reconciling theory and practice.