JMIR Publications

ABSTRACT

Background:

Healthcare databases contain a wealth of information that can be used to develop programs and mature healthcare systems. Of concern, the sensitive nature of health data (e.g. ethnicity, reproductive health, sexually transmitted infections, lifestyle information, etc.) can have significant impact on individuals if misused, particularly among vulnerable and marginalized populations. As academic institutions, NGOs, and international agencies begin to collaborate with low and middle-income countries (LMICs) to develop and deploy health information technology (HIT), it is important to understand the technical and practical security implications of these initiatives.

Objective:

Our aim was to develop a conceptual framework for risk stratifying global health data partnerships and HIT projects. In addition to identifying key conceptual domains, we mapped each domain to a variety of publicly available indices that could be used to inform a quantitative model.

Methods:

We conducted a non-systematic review of the literature to identify relevant publications, position statements, white papers, and reports. The research team reviewed all sources and used the Framework Method and Conceptual Framework Analysis to name and categorize key concepts, integrate them into domains, and synthesize them into an overarching conceptual framework. Once key domains were identified, public international data sources were searched for relevant structured indices to generate a quantitative counterpart.

Results:

We identified five key domains to inform our conceptual framework: 1) State of Health Information Technology, 2) Economics of Healthcare, 3) Demographics and Equity, 4) Societal Freedom and Safety, and 5) Partnership and Trust. Each of these domains was mapped to a number of structured indices.

Conclusions:

There is a complex relationship between the legal, economic, and social domains of healthcare, which impacts the state of HIT in LMICs and associated data security risks. The strength of partnership and trust between collaborating organizations is an important moderating factor. Additional work is needed to formalize the assessment of partnerships and trust, and to develop a quantitative model of the conceptual framework that can help support organization decision-making.