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Consumer Health Care: Current Trends in ConsumerHealth MonitoringJournal ItemHow to cite:

Garge, Gopi Krishna; Balakrishna, Chitra and Datta, Soumya Kanti (2018). Consumer Health Care: CurrentTrends in Consumer Health Monitoring. IEEE Consumer Electronics Magazine, 7(1) pp. 38–46.

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Consumer Healthcare: Current TrendsGopi Krishna GargeFellow, IPv6 Forum

Chitra BalakrishnaEdge Hill University, UK

Soumya Kanti DattaFuture Tech Lab, India

Abstract—The term healthcare has a very wide scopethat ranges from lifestyle and wellness right up to carefor acute conditions. With the availability of digitalaccessories for monitoring basic biological functions,the potential for obtaining detailed data on life style,habits and behaviour of an individual exists. Such datacan enable diagnosis of the causes for a condition withhigher accuracy. In the recent past, a large numberof devices have become available in the market, thatcan monitor various aspects of lifestyle and biologicalfunctions. Such data provides a feedback to an indi-vidual for compliance with “healthy guidelines” as wellas contribute information to the healthcare providerfor use in diagnosis, in the event of an ailment. In thispaper, we identify the various aspects of care that canbenefit from consumer grade health monitoring devicesand present the overall landscape in the context ofself care. We qualify the term “consumer healthcare”,assigning the context to it and identifying the servicesavailable in the context.

I. IntroductionThe term consumer healthcare is of recent origin in the

industry. Increased health awareness amongst people com-bined with the consumerism of the Internet has providedthe potential for every citizen to be health-conscious. Itis the feasibility and affordability of the solutions (devicesand applications) emerging in the market that is propellingthe advances in healthcare. A fundamental question iswhether the end user in healthcare must be termed as apatient or a consumer [1].

“Consumer healthcare” is an industry-coined termwhich is centered around empowering individuals (con-sumers) to self-manage their health. This was traditionallyachieved through over-the-counter medications and theconsumer-health care movement was largely led by thepharmaceutical companies. With the ongoing consumerrevolution in healthcare primarily driven by digital disrup-tion and the entry of new players such as electronic devicevendors, mobile application developers, mobile operators,there is need to contextualize consumer healthcare for thetraditional players within the healthcare sector. Further,what kind of care constitutes healthcare? These are someof the debates in the industry today. Therefore, there isa need to provide a context to defining what consumerhealthcare is.

The general difference between the terms patient andconsumer, reflects the role of the end user in the careprocess. Often, the end user is a consumer – assessingcost-benefits for treatment options, choosing a treatment

option, and in some contexts, choosing the experts theywould want to consult with, in the case of short termailments and treatment. In case of long term/major ail-ments or end-of-life (palliative) care the user’s preferenceis care rather than cost or even making a choice. Theuser is completely led by the medical expert and maynot make choices as in the case of short-term ailments.It is when such continued care is sought, either in a homeor a hospital setting that the term “patient” is used [1].However, from a service standpoint, a patient is always aconsumer In contrast to the short and long-term ailmentconditions, there are the common ailments that havestandard treatment processes that enable self-care; usershave the common knowledge available through variousmeans and the medications available as off-the-counter(OTC) drugs. The last type of care is the intensive careas in the event of a surgery or an emergency in a chroniccondition [1]. Healthcare, as a function, encompasses thesefour types of care in the context of adults - acute care,post-acute care, chronic care, and prevention and wellness.Our discussions will address prevention and wellness andchronic care, both of which have their setting outside ahospital.

A. Healthcare, in contextHealthcare is delivered as part of a system. But, is

healthcare a system in the traditional sense? [2] comparesthe healthcare industry and the airline industry to illus-trate that the former is not a system in the traditionalsense. The difference between the airline industry andhealthcare when managing decision-making processes isthat the airlines have moved towards a system of produc-tion. In contrast, healthcare is a system of craftsmanshipwhere successful outcomes largely depend on the native in-telligence and memory capacity of an individual provider,like how an aircraft was piloted years ago. Hundreds ofdata points coming in real time, provide a continuousfeedback to the pilot. They are well-trained on standard,routine methods with a system of checks. These systemsprovide the confidence that any of the pilots that arepart of the system can transport people from point A topoint B. In contrast, healthcare systems do not function asdeterministically. The outcomes vary with the individualsand are a function of their expertise [2]. IoT can providethe data points of the consumer and the low level supportsystems that healthcare is lacking, when compared tothe traditional systems. The expectation is the healthcare

Figure 1. Increase in world population relative to 2000 [4]

industry can evolve into an entity closer to a traditionalsystem. Both these aspects play a role in the generalhealthcare of a consumer.

The authors of [3] mention that the healthcare systemcontributes only about 10% to an individual’s overallhealth, in her/his lifetime of health. This limitation isdue the reactive nature of both the healthcare systemas well as the individual. There is a need for the systemto explore other components of health status to managecare better, especially in the context of chronic diseases.The authors point out that behavioural patterns (lifestyle,medication adherence, patient engagement, depression,utilization of health services, etc.) represent the largestdomain (40%) of an individual’s health status. It is thisgap that the healthcare industry is attempting to addressin the consumer’s interests.

An increasing concern, over the last decade, is thehealthcare for a growing, ageing population (Figure 1).Between 2015 and 2030, the number of people in theworld aged 60 years or over is projected to grow by 56per cent, from 901 million to 1.4 billion, and by 2050, theglobal population of older persons is projected to morethan double its size in 2015, reaching nearly 2.1 billion[4]. It is often assumed that increasing longevity is beingaccompanied by an extended period of good health, thereis little evidence to suggest that older people today areexperiencing better health than their parents did at thesame age. However, poor health does not need to dominateolder age. Most of the health problems that confront olderpeople are associated with chronic conditions, particu-larly non-communicable diseases. Many of these can beprevented or delayed by engaging in healthy behaviours.Notice, this again points towards behavioural patterns andaddresses prevention and wellness.

II. Consumer HealthcareThe global healthcare landscape is changing rapidly

with the infusion of digital technologies. The primary im-pact is on the routine delivery of healthcare, the provider-consumer engagement, and a reduction of errors in diag-nosis, medication and care. There is a consumer move-ment of sorts in terms of health awareness and healthy

Figure 2. The self-care continuum [6]

lifestyle adoption. Sensor-based digital accessories are usedto monitor lifestyle and make routine decisions about diet,nutrition, hydration, stress levels, etc. Digital technologiesare providing new possibilities on all fronts – customer-facing, professionals-facing, and organisation/provider fac-ing. The challenge is to make them interwork and deliverimproved care systems that involve the customer/patientand deliver reliable care with positive outcomes, whileremaining cost-effective [5]. In this context, we briefly lookat self-care and wellness which are two recent trends in thehealthcare landscape that can be impacted substantiallyand positively by digital technologies.

A. Self-care

People have a key role in protecting their own health,choosing appropriate treatments and managing long-termconditions. Self-management is a term used to includeall the actions taken by people to recognise, treat andmanage their own health. They may do this independentlyor in partnership with the healthcare system. During thepast decade,increasing number of over-the-counter (OTC)drugs were aimed to ease the pressure on public healthcare,allowing consumers to treat more of their everyday healthconditions with no additional cost to the taxpayer, whilealso enabling healthcare professionals to spend more oftheir time and attention on patients that require morecare1. Digital technologies-assisted selfcare can potentiallymaximise the benefits that the over-the-counter medica-tions are aiming to achieve, in addition to paving theway for innovations within healthcare provisioning. Theterms self-care and self-management cannot be used inter-changeably due to the distinctions between them. Self-carefocuses entirely on treatment. It is defined as the actionsthat individuals take for themselves, on behalf of and withothers, to develop, protect, maintain and improve theirhealth, wellbeing or wellness [6]. Self-care is projected as acontinuum, which extends across daily choices of users andlifestyle up to long-term illnesses, with acute conditionsout of scope (Figure 2).

1http://en.sanofi.com/healthcare-solutions/consumer-healthcare/consumer-healthcare.aspx

The working definition of self-care is the ability ofindividuals, families and communities to promote health,prevent disease, and maintain health and to cope withillness and disability with or without the support ofa health-care provider. Self-management is used in thecontext of long-term, chronic health conditions while self-care applies to acute illness or injuries. Self-managementis about coping with long-term health conditions, andmanaging the emotional and practical issues they present.Self-management support can be viewed in two ways: asa portfolio of techniques and tools to help patients choosehealthy behaviours; and as a fundamental transformationof the patient-caregiver relationship into a collaborativepartnership. The scope of self-management is far higherthan that of self-care.

B. WellnessThere has been a large increase in products relating to

“wellness”. In general, wellness is the state of being ingood health, especially as an active pursued goal (Ox-ford Dict.). The National Wellness Institute has a moredetailed definition. They model wellness with six compo-nents. There have been significant industry investmentsdue to the market prospects, globally. The ConsumerElectronics Show, 2016, (CES 2016) showcased emergingtechnologies for health and wellness. It is rapidly be-coming a forum for consumer health and wellness solu-tions. The focus in CES 2016 was largely on Internet ofThings (IoT). IoT is the enabling technology for well-ness and healthcare [7]. The Global Wellness Institutein its Global Wellness Economy report, 2017 estimatesa 3.72 trillion USD estimate with a 11% year-on-yeargrowth between 2013−2015 in sectors such as Beauty& Anti-Aging, Healthy Eating, Nutrition & Weight Loss,Wellness Tourism, Fitness & Mind-Body, Preventative &Personalized Medicine and Public Health, Complementary& Alternative Medicine, Wellness Lifestyle Real Estate,Spa Industry, Thermal/Mineral Springs, and WorkplaceWellness. At CES 2017, in the wellness segment, sleeprelated (Sleep apnea, sleep management, etc.) solutionswere prominent apart from the focus on wearable devicesand virtual reality (VR). There was also ample evidencethat healthcare industry has begun to address the self-caresegment. Two specific products, a telemedicine station androbotics in rehabilitation care stood out. Figure 3 shows alist of sensor-based devices in the market today and theirfunctional components.

All health-related activities of an individual that aretowards the left end of the self-care continuum Figure2 are enabled by assistive technologies such as sensorsand complimented by the availability of computing andstorage, be it on a smartphone or in the cloud. A similarcapability is applicable to self-care and self-management.It is a combination of the technologies, infrastructureand the services that are delivered to the end user –the consumer – to enable them effectively to track and

Figure 3. Sensor-based wellness devices and components ([8])

monitor all aspects of daily life in the context of wellnessand care. In the context of care, there is an additionalactor – the health care provider, involved. Similar assistivetechnologies are deployed in “in-hospital” care, but theyare part of a larger system such as a telemedicine stationdemonstrated at CES 2017

C. Common Terms in useThere are many terms that are used in the context of

IoT solutions available in the market. Consumer Internetof Things (CIoT) is used to denote the use of IoT in con-sumer devices such as smart TVs, wearable health track-ers, Internet-enabled home control devices and systems,appliances, virtual reality (VR) headsets, smart glasses,connected cars and so on. They are a class of connecteddevices that target the consumer market. Another term inuse is the Internet of Health/Healthcare Things (IoHT),which deals with devices (ingestible/implantable sensors; refer Figure 3), equipment (smart beds, medicationdispensers, bedside dashboards) and IoT-based solutionsin the healthcare industry targeted at improving access tohealth, quality of care, user experience, and operationalefficiency. Industrial IoT (IIoT), an orthogonal domainto CIoT in terms of devices and functions that primarilyconcerns manufacturing and industrial automation, hassubstantial applications in healthcare infrastructure andoperations. Clearly, there are functional overlaps resultingin overlaps across the domains the terms signify.

There are two other terms – personalised care andprecision medicine. Personalised care deals with adaptingthe care to the specific needs of an individual to ensurethe support they receive is around their desired outcomes.This need arises from the findings that more than 60 % of“health” is based on patient contexts such as behaviouralpatterns, social circumstances and environmental expo-

sures [9]. Precision medicine is ”an emerging approach fordisease treatment and prevention that considers individualvariability in genes, environment, and lifestyle for eachperson”, according to the National Institutes of Health.Precision medicine is relatively new; the concept, however,has been a part of healthcare for many years. Genomicsprovides the various data points necessary for the precisionof medication and forms the basis of personalised care.The role of IoT-based devices in precision medicine is notentirely evident, yet.

It is in this context that we attempt to define and scopeconsumer healthcare.

III. Consumer Healthcare: Landscapes

Healthcare, in general, encompasses the entire range ofwellness, self-care, self-management, and hospitalised care.The healthcare provider has varying roles and involvementacross each of the care types. Doctors, surgeons, nurses,carers, etc., are part of the provider eco-system.

We define consumer healthcare as the functional com-ponent of the healthcare which:

• Involves activities of consumer concerned with ahealthy routine and therefore a healthy lifestyle (well-ness)

• Involves the activities a consumer to heal oneselfin the event of common ailments (cold, cough, sorethroat, etc.)

• Involves activities of a consumer to heal oneself inthe event of long term ailments

• Involves activities of a consumer in the event of post-discharge recovery, after hospitalisation

Some or all activities of the consumer, as needed, aremonitored with devices and the data is either retained bythe consumer (as in the case of wellness) or shared withthe healthcare provider. In the case of wellness data, onlythe anomalies need to be shared.

A. The Wellness LandscapeWellness is a term used to denote the broader context

of healthy (practices that ensure very low susceptibil-ity to diseases, especially chronic) living. It is used asa means of disease prevention. Wellness practices havebeen encouraged for adoption in different ways across agegroups. Older adults (senior citizens) are typically guidedby the healthcare system or via the community. Employedadults benefit from employer sponsored wellness activities.Younger adults are generally on their own seeking anactive lifestyle while in schools and colleges. There isa relatively high focus on wellness of middle-aged andolder adults. Typical wellness activities range from visitingfitness centres, spas and beauty salons, going on activityholidays, and taking silent retreats. Tools such as sensor-based consumer health devices (currently with featurescovering the areas of cardiovascular, overall fitness and de-velopment, pulmonary medicine, endocrinology neurology,

Monitored Attributes Units

Accelerometry Activity intensityBlood Pressure mmHgBlood Levels Glucose, MedicationEnvironment Exposure-dependentFall Times fallenGeo-location Geo-coordinatesHeart rate Beats per minutePedometry StepsSleep Duration, interruptions, latencyTemperature Centigrade/FarenheitWeight Stones, pounds, kilograms

Table ITypical consumer attributes that constitute CGHD [10]

and ophthalmological wellness) that provide consumer-generated data, help to increase medication adherenceand allow better management of their own health. Suchpreventive measures will ultimately reduce the overallcosts of healthcare in the future, while increasing thequality of life for the consumer.

The key transformative component in healthcare isconsumer-generated healthcare data (CGHD), defined ashealth-related data created, recorded, gathered, or inferredby the consumers (Table I) or their apps to address ahealth concern [11]. All wellness data is completely storedand owned by the consumer and used personal decision-making. Being outside a clinical setting, an interface withthe healthcare system is conspicuously absent. The acces-sibility and clinical utility of such data for diagnosis orresearch is currently limited. Accuracy of CGHD, it’s char-acteristics (sampling rate, precision, etc.), security, andthe lack an API for the healthcare system’s health/medicalrecord database contribute to the limitations. Unificationof the data from a diverse device ecosystem is pioneeredby initiatives such as Aqua.io, Human API, “Here is myData” and Vivametrica that provide APIs for developersto use the data. There is no effort towards integratingsuch data into the healthcare systems. The challenge hereis the usability (accuracy, precision, etc.) of the data sincethe consumer devices are not yet approved as “medical”grade devices. A recent draft guidance document from TheCenter for Devices and Radiological Health (CDRH) atthe U.S Food and Drug Administration (FDA) defines awellness device or product as one that is only intended forgeneral health and wellness and which also presents a verylow risk to the user.

The Industry however, has responded with integratedapplication development frameworks such as the AppleHealthKit, Microsoft HealthVault and Google Fit offeroptions for wellness data gathering. HealthKit and Re-searchKit help to develop applications that can interactwith various consumer devices and sensors, specificallythe Apple smartphone. The Google Fit SDK, in con-trast, is focused on fitness apps and enables consumerscontrol their fitness data as well as enable developersand manufacturers create a variety of smart apps andconsumer devices embedded in routinely used accessories.

Microsoft’s HealthVault is a platform that is geared toprovide the infrastructure that is both patient-facing aswell as provider-facing to integrate the medical recordinformation from the provider with the CGHD from theconsumer. The objective is to provide the consumer (andthe provider) a holistic view of the status of the consumer’shealth. The status includes information about the con-sumer’s behavioural events and patterns.

On similar lines as the industry’s application de-velopment frameworks, there are open source efforts.Openhumans.org provides a means of sharing members’wellness data through an API for purposes of research.SHIMMER provides a simple API which serves clinically-valid data in the Open mHealth format. Physionet pro-vides MIMIC, an openly available dataset comprisinganonymised health data associated with 40,000 criticalcare patients. It includes demographics, vital signs, labo-ratory tests, medications, etc. Kaggle provides data miningand analysis tools for large data sets. Between them, theseplatforms provide the databases, the APIs for their accessas well as the tools for processing them. They are intendedprimarily for research but evolving to be platforms forlimited public use, for now.

1) Observations: In terms of building solutions for con-sumer use, several generic hardware and software plat-forms for IoT are available. They increase the potentialfor the wide-spread generation of CGHD [12]. IntegratingCGHD with existing health data into electronic medicalrecords (EMR), or personal health records (PHRs) alongwith other biological and genetic data could provide in-formation to assess patients’ progression from health tosub-clinical disease to a clinically significant pathologicalstate [13]. While this is the future one anticipates, theneed for accurate data from the devices is a primaryrequirement. A few consumer devices that were calibratedwere not sufficiently accurate. Personal fitness tracker–derived heart rates were slightly lower than those derivedfrom cECG monitoring in real-world testing and not asaccurate as pulse oximetry (SpO2.R-derived) measuredheart rates [14]. [15] estimated accuracy of heart rate andenergy expenditure monitoring of three consumer devicesthe Apple Watch, Fitbit Charge HR and Garmin Forerun-ner 225 and reports that Apple Watch had the lowest meanabsolute percentage error across three different levels ofexercise for both heart rate and energy expenditure, withFitbit Charge and Garmin Forerunner 225 being secondand third in terms of the mean absolute percentage error.

Several fitness devices (Jawbone UP, Fitbit Ultra, Fit-bit One; Zip, Jawbone UP, Mifit Shine, Nike Fuelband,Sensewear Armband Mini, Striiv Smart Pedometer, andWithings Pulse) have been tested for functional accuracy.Measuring steps for walking, running, elliptical exercisesand agility drills and estimates of energy expenditure aretwo basic functions that have been verified for accuracyand consistency and their results compared with thosefrom similar research grade devices [16]. Therefore, there

is evidence that fitness devices are evolving to be reliablein recording functional information. Transparency of algo-rithms used to calculate activity levels would be useful inmaking appropriate evaluations for accuracy as well as forproduct comparisons.

[8] also reports a somewhat unsatisfactory overall expe-rience with the use of devices by consumers with incon-sistent results; they do not report the expected outcomes.Reports of negative outcomes exist, though the reasons areyet to be established. Despite these findings, the overallutility of wearable devices and their use is positivelyarticulated in [17]. The use of technologies such as fitnesstrackers and smartphone apps, demonstrate a large po-tential for measuring and encouraging physical activity.There is evidence of impact of the use of “consumer”technologies to effect substantial changes in lifestyle acrossage groups, to achieve wellness. Older adults benefit byhaving healthy lifestyles and preventing disease, youngeradults adopt healthy lifestyles. The consumer devices,when combined with behavioral strategies, show evidenceof achieving objectives.

B. The Self-care LandscapeSelf-care is a set of activities that a consumer performs

on her/his own as part of self-management of a healthcondition that is:

• as part of a recovery process after a period of post-acute care in a hospital

• as part of a continued treatment for a chronic condi-tion, with assistance from a provider that is responsi-ble for continuous monitoring of the condition of theconsumer

Self-care is typically in a home (outside of a hospital) set-ting, where the consumer has complete autonomy. Studieshave shown that consumers discharged from hospitals afteracute care have often had a re-occurrence of an emergencydue to lack of adherence to the recommended medicationplan as well as lifestyle. Monitoring such consumers fortheir routine activities and adherence to medication canhelp fine-tune the medication as well as ensure that theirbody condition (weight, sleep and rest, activity, heart rate,oxygen levels, etc.) is on par with guidelines and the riskof re-occurrence of an emergency condition is low.

The chronic care model (CCM), specifically lists self-management support as one of its components and de-scribes it as a means to help consumers acquire skills andconfidence to self-manage [18].

Typically, in the case of chronic illnesses, post-hospitalization, or long-term ailments the consumers ofcare are passive in the course of the treatment. Currently,their engagement in the care process is encouraged andpartnerships between healthcare professionals (HCP) andthe consumer are yielding better healing and a reductionin healthcare costs.

The devices used in such consumer care are referredto as “point-of-care technologies” (POCT). Figure 4 illus-

Figure 4. Wearable POCT devices ([19])

trates the use of implantable devices for highly sensitivepoint-of-care diagnostics. POCT has been prevalent in thecontext of blood glucose testing and monitoring of anti-coagulation in warfarin-treated individuals (thromboticproblems). With IoT, the scope of POCT has increasedimmensely and they can assist in monitoring adherence tothe carer’s/provider’s recommendation (currently, poor),medication compliance, and adherence to recommendedpharmacological therapy. IoT-based technologies have en-abled Wi-Fi–connected pill bottle caps and internet-connected sealable blister packs, inhalers, or injectablesto provide monitoring of patient medication compliance.

The use of devices for remote symptom monitoring forolder adults susceptible to heart failure have shown toimprove outcomes In the results reported in [20], studieson the use of information and communication technologies(ICT) to provide person-centered care to consumers withchronic conditions (cancer, cardiovascular, diabetes, respi-ratory and stroke), 64% of the studies reported a positiveoutcome and 12.9% reported a negative or no impact.The use of ICT, termed as Internet intervention, includedmonitoring devices and corresponding apps, in addition tothe use of web-based tools and apps providing access tomedical records.

[21] studied patients in a hospital that required con-tinuous predictive monitoring during their post-surgerystabilisation and recovery period, on the ward. Wearabledevices such as mobile pulse oximeters and mobile ECGsensors were used for continuous data acquisition afterwhich machine learning methods were applied. The goalwas to provide early warning of serious physiological oc-currence, such that predictive care may be provided. Thestudy highlights the difficulties of implementation, whilealso illustrating that such predictive monitoring is feasibleand practical.

There is substantial evidence that engaging a con-sumer/patient in her/his care of a chronic condition im-proves the outcomes [22]. The consumer benefits from

various means of engagement with the provider, withinformation exchange both ways; the consumer reportingdone using CGHD and the provider by way of verifyingadherence, revising activity regimes contextually, and fine-tuning medication, all of which leads to a higher mortalityand a better quality-of-life to the consumer. In summary,consumers with chronic diseases have benefited from the“disease-state” monitoring (CGHD), to receive fine-tunedcare and increased life-spans [23].

IV. State-of-the-Art

The feasibility of use of consumer health devices forwellness monitoring and prevention is now well estab-lished. The consumer-facing infrastructure for wellnessmonitoring has evolved significantly to provide a stablemonitoring infrastructure for wellness parameters. Thereare well defined interfaces between the consumer devicesand apps/apps providers. The accuracy of the devicesare currently acceptable. The CGHD from the devicesare mostly stored within the apps. The apps set activitygoals on a per-day basis and provide notifications to theconsumers to remind them to meet the goals, in additionto projecting the trends of the various monitored wellnessparameters on a dashboard. The consumer data is furtherbacked up to storage provided by the device/app provider.

While the utility of IoT devices and apps in the contextof care is well established, there are limitations in itswidespread use and integration into the main stream ofhealthcare. Two primary problems are apparent:

• the evolution of device technologies is still underway.Improvements in accuracy and consistency are ex-pected along with refinement of algorithms to includethe right parameters for energy expenditure estima-tion

• the integration of CGHD into the mainstream health-care data (often owned by the government) remainsto be done.

In the meantime, app vendors have begun to provideapps that can store health records and CGHD, within theapp itself. One such app that mentioned in literature ismyFitnessCompanion. It can upload and download healthdata from various servers, such as Microsoft HealthVault,Google Fit, Jawbone, Fitbit, and many more.

Healthcare apps developed using HealthKit can nowrequest medical records that conform to Health Level 7(HL7). The HL7 Version 3 Clinical Document Architecture(CDA) is a document markup standard that specifies thestructure and semantics of “clinical documents” for thepurpose of exchange between healthcare providers andpatients. Similar developments are available with Health-Vault. It is obvious that these providers are enabling usersto store their health data, both existing data as well as thedata they generate from their consumer healthcare devicesin a single consolidated medical record. Consequently, suchmedical records will have the complete long-term data of

the consumer in significant detail due to the availabilityof lifestyle and medication adherence information.

The introduction of health monitoring and telemedicinedevices approved by the FDA provide real-time and re-mote health monitoring of patients with chronic conditionsfor rapid monitoring of blood glucose levels or other vari-ables. While a subset of these data are currently availableto the care provider, a systematic way to integrate thesedata during the “disease window” of the patient with datafrom his or her prior healthy state is currently limited.

V. Security in HealthcareThere are many challenges that are associated with

integrating the digital technologies into the existing healthcare fabric. Within the Self-care and wellness landscape,one of the main challenge is the interoperability betweenthe heterogeneous self-care and Wellness technologies, thePersonal Health Records(PHRs) and the centralised Elec-tronic Health Records (EHRs), which is being addressedby many researchers. Interoperability is crucial for record-ing health information, developing common interfaces,agreeing on common data sets, and defining quality stan-dards. Interoperability necessitates development of dataplatforms in an international, comparable context andthus requires common principles.

While the open challenges relating to information ex-change between health information systems and hetero-geneous set of medical devices including the wearablesare being addressed by the research community, a majorroadblock on the road to large scale digitization of healthcare is security concerns. In particular, the safety andsecurity of individual patient records in a digital world andthe security threats emerging out of self-care and wellnessdevices connected to the Internet [24]. Balancing patientprivacy protections with advancing systems interoperabil-ity and enabling more data-driven analytics is an ongoingchallenge for many healthcare organizations.

The security challenges relating to the health care canbe broadly classified as data-centric and device-centric.Data-centric concerns are ethical in nature and addressdata confidentiality, privacy and data ownership. Device-centric challenges are technical in nature, particularlycaused by the devices and wearables due to the needfor their availability and constant connectivity for accessto services. Disruptions affect the device data streams.Attacks impact the service delivery, severely. The impactis not restricted to reputation, financial loss and customerdissatisfaction, but can affect patient safety making thisa safety-critical issue. Finally, authentication and identitymanagement of the devices to ensure encryption of datain transit is an existing challenge [25]

A. ConfidentialityConfidentiality of personal information gathered by self-

care and wellness technologies entirely relies on trust,given the fact that users are unaware internal working of

self-care/wellness devices and applications or the servicesthey connect to. The pre-requisite is a trust relationshipbetween the consumers and the service providers andapplication developers ensuring compliance with privacyregulation and security-best practices [26] and that theregulations and standards are in place to safeguard con-sumer interests. While the patient privacy dictates thatthe consumers have the right to control how their in-formation is collected and used , in practice the patientinformation is at risk in a number of ways. Medical infor-mation stored on devices that are lost or stolen may beaccessed by malicious users, particularly if information isnot secured using encryption. Information may be sharedunexpectedly because privacy practices and settings areconfusing or poorly described. Some apps may offer freeservices in return for access to personal information, anarrangement to which users can only give informed consentif fully disclosed. When physical, technical or organiza-tional confidentiality arrangements are inadequate, infor-mation transmitted online may be at risk of interceptionor disclosure and could potentially have drastic personalconsequences such as on health insurance and employmentcontracts etc. [26]

B. Data ReliabilityData reliability is a concern in large-scale implementa-

tion and integration of self-care and wellness technologiesinto the existing systems. Both the consumers and healthcare providers require the data generated by self-care andwellness technologies to be reliable and accurate, particu-larly when some systems rely on manual entry of healthdata (PHRs) that may be prone to error and bias fromhuman entry. Data validity is another concern. Monitoringdevices would require calibration to ensure that the senseddata is accurate and to estimate the error margins. Theremay be a need to calibrate periodically. One of the largestconcerns for CGHD is in regards to data provenance, orthe process of tracing and recording the source of the dataas it enters the system and moves across databases. Theability to capture and record contextual and source infor-mation ensures CGHD is useful, as these details impact theprovider’s understanding of the information and enhancestheir trust in the data. This is a policy-related issue asmuch as it is a technical one, as standards are yet to bedeveloped.

VI. ConclusionsThe availability of consumer devices, essentially IoT-

based, for purposes of monitoring daily activities or ele-ments of biological function of an individual has openedup a wide range of possibilities from maintaining well-ness to disease prevention. There is a range of devicesavailable in the market that address wellness and lifestyleand some elements of self care. Their accuracy levelshave evolved substantially enough for consistent use butnot to be imported into medical records. Integration of

such CGHD into medical records is facilitated by a fewproviders by storing them in HL7v3 CDA, making itavailable for integration with data with the healthcareproviders. Security and privacy of CGHD are concernsbeing addressed, as are data validity and reliability. Ourongoing work addresses some questions on type of care vs.,their requirements and devices, such as How does self-careapparatus change in terms of monitoring devices? What arethe medical requirements of a continuous monitored datastream (sample rate, missed samples and data drop patternspermissible, velocity, etc.), standards for the monitoringdevices, the certifying bodies and their recommendations

VII. Biography of AuthorsGopi Garge is the Director of SmartLancs Ltd., UK,

and a Fellow of the IPv6 Forum. He was the Convenerof the Network Services group at the Indian Institute ofScience (IISc), Bangalore after serving as a member of theNetwork Services & Engineering team of the Education& Research Network, ERNET. He can be contacted at -ggarge@gmail.com.

Chitra Balakrishna is a Senior Lecturer at the EdgeHill University, UK. She is the program leader for CyberSecurity. Her current research interests include Smartspaces and cyber security. She headed the research wing ofthe Centre of Excellence for Mobile Applications and Ser-vices (CEMAS), while at the University of South Wales.She can be contacted at Balakris@edgehill.ac.uk.

Soumya Kanti Datta is a Co-Founder of FutureTech Lab (in India) , a digital transformation provider.His activities focus on innovation, standardization anddevelopment of next-generation technologies in IoT, SmartCity and Cybersecurity. He has published more than 60research papers and articles in top ACM and IEEE Con-ferences, Magazines and Journals. He obtained an M.Scin Communications and Computer Security from TelecomParisTech (EURECOM), France. He can be contacted at- skd@future-tech-lab.com.

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