Suppose that the government would like to create a database with a national scop

Question

Suppose that the government would like to create a database with a national scope, aiming to record patients' details about when and where do they perform medical checkups and what is the reason/illness for the checkups. Patients may opt to include their records into the database, or they may opt out.

In terms of information security, think of at least one different:

1. Benefit for the individual.

2. Benefit for the wider society.

3. Serious risk for the individual.

4. Serious risk for the wider society.

5. Benefit or risk of a specific entity other than a patient (such as a doctor, or any stakeholder involved).

Explanation / Answer

Jones [75] carried out a study of NHS kiosks in 2001. Automatic monitoring statistics were produced for all 136 kiosks for four months showing number of user episodes. A sample of twenty kiosks representative of type of site and geographical location was taken for an ‘exit poll’ and geographically defined postal survey. A total of 1,666 people were interviewed leaving nineteen sites. (One site was unable to participate in interviews.) Postal questionnaires were sent to 1,400 randomly selected households living within five kilometres of the twenty kiosks. Kiosk sites and respondents to the postal survey were classified by deprivation category. All 1,652,586 English postcodes were ranked according to an index of multiple deprivation and postcode areas then classified according to their decile of deprivation.

Routine statistics for all 136 kiosks showed they were used on average twelve times a day; one was used 49 times but a fifth less than four times a day. Fifty-three percent of kiosks were in the two most deprived but eight percent were in the four most affluent deciles of English postcodes. Leisure centres, tourist sites, hospitals, and supermarkets had the highest usage and community and education sites the least use. As a result of the opening hours of each site, kiosks were available from 20 hours a week through to 168 hours (24/7) a week and (not surprisingly) those available for longer hours were used more. A third of those interviewed leaving the site had seen the kiosk but only 6% (94) had used it, the main stated reason for non use being that they did not know what it was. Only nine gave their reason for not using the kiosk as their ability to get information from the Internet. Overall 63% might use it in the future but this varied from 2% to 100% by site. Older people were less likely to have noticed the kiosk, used it or possibly would use it in the future.

Those who had obtained other health information were more likely to use the kiosk than people who had not obtained other health information (8% vs 4%; 2 = 7.4; 1df; p = 0.006). The kiosk attracted users who were already seeking information from computers, written information, or who had used NHS Direct in the last two weeks. A small minority (39, 2% of total) used the kiosk who had not obtained any other health information in the last two weeks. These 39 were younger (37 vs 46 years old; t = 3; 1642df; p = 0.002) but there was no difference in gender, car ownership, and first language with the rest of the interviewees. Thirty-four (87%) said they were likely to use the kiosk again.

Just under half (44%) of the postal respondents had obtained health information from any source in the last two weeks, the majority (33%) being in face-to-face contact. Fifty-eight percent (160) of those with home or work access to the Internet had used it to obtain health information at some time. Nineteen had used the Internet without access at home or work. Of the 223 who had Internet access but had not used it, 127 (57%) said they may use the touch-screen kiosk. A quarter had obtained health information from the Internet, 36% had not used the Internet to obtain health information nor would they use the kiosk, but 39% who had not used the Internet would use the kiosk now that they knew about it.

Although the study provided some evidence that kiosks can increase accessibility of health information, level of use was low. Many kiosks could have been better sited and this study was used to review locations. Sites such as supermarkets and leisure centres, visited frequently by people aged over 60, were more likely to reach those who did not use the Internet for health information. Many did not notice the kiosk and others did not know what it was. A less ‘corporate’ kiosk design may have been more eye-catching and may have encouraged more users. NHS kiosks were decommissioned around 2005 (Bob Gann, personal communication).

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