Web Science Institute Research Collaboration Stimulus Fund Final Report

Individual and Network Trust in Remote Monitoring Systems (INTRMS)

Investigators: Jane Prichard, Marta Glowacka (Health Sciences: HS), Brian Pickering (IT Innovation: ITI), Melanie Ashleigh (Business School: SBS), Service Provider Partner: Prof Chris Edwards(NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust: UHS)

Project Overview

Contemporary advances in web systems have made possible the design of a plethora of new technologies aimed at revolutionising healthcare delivery (Craig et al., 2015). Facilitated by the IoT(Gubbi et al., 2013; Tarouco et al., 2012), e-Monitoring of patients is a rapidly emerging part of this development potentially offering a range of benefits that could reduce the costs of healthcare delivery and improve the quality of care provided (Bruining et al., 2014) . However, whilst scientific advances makes such new technology possible, whether or not these are then adopted by users is not a given and is partially influenced by the trust users place in response to the perceived trustworthiness ofthe socio-technical network required. This project considers the role of trust in eHealth monitoring to inform distributed Internet-based service design.

Work undertaken

Literature Review.

The literature review was undertaken to explore the topic of trust and technology with special focus on trust in the context of eHealth. PsycINFO, CINAHL Complete, MEDLINE, Web of Science and Computer & Applied Science Complete databases were searched to identify relevant articles published in peer reviewed journals in English. The key search terms included: trust, apps, mobile applications, telehealth, telemedicine and technology. Key findings from the literature review revealed consensus that it is acceptable to borrow models of trust from human-to-human interactionsin order to understand trust in technology but to adapt them around characteristics of the IT artefact,the data being acted upon, the domain, and the wider socio-technological system in which it operates. Several models of H2T trust were identified which draw on theoretical models of H2H trust (e.g. Thatcher et al 2011; Söllneret al 2012). Key variables found to influence trust in technology includedfactors of trustworthiness made relevant to IT artefacts (e.g. functionality, predictability, helpfulness, process, performance and purpose)which were embedded in a wider socio-technical context. In eHealth, factors in this wider context might typically include beliefs about care providers, and purpose in the wider system of care. Furthermore, trust is widely agreed to involve cognitive, affective and behavioural dimensions operating together in a reciprocal, dynamic cycle.

In the data collection stage of the project, these variables wereused to develop relevant themes for user and clinician interviews with the aim of identifying factors that influence user propensity to trust in eHealth using monitoringApps specifically. Two semi-structured interview schedules were developed and piloted on RA sufferers asked to reflect on hypothetical use of an eHealth monitoring App. Feedback from this pilot wasused to refine the final questions intended to explore the use of the app with patient users and clinicians.

Ethics and research access.

As this project involves NHS patients and staff it was necessary to gain ethics approval from the NHS Research Ethics Committee. The INTRMS pilot study is embedded in a larger project (RApp) aimed at developing eMonitoring devices for the treatment of rheumatoid arthritis patients and therefore a single application was made that incorporated both research projects.Whilst not atypical, gaining approval was a lengthy process and was only provisionally gained on 10th February 2016 pending minor clarifications. Unfortunately, we were further held up as the PI on the wider project was delayed in gaining R&D approval from the hospital as he did not have a research passport and current DBS check. This was only finally obtained at the beginning of July and only at that point where we able to start to recruit clinicians for the WSI part of the study. This has proven difficult to achieve across the period due to staff holidays and shift patterns with only two interviews performed to date. We hope to collect the remaining clinician data in August and September. The patient data collection has been completely held up until the start of August due again to the PI of the wider project who is providing the app not being available. We hope to be able to collect this data subject to finding money for the RA from other sources or finding the time to collect the data ourselves. The net effect of all these problems is that we are unable to present any data at this time which is very disappointing but completely outside of our control. Nonetheless, the design of the research protocol, including one developed for the interim report, as well as the initial literature review contributed significantly to the development of an external research proposal and establishing collaborative contacts (see below).

Costs

Monies awarded were slightly reallocated to the Faculties of the researchers involved to reflect more fully the cost of their activity due to the work on the proposal development. This was diverted from the underspend on the RA costs due to problems with research approval. Otherwise the project came in slightly under budget.

Outputs

Although we are not yet in a position to report on the project findings we do still intend to collect this data and write it up in the coming months. On the basis of this expectation we have submitted a paper to the First International Network on Trust conference which will take place in Dublin this November. This paper will be in the “First Cut” section of the conference to get feedback on our ideas at an early stage of development to further inform our thinking and refine it for publication. We are also looking at the possibility of submitting in the coming weeks to the 2ndIoT & Cloud Computing conference in Cambridge next March.

More significantly the team have already submitted a funding grant application to the EPSRC based on the work and ideas incorporated in the WSI study. The proposal was submitted in June for a total sum of £717,553.60 with a notification expected from the EPSRC in November. Rather than producing a three page summary, for convenience we have attached the case for support submitted. The proposal to the EPSRC Cyber Security programme draws on our thinking around the role of trust in cyber security in EHealth monitoring apps across the health and social care sector. As with the pilot it looks at the factors that matter to people around the cyber security of this health data across the network of users. Specifically it aims to enhance understanding of the human dimensions of cyber security in two senses:

  • increasing understanding of how user perceptions and attitudes affect the security of multi-stakeholder eHealth monitoring systems against cyber threats; and
  • improving the resilience of systems through incorporating this understanding into a co-design methodology which builds cyber security into eHealth and eSocial care applications.

Led by IT innovation with input from Health Sciences, the Buisness School and Social Sciences, the proposal development has also enabled us to build a wide network of collaborators who either research cyber security or e-Monitoring in healthcare or whom are involved in app development. During the preparation for the proposal, we developed contact and support from a number of commercial organisations (IBM Israel, OCC and OYSTA in the UK), as well as research organisations (NORUT in Norway, and Ospedale San Raffaele in Italy). This growing research network will facilitate other research opportunities should we fail to be successful with the proposal submitted.

Although we realise that we have not quite achieved all our aims in relation to data collection at this time, we hope that the submission of the research proposal will show the enormous benefit that has come from the WSI stimulus fund awarded to us by giving our team a platform for research and network development activity in the important and unique area of e-Monitoring in healthcare.

References

Bruining, N., Caiani, E., Chronaki, C., Guzik, P., & van der Velde, E. (2014). Acquisition and analysis of cardiovascular signals on smartphones: potential, pitfalls and perspectives. European Journal of Preventive Cardiology, 21, 4-13. doi:10.1177/2047487314552604

Craig, J. A., Carr, L., Hutton, J., Glanville, J., Iglesias, C. P., & Sims, A. J. (2015). A review of the economic tools for assessing new medical devices. Applied health economics and health policy, 13(1), 15-27. doi:10.1007/s40258-014-0123-8

Gubbi, J., Buyya, R., Marusic, S., & Palaniswami, M. (2013). Internet of Things (IoT): A vision, architectural elements, and future directions. Future Generation Computer Systems, 29(7), 1645-1660. doi:10.1016/j.future.2013.01.010

Tarouco, L. M. R., Bertholdo, L. M., Granville, L. Z., Arbiza, L. M. R., Carbone, F., Marotta, M., & de Santanna, J. J. C. (2012). Internet of Things in healthcare: Interoperatibility and security issues. Paper presented at the 2012 IEEE International Conference on Communications (ICC).

Söllner, M., & Leimeister, J. M. (2013). What we really know about antecendetns of trust: A critical review of the empirical information systems literature on trust. In D. Gefen (Ed.), Psychology of Trust: New Research (pp. 127-155). Hauppauge, NY: Nove Science Publishers.

Thatcher, J. B., McKnight, D., Baker, E. W., Arsal, R. E., & Roberts, N. H. (2011). The role of trust in postadoption it exploration: An empirical examination of knowledge management systems. Engineering Management, IEEE Transactions on, 58(1), 56-70. doi:10.1109/TEM.2009.2028320