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4.1 Health Grid (Summary)

Healthgrid is a computing system that is used in biomedical sciences and the application in medical is still in research. There arise some tension between grid paradigm and requirement of healthcare provider.
Healthgrid stores data at most convenient nodes through virtual organization (VO), which allow the users to to join the grid from time to time.  Meanwhile, the healthcare provider need to maintain the confidentiality of patient data. a suitable healthcare application should have the authorization and authentication of users in protecting patient privacy by anonymisation for individual data.

4.2 Breast Cancer
Issues
1. Confidentiality breach while transferring of  mammographic image (patient's data) to many imaging centre thru virtual organization.
2. Right to access patient's information (mammographic images) whether based on individual or location .

Solutions
1. The access should be made possible for individual instead of location. Only authorized personnel can access the information needed where ever he is. the attending physician will be held responsible for any breach of information because only he can have the access to the patient's information no matter where the treatment is taking place. (own)
2. The data can only be access by the authorized personnel based on the level of certificate right (administrator, doctor, radiographer, radiologist etc.). Administrator might not have the vast information regarding the patient as radiologist do thus decrease the possibility of information breach.
3. The images can be encrypted so that only the personnel who has the password can access the images. (own)

Islamic Perspective
Allah S.W.T mentioned in Al-Quran in Surah Al-Hujurat verse 12  'and spy not, neither back bite to one another'. Breaching patient's information can be considered as spying on others. This action is strongly prohibited in Islam because it gives greater bad than good. This action is the result of failure to appreciate the concept of Amanah (responsibilty) given to one. The personnel involved in handling the patient's data must not easily breach the responsibilty given to promote greater good and prevent greater .

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Introduction
Ethical Issue:
1. Issue of inaccuracies and misuse of patient's medical data.
This results in misdiagnosis and application of legal sanction upon medical practitioner due to malpractice (disclosure of medical data)

Solution:
1. The medical professionals and the researchers must understand well the ethical principles as well as practice the legal measures.
2. The viability and the sustainability of the ICT must be taken into account by the medical professionals and the researchers
3. Allow only an authorized person can access the  patient's medical data (own)
4. Apply two factors authentications PIN (own)

Islamic Perspective:
1. Amanah - Human being is created as a Khalifah on the earth to establish a just social order and peaceful society. Accountability, honesty, transparency and perfection of action are parts of Amanah. In medical imaging field, it is important for us a radiographer to protect patient's privacy and confidentiality of patient information.
Holy Quran, "Do not spy on one another". (49:12)

2. Summary of transforming ethical principle:
To respect patient confidentiality and protect them from harm and injustice, the basic ethical duties which are beneficence, non-malfeasance, autonomy and justice must be applied.

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1.       Issues in processing personal medical data without notifying the Information Comissioner

Solution:

The EU Directive prohibits the processing of data concerning health or sex life except for certain reasons such as the processing is necessary for medical purposes.

Solutions (Own):

- Practicing the Code of Amanah and Professionalism while processing medical data of the patient

- Only authorized person/people can access medical data of the patient

2. Breaching duty of confidence in imparting medical data which can cause pain and suffering to one who imparts the data

Solution 1
-Impose Health and Social Care Act 2001 (section 60) which gives Secretary of state to temporarily suspend the duty of confidence so that medical data can be used.
- Second party who imparts the data should have been properly assured by the third party that the data imparted will not make the second party to be humiliated nor harm.
- Third party who receive the information should abide to the duty of confidence by not disseminating medical data irresponsibly.

3. Issue of security in medical electronic records and protection of patient confidentiality.

SOLUTION:

Implementation of electronic card record by National Health Services (NHS), UK.

All patient’s current medical record (eg: allergy), will be uploaded into a database known as Summary Card Record (SCR) which based on mutual agreement between patients and healthcare practitioners involved. In fact, only patient and healthcare practitioners involved have access to this SCR by using smartcard and PIN.

(OWN) All healthcare practitioners should adhere to code of conduct and code of practice which they are obligated to not expose patient medical information to others party without their permission.

(OWN) Strict punishment by the authorized party should be implemented to those healthcare practitioners who are found guilty exposing patient medical information to other party without patient permission.

Islamic perspective:

We should not expose the information of other to other party without their permission especially their important information such medical records.  Allah says in the Holy Quran:

Allah loves those who turn to Him constantly (for forgiveness) and He loves those who keep themselves pure and clean. (Quran, 2:222)

If we see or hear about someone else committing a sin, we should always try to ignore it. Instead of spreading it, we should hide it and keep it a secret.

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Issue 1
-Breaching duty of confidence in imparting medical data which can cause pain and suffering to one who imparts the data

Solution 1
-Impose Health and Social Care Act 2001 (section 60) which gives Secretary of state to temporarily suspend the duty of confidence so that medical data can be used.
- Second party who imparts the data should have been properly assured by the third party that the data imparted will not make the second party to be humiliated nor harm.
- Third party who receive the information should abide to the duty of confidence by not disseminating medical data irresponsibly.

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Ethical issues:
1.Protection of the information regarding the public interest ( patient information)
2. The data security relates to privacy and maintenance of patient confidentiality and securely held data is less liable to unknown user.
3. Poor material quality can cause ambiguity in the image and may be detrimental to diagnosis.
4. Technical changes to the image (enlargement of images, changes in image definition) will create difficulties when accessed by the user.
5. cultural influences such as radiologist is trained to interpret images in a different way and different approaches to medicine as practiced by different cultures would affect the perspective of the interpretation and the ability to interpret the images.

Solutions:
1)  Follow the principle laid by the EU under data protection legislation

Own Solutions:
1. To provide guideline for the workers regarding the information that they can access and disclose.
2.  Develop a comprehensive confidentiality policy
3. Make sure all confidential information is stored within secure systems
4. Do the quality assurance program to make sure the modalities are maintained.
5. synchronization of the image into the same formats.
6. establish general guidelines among the radiologist for basic image interpretation.

Relevant Islamic perspective:

- Islam stress on the significant of Human right to privacy as the Holy Quran says:" Do not spy on one another" (49:12)

- Hadith :
It was narrated from ‘Abd-Allaah ibn ‘Amr that the Prophet (peace and blessings of Allaah be upon him) said: “There are four qualities, whoever has all of them is a pure hypocrite, and whoever has some of them has a characteristic of hypocrisy until he gives it up: when he is entrusted with something he betrays that trust; when he speaks he lies; when he makes a promise he breaks it, and when he disputes he resorts to lies and falsehood.” Narrated by al-Bukhaari, 34; Muslim, 58.

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4.3
Ethical issues 1:
Issues in unnecessary diagnostic examination undergo by patient to make initial diagnosis

solution:
1. MammoGrid project will standardize and summarize the images from the database into similar parameter (for example: information of type of x-ray machine and setting mammography). This will help the radiologist to come out with the history  from other cases and related to current patient cases to make a diagnosis. Thus, it can eliminate the unnecessary examination.
2. Provide an interface between radiologist to discuss (own)

Islamic perspective :
Based on hadith " Do not cause harm, or  return harm
- Muslim avoid to do harm to other Muslims

issue 2
- Issue in validity informed consent that can be guaranted by the Mammo Grid Project, since the information will remain outside as references to others.

solution :
-The data must be encrypted and pseudomysed before trasmitted
- Use authentication ID to access the data (own)

Islamic perspective :
Al- Quran (24:27)
- Importance of getting permission from the owner before entering their own place

4.4
Ethical issues:
- Issues in confidentiality and duty of care as the genetic information of one person will reveal the genetic map of his/her siblings as well.

4.5
- Health e-Child Project focused on development and illness in childhood, especially conditions in which genetic predisposition is at least suspected and in the diagnosis of which imaging is also essential.
- Issues same with 4.4

Solutions:
- Ensure the healthcare professionals that can access the genetic information are put under heavy scrutiny to ensure there is no conflict of interest.
- Deployment of global data management that are equipped with integrity function, corruption detection and index rebuilding

Islamic perspective:
Islam advocated justice and human rights.
Ṣaḥīḥ Muslim Kitāb al-Li` ān. Ḥadīth no. 1500