BackgroundIncreased digitalization of healthcare comes along with the cost of cybercrime proliferation. This results to patients’ and healthcare providers' skepticism to adopt Health Information Technologies (HIT). In Europe, this shortcoming hampers efficient cross-border health data exchange, which requires a holistic, secure and interoperable framework. This study aimed to provide the foundations for designing a secure and interoperable toolkit for cross-border health data exchange within the European Union (EU), conducted in the scope of the KONFIDO project. Particularly, we present our user requirements engineering methodology and the obtained results, driving the technical design of the KONFIDO toolkit.MethodsOur methodology relied on four pillars: (a) a gap analysis study, reviewing a range of relevant projects/initiatives, technologies as well as cybersecurity strategies for HIT interoperability and cybersecurity; (b) the definition of user scenarios with major focus on cross-border health data exchange in the three pilot countries of the project; (c) a user requirements elicitation phase containing a threat analysis of the business processes entailed in the user scenarios, and (d) surveying and discussing with key stakeholders, aiming to validate the obtained outcomes and identify barriers and facilitators for HIT adoption linked with cybersecurity and interoperability.ResultsAccording to the gap analysis outcomes, full adherence with information security standards is currently not universally met. Sustainability plans shall be defined for adapting existing/evolving frameworks to the state-of-the-art. Overall, lack of integration in a holistic security approach was clearly identified. For each user scenario, we concluded with a comprehensive workflow, highlighting challenges and open issues for their application in our pilot sites. The threat analysis resulted in a set of 30 user goals in total, documented in detail. Finally, indicative barriers of HIT acceptance include lack of awareness regarding HIT risks and legislations, lack of a security-oriented culture and management commitment, as well as usability constraints, while important facilitators concern the adoption of standards and current efforts for a common EU legislation framework.ConclusionsOur study provides important insights to address secure and interoperable health data exchange, while our methodological framework constitutes a paradigm for investigating diverse cybersecurity-related risks in the health sector.Electronic supplementary materialThe online version of this article (10.1186/s12911-018-0664-0) contains supplementary material, which is available to authorized users.

It is often said that the Internet is ubiquitous in our daily lives, but this holds true only for those who can easily access it. In fact, billions of people are still digitally-disconnected, as bringing connectivity to certain zones does not make a good business case. The only solution for these unsatisfied potential users is to directly undertake the building of the infrastructure required to obtaining access to the Internet, typically forming groups in order to share the corresponding cost. This article presents a global classification and a summary of the main characteristics of different Alternative Network deployments arisen in the last years with an aim to provide Internet services, in places where mainstream network deployments do not exist or are not adequate solutions. The "Global Access to the Internet for All" Research Group of the Internet Research Task Force, where all authors actively participate, is interested in documenting these emerging deployments. As an outcome of this work, a classification has converged by consensus, where five criteria have been identified and, based on them, four different types of Alternative Networks have been identified and described with real-world examples. Such a classification is useful for a deeper understanding of the common characteristics behind existing and emerging Alternative Networks.

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Innovative eHealth technologies and solutions are changing the way healthcare is delivered, raising many challenges regarding the ethical concerns that need to be addressed. There is a growing demand for tools that enable the assessments of the ethical impact in order to assure compatibility or highlight areas of incompatibility. This paper aims to address the ethical challenges that will arise during KONFIDO EU-funded project. KONFIDO project aims to develop tools and procedures to create a paradigm for secure inner and cross-border exchange of healthcare data in a legal and ethical way at both national and European level. The paper proposes an ethical framework that consists of a set of ethical principles derived from recent literature and European regulation and a supporting checklist. The ethical framework represents a concrete and practical guidance for healthcare professionals and developers in order to build ethically acceptable KONFIDO solutions.

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