Ethical Resilience Management Framework for Critical Healthcare

Information Infrastructure

JYRI RAJAMÄKI, AARNE HUMMELHOLM

Leppävaara Campus

Laurea University of Applied Sciences

Vanha maantie 9, 02650 Espoo

FINLAND

Abstract: - The growing complexity of the digital ecosystem in combination with increasing global risks

that the focus is shifting from the control and securing of health and welfare data in a silo to using that data to

promote health and wellbeing worldwide in our connected world. On the other hand, we have an ethical need to

complement the existing security and risk management knowledge base by developing frameworks and models

where we are using, for example, artificial intelligence systems that enable network-wide flexibility and

resilience management that strive to maintain and improve critical operations.

Key-Words: - cloud services, cross-border healthcare, eHealth, healthy aging, SHAPES project, well-

being

Received: April 18, 2021. Revised: January 27, 2022. Accepted: February 28, 2022. Published: April 4, 2022.

ecosystem thinking steer the Smart and Healthy

Ageing through People Engaging in Supportive

Systems (SHAPES) project that supports the

wellbeing of the elderly at home. Ethical questions

have always been crucial in H&W. The rapid

dissemination of ICT makes some of those

questions even more pressing making cybersecurity

an important ethical dimension of the features of

future H&W solutions ethical principles [1], [2].

This design science research (DSR) continues the

the design science activities [4]. This DSR’s

environment is the e-health and e-wellbeing domain

and ambient assisted living of elderly persons. The

main problem concerning this DSR: The mental

them to live longer in their homes and live there

better. Elderly persons can be provided with better

home care and preventive healthcare. Elderly

persons can easily carry portable sensors and

intelligent devices on their bodies and wrists that

relay their vital information to hospital systems in

real-time, from which healthcare staff can track

using different types of communication technologies

(e.g. device-to-device, machine-to-machine, sensor-

to actuators communications systems). All this kind

of development together with artificial intelligence

gives elderly persons better life and healthcare

possibilities, now and in the future when they are

living in their homes.

2.1 People in the Environment

The latest sustainable development systems and

(IoT) devices, actuators, and sensors can be used to

improve the safety of the elderly lifestyle and home

environment. Such developments are very important

for the elderly and society as a whole, as the number

of elderly persons is growing rapidly, as lifestyle

changes in developed countries and improvements

in the medical field increase the amount of the aging

population. These innovations are used together

with information and communication technologies

to develop applications and services for elderly

new environment, so that they can use and manage

they get from new technologies - and healthcare

information and wellbeing information obtained

from them so that they would make their treatment

decisions as quickly and efficiently as possible. As

applications for intelligent sensor systems,

analytical equipment, telecommunications systems,

and various information systems evolve rapidly and

such information and communication environments,

it is difficult to ensure that security and

cybersecurity are implemented by the requirements

service providers use and store these patients’

information.

Integrating healthcare requirements in line with

providers in data centers are done according to

Fig.2 shows an access network environment

to be taken into account and addressed when using

this monitoring system, even if we use this

monitoring system to save lives in critical situations.

Location data has also been used against a person

when someone knows the person’s smart device and

its movements and knows exactly where the person

is. An example is that when a person goes into

communications environment, we must separate

bio-signals data from other information so that the

data can be safely transmitted from end to end of the

service chains and there are not any other

information going to the same address. Fig.4 shows

one service chain from IoT devices and sensors to

elderly persons’ smart devices and from that to a

data center and storage systems there. Table 1

sensors shown in Fig.4, as well as the user interface

vulnerabilities and also the probabilities of attack.

Fig. 3: Network architecture [11].

Fig. 4: Access Network architecture and sensors

used by the elderly.

devices use wireless interfaces when connected

also take care of security things so that hackers and

cyber attackers could not attack our systems and use

malware there. Because our IoT devices and sensors

are many different suppliers that mean also

challenges these devices’ resilience management.

3 Designing Path of Resilience

Management Framework

3.1 Ethics of Cybersecurity in Healthcare

freedom or privacy. However, neglecting

cybersecurity could undermine citizens’ trust and

confidence in the digital infrastructure, in policy

makers and in state authorities.” They continue

“cybersecurity is still an under-developed topic in

technology ethics. Although there are numerous

papers discussing issues such as ‘big data’ and

privacy, cybersecurity is—if at all—only discussed

as a tool to protect (or undermine) privacy.” For

example, if a medical implant producer protects the

the implant and frequently requires more surgeries

approach of principlism based on Beauchamp and

Childress’s [13] four principles of biomedical ethics

(respect for autonomy, nonmaleficence,

beneficence, and justice). The important aims of the

employment of ICT in H&W are efficiency and

quality of services, the privacy of information, and

confidentiality of communication, usability of

services, and safety [1]. Fig.5 maps the ethical

principles to technical aims.

isolating the disruption.

availability to their pre-event functionality.

protocol, a configuration of the system, personnel

training, or other aspects to become more

resilient.

Linkov et al. [17] combined the event

management cycles and NCW domains to create

resilience metrics for cyber systems. The process of

building resilience is a collective action of public

and private stakeholders responding to infrastructure

disruptions [18].

The purpose concerning security is to know what is

define trade-offs for security and privacy levels

versus system’s usability [9]. The overall aim is to

mitigate cybersecurity risks, which in turn supports

the business continuity and operations of the whole

society [9].

Investing in systems that improve confidence and

trust can significantly reduce costs and improve the

speed of interaction. From this perspective,

cybersecurity should be seen as a key enabler for the

development and maintenance of trust in the digital

world. Cybersecurity has the following four themes

understanding of security incidents, network traffic,

can prepare and plan for, absorb, recover from, and

Indicator of Compromise (IOC) information, and

3.4 Cyber Security Science

damage or threat. Fig.7 shows three perspectives of

properly managed and meets regulatory security

requirements. An information security audit is an

audit of the level of information security in an

organization. Security aware customers may require

ISMS certification before a business relationship is

established. Unfortunately, ISMS standards are not

perfect and they possess potential problems.

In Fig.8, security management covers the human

and organizational aspects of cybersecurity. Its

focus areas include security policy development and

implementation, risk management and information

security investment, incentives, and trade-offs.

Security management also integrates the social

layer’s operational and cognitive aspects; all

technical and organizational components should

development and deployment. Security technologies

are needed for fulfilling the recognized security

requirements, and for building resilient

infrastructures and systems with dependable

hardware and software that can also meet future

security challenges [9].

Security technologies enable the technical

protection of infrastructures, platforms, devices,

services, and data. Technical protection starts with

secure user identification and authorization which

access rights for others. A global trend is to increase

the use of cloud service technology when providing

critical services. Data go into a cloud and will not

come back to end-user’s devices. Also, government

data has already gone to a cloud, and in the future

more and more government data will migrate to

cloud servers and services. Partnerships between

cloud service providers and security solution

providers are becoming more common. We will see

the emergence of cloud service-specific solution

intelligence for cybersecurity develops with high

speed and offers new possibilities for better SA.

impossible [14]. No one can control the whole

system of infrastructures, and our outlook should

move to coordination and cooperation. The

these systems challenge our ability to understand

management are no longer sufficient in the modern

non-calculable stress situations. To address these

challenges, a risk assessment should be used

the consequences of foreseeable events, but

quickly recover and adapt when adverse events do

occur [14].