6th European Conference - Academic Conferences

Shada Alsalamah et al.
Level 3 allows dynamic control. It enables persistent control over information anywhere outside
domain(a), including domain(b), using the rules(a) by communicating rules(a) along with the
shared information. Furthermore, persistent control, in this context, enables synchronisation of
any changes made regarding the protection level of the original information in domain(a) with the
shared version of the information in domain(b). This guarantees full control of user(a) at all times
by sustaining the original information protection level outside its domain, making it remotely
editable. In this context, only the final protection level creates an SCE in a VO, therefore, a
collaborative environment, with multiple independent domains, is referred to as an SCE, when
each domain has persistent control over its shared information.
Based on this, we can differentiate between level 2 and 3, in that the dynamic control creates an SCE,
whereas the static control does not. This is because the latter leaves the information out of both
users’ control at the point when it leaves domain(a) and before being received at domain(b), although
it is secured otherwise.
In fact, static and dynamic levels of information protection could suit different scenarios based on the
information protection level required. This paper explores the need for SCEs in VOs and the
challenges in implementing this environment by investigating a representative example of a VO,
namely the healthcare scenario. This paper is based on a study-case scenario carried out in this
naturally complex environment where healthcare professionals from different organisations critically
need to collaborate and have control over exchanged medical information when treating a patient with
breast cancer in Wales, UK. The paper is now divided into five main sections, which cover the
problem statement, method for understanding the problem, results, a discussion of the results and
conclusion.
2. Problem statement
In this scenario, the patient treatment delivery model is shifting from a disease-centric approach
towards one that is patient-centric (Allam, 2006; Al-Salamah et al., 2009), and considers the patient’s
medical condition as a whole rather than by managing patients as having separate diagnosed
diseases, each treated by different professionals (Department of Health, 1997; Pirnejad, 2008; Al-
Salamah et al., 2009). In a patient-centric approach, the patient is the central focus and is treated by a
Multi-Disciplinary care Team (MDT) (Allam, 2006; Al-Salamah et al., 2009). This team consists of
different healthcare professionals coming from different healthcare organisations to form a VO for
patient treatment. This MDT, and hence the VO, evolves over time in response to the patient’s
changing medical condition. In addition, in order to organise the MDT work and assist the delivery of
patient treatment, a visual and structured care plan, called an Integrated Care Pathway (ICP), is
followed. This plan reflects an ideal, evidence-based patient treatment journey for the condition
(Zander, 2002; Al-Salamah et al., 2009; Map of Medicine, 2010e). In the UK, ICPs are based on
having regular MDT meetings to discuss the patient’s case and provide recommendations for the
treatment management plan. This new approach is increasing the need for sharing medical
information among MDT members as they work together on treating the patient. Consequently, this
will possibly require the information to leave the systems where each member stores patient
information (Smith and Eloff, 1999; Thompson et al., 2003; Beale, 2004; Pirnejad, 2008). The
distributed nature of this collaboration demands an effective SCE, that facilitates secure interprofessional
communication among members, to exchange often-sensitive information.
HISs currently used in patient treatment are hindering inter-professional communication among MDT
members in the health environment. The literature shows that healthcare is suffering from poor interprofessional
communication (Pirnejad, 2008) and this is a key factor contributing to medical errors
(Mohyuddin et al., 2008; Al-Salamah et al., 2009). Indeed, research estimates an annual figure of
850,000 medical errors occurring in NHS hospitals (Department of Health, 2000). These can lead to
death, life-threatening illness, disability, admission to hospital, or prolongation of a hospital stay, as
well as inevitable complications in treatment in some cases which might have been avoided in most
cases if the patient had received ordinary standards of care (Department of Health, 2000; Aylin et al.,
2004). Furthermore, the NHS spends around £400 million annually in settlement of clinical negligence
claims, and has a potential liability of around £2.4 billion for existing and expected claims (Department
of Health, 2000). However, a prime reason behind communication issues and medical errors in the
healthcare environment is the limitation of HIS and ICT used in patient treatment (Smith and Eloff,
1999; Commission for Health Improvement and Audit Commission, 2001; Anderson, 2008;
Mohyuddin et al., 2008; Pirnejad, 2008; Al-Salamah et al., 2009; Skilton et al., 2009). These cause
problems in data processing and representation, the amount of information they are capable of
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