Cybersecurity design considerations for cross-boundary clinical decision support

The idea of cross-boundary clinical decision support has the potential to transform the design of open data and decision support platforms through a connected system that allows for harnessing of information and peer opinion across geographical and organizational boundaries for more effective decision making. In health care, cross-boundary clinical decision systems pose a major challenge from the perspective of e-security design. When clinical decision support systems, which essentially enable the transfer and storage of patient data, become cross-boundary systems, the protection of this data at different storage locations and in transit becomes more challenging. In this paper, we present a model of awareness for cross-boundary clinical decision support, which takes account of the concept of work practice as a design feature for enabling context-aware information sharing and secured health data management in cross-boundary clinical decision support. The proposed model is based on the practice theoretic paradigm and draws from a notion of context awareness as an interaction problem with a view to representing work practices as a context parameter for the design of computational systems for cross-boundary decision support. We illustrate how the approach addresses key security and privacy challenges in clinical decision support systems for cross-boundary support.