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Table 1 The second reference scenario considered in KONFIDO

From: Comprehensive user requirements engineering methodology for secure and interoperable health data exchange

Phase 1: Milan
Anna is a 45-year-old university professor living in Milan (Lombardy Region), Italy. For the summer holidays, Anna and her daughter are planning a cruise to Barcelona, Spain. Anna suffers from Diabetes type 2, while her 6-year-old daughter Cristina has heart disease since she was born. Being a chronic patient, Anna has learnt how to live with her disease and to manage her daughter’s health too, undertaking routine tasks such as measuring periodically Cristina’s vital signs (e.g., blood pressure), taking medicines, or performing tasks like glucose measurements and insulin injections. Cristina was enrolled in the Regional Program called CReG (Chronic Related Groups) and together with her mother they use a tele-monitoring service. CReG is a program which delegates the care management of chronic patients to General Practitioners, supporting them in the prescription, monitoring and renewal of care plans. The hospital of Milan has equipped both Anna and Cristina with a tele-monitoring kit for remote monitoring of their health condition. The kit includes medical devices and a gateway which sends the measured vital signs to the respective Service Center in Milan.
Phase 2: Naples
Travelling by car for a conference in Naples (Campania Region) with her husband and their daughter, Anna experiences a quite serious car accident and Cristina has serious wounds. The healthcare authorities in Naples, where the accident takes place, offer an innovative telemedicine application empowered by KONFIDO. Particularly, using the national eID technology that KONFIDO recognizes and handles properly, the retrieval of all the information needed to intervene while in the ambulance (patient identification, clinical details, immunization details, and usual therapy) is made possible. Specifically, Cristina’s data are retrieved from the EHR system of the healthcare authorities in the Lombardy Region.
Using the telemedicine application and a tablet, Cristina’s personal data (including pictures of her wounds) are transmitted through the mobile network to the emergency department by paramedics. Using KONFIDO technologies, paramedics can safely authenticate her and the encrypted transmission of her medical data is conducted. The application monitors the child, suggests actions, possibly re-routes the ambulance, and makes sure that everything is ready upon arrival at the hospital with the aim to speed-up the triage process and reinforce the preparedness levels.
Phase 3: Barcelona
After a few weeks, Cristina is discharged from the hospital in Naples and, given her risky heart condition, the doctor in Milan is immediately informed by the hospital in Naples that anti-coagulant therapy had to be interrupted. Consequently, the doctor decides to adjust the therapy and review the monitoring plan. Cristina and Anna can realize their vacation plans in Spain using the tele-monitoring service.
Anna and Cristina know that in case of problems, any hospital they might have to visit in Barcelona will have access to their patient summaries in Italy. During the journey, Anna faints and she is transferred to the nearest hospital in Barcelona to check her health condition. While the Spanish doctor is accessing Anna’s patient summary, a cyberattack tries to compromise the data exchange. Specifically, an international hacker group, using a system vulnerability, attacks and takes control of the NCP in the Spanish OpenNCP deployment. Thanks to KONFIDO security mechanisms, Anna’s data integrity and confidentiality is protected against the cyberattack and the doctor can make a diagnosis and provide the medical treatment.
  1. Terms highlighted in bold indicate verbs or phrases that have been used to identify the respective BPs in the scenario