Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment

BMC Medicine

Josip Car³  Pierre-Jean Benghozi¹  Myra Tilney²  José Tomás Prieto¹  Kit Huckvale² 

[1] CRG, Ecole polytechnique CNRS, Bâtiment Ensta, 828 boulevard des Maréchaux, Palaiseau 91762, Cedex, France;Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK;Health Services and Outcomes Research Programme, LKC Medicine, Imperial College, Nanyang Technological University, Singapore, Singapore

关键词: Systematic assessment;    Cross-sectional study;    Confidentiality;    Privacy;    NHS;    Accreditation;    Apps;    Mobile;    Smartphone;   

Others  :  1227218
DOI  :  10.1186/s12916-015-0444-y

 received in 2014-12-18, accepted in 2015-08-07,  发布年份 2015

【 摘 要 】

Background

Poor information privacy practices have been identified in health apps. Medical app accreditation programs offer a mechanism for assuring the quality of apps; however, little is known about their ability to control information privacy risks. We aimed to assess the extent to which already-certified apps complied with data protection principles mandated by the largest national accreditation program.

Methods

Cross-sectional, systematic, 6-month assessment of 79 apps certified as clinically safe and trustworthy by the UK NHS Health Apps Library. Protocol-based testing was used to characterize personal information collection, local-device storage and information transmission. Observed information handling practices were compared against privacy policy commitments.

Results

The study revealed that 89 % (n = 70/79) of apps transmitted information to online services. No app encrypted personal information stored locally. Furthermore, 66 % (23/35) of apps sending identifying information over the Internet did not use encryption and 20 % (7/35) did not have a privacy policy. Overall, 67 % (53/79) of apps had some form of privacy policy. No app collected or transmitted information that a policy explicitly stated it would not; however, 78 % (38/49) of information-transmitting apps with a policy did not describe the nature of personal information included in transmissions. Four apps sent both identifying and health information without encryption. Although the study was not designed to examine data handling after transmission to online services, security problems appeared to place users at risk of data theft in two cases.

Conclusions

Systematic gaps in compliance with data protection principles in accredited health apps question whether certification programs relying substantially on developer disclosures can provide a trusted resource for patients and clinicians. Accreditation programs should, as a minimum, provide consistent and reliable warnings about possible threats and, ideally, require publishers to rectify vulnerabilities before apps are released.

【 授权许可】

   
2015 Huckvale et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Klasnja P, Pratt W. Healthcare in the pocket: mapping the space of mobile-phone health interventions. J Biomed Inform. 2011; 45:184-98.
• [2]research2guidance. Mobile health market report 2013–2017. http://www. research2guidance.com/shop/index.php/downloadable/download/sample/sample_id/262/ webcite
• [3]Comstock J. Survey: 32 percent of mobile device owners use fitness apps. http://mobihealthnews. com/29358/survey-32-percent-of-mobile-device-owners-use-fitness-apps/ webcite
• [4]Manhattan Research. 2014 environment. http://manhattanresearch. com/Products-and-Services/Physician/Taking-the-Pulse-U-S webcite
• [5]Steinhubl SR, Muse ED, Topol EJ. Can mobile health technologies transform health care? JAMA. 2013; 310:2395-6.
• [6]Kotz D. A threat taxonomy for mHealth privacy. In: Third International Conference on Communication Systems and Networks (COMSNETS), 4–8 January 2011. COMSNETS, Bangalore; 2011: p.1-6.
• [7]Cohn SP. Privacy and confidentiality in the nationwide health information network. National Committee on Vital and Health Statistics, Washington; 2006.
• [8]Smith HJ, Dinev T, Xu H. Information privacy research: an interdisciplinary review. MIS Q. 2011; 35:989-1016.
• [9]Njie L. Mobile health and fitness apps: what are the privacy risks? https://www. privacyrights.org/mobile-health-and-fitness-apps-what-are-privacy-risks webcite
• [10]Sunyaev A, Dehling T, Taylor PL, Mandl KD. Availability and quality of mobile health app privacy policies. J Am Med Inform Assoc. 2014; 22:e28-33.
• [11]Dehling T, Gao F, Schneider S, Sunyaev A. Exploring the far side of mobile health: information security and privacy of mobile health apps on iOS and Android. JMIR Mhealth Uhealth. 2015; 3:e8.
• [12]He D, Naveed M, Gunter CA, Nahrstedt K. Security concerns in Android mHealth Apps. AMIA 2014 Annual Symposium, 15–19 November 2014. AMIA Symposium, Washington; 2014.
• [13]Adhikari R, Richards D. Security and privacy issues related to the use of mobile health apps. 25th Australasian Conference on Information Systems, 8–10 December 2014. Australasian Conference on Information Systems, Auckland; 2014.
• [14]NHS Choices. Health apps library – safe and trusted apps to help you manage your health. http://apps. nhs.uk/ webcite
• [15]Agencia de Calidad Sanitaria de Andalucia. [Distintivo appsaludable]. http://www. calidadappsalud.com/ webcite
• [16]England NHS. Five year forward view. HM Government, London; 2014.
• [17]Happtique I. Happtique: recommend the best apps (iOS, Android) to patients. https://www. happtique.com/ webcite
• [18]MyHealthApps.net. My health apps – tried and tested by people like you. http://myhealthapps. net/ webcite
• [19]LaRose R, Rifon N. Your privacy is assured - of being disturbed: websites with and without privacy seals. New Media & Soc. 2006; 8:1009-29.
• [20]Dolan B. Happtique suspends mobile health app certification program. http://mobihealthnews. com/28165/happtique-suspends-mobile-health-app-certification-program/ webcite
• [21]Singh I. Introducing the health apps library. http://www. england.nhs.uk/2013/03/13/health-apps-blog/ webcite
• [22]NHS Health Apps Library. Review process. http://apps. nhs.uk/review-process webcite
• [23]HM Government. Data Protection Act 1998. http://www. legislation.gov.uk/ukpga/1998/29/contents webcite
• [24]iFunBox Dev Team. iFunBox – app installer & file manager for iPhone, iPad and iPod Touch 2.7. http://www. i-funbox.com/ webcite
• [25]ES APP Group. ES file explorer file manager 3.0.7.0. https://play. google.com/store/apps/details?id=com.estrongs.android.pop webcite
• [26]Open Web Application Security Project. Man-in-the-middle attack. https://www. owasp.org/index.php/Man-in-the-middle_attack webcite
• [27]Cortesi A. mitmproxy: a man-in-the-middle proxy 0.9.2. http://mitmproxy. org/ webcite
• [28]Callegati F, Cerroni W, Ramilli M. Man-in-the-middle attack to the HTTPS protocol. IEEE Secur Priv. 2009; 7:78-81.
• [29]Open Web Application Security Project. Certificate and public key pinning. https://www. owasp.org/index.php/Certificate_and_Public_Key_Pinning webcite
• [30]Privacy notices code of practice. Information Commissioner’s Office, Wilmslow; 2010.
• [31]Information Commissioner’s Office. Privacy in mobile apps – guidance for app developers. http://ico. org.uk/for_organisations/data_protection/topic_guides/online/~/media/documents/library/Data_Protection/Detailed_specialist_guides/privacy-in-mobile-apps-dp-guidance.pdf webcite
• [32]European Commission. Commission decisions on the adequacy of the protection of personal data in third countries. https://web. archive.org/web/20150628225441/http://ec.europa.eu/justice/data-protection/document/international-transfers/adequacy/index_en.htm webcite
• [33]Open Web Application Security Project. SQL injection. https://www. owasp.org/index.php/SQL_Injection webcite
• [34]Agencia de Calidad Sanitaria de Andalucia. [Estrategia de calidad y seguridad en aplicaciones móviles de salud – confidencialidad y privacidad]. http://www. calidadappsalud.com/recomendaciones/confidencialidad-privacidad/ webcite
• [35]Agaku IT, Adisa AO, Ayo-Yusuf OA, Connolly GN. Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers. J Am Med Inform Assoc. 2014; 21:374-8.
• [36]King J. “How come I’m allowing strangers to go through my phone?” – smartphones and privacy expectations. Symposium on Usable Privacy and Security (SOUPS), 11–13 July 2012. SOUPS, Washington; 2012.
• [37]Boyles JL, Smith A, Madden M. Privacy and data management on mobile devices. http://www. pewinternet.org/2012/09/05/privacy-and-data-management-on-mobile-devices/ webcite
• [38]Shklovski I, Mainwaring SD, Skúladóttir HH, Borgthorsson H. Leakiness and creepiness in app space: perceptions of privacy and mobile app use. In: 32nd annual ACM CHI Conference on Human Factors in Computing Systems, 26 April–1 May 2014. ACM, Toronto; 2014: p.2347-56.
• [39]Office of the Privacy Commissioner of Canada. Results of the 2014 Global Privacy Enforcement Network sweep. https://www. priv.gc.ca/media/nr-c/2014/bg_140910_e.asp webcite
• [40]Finkle J, Chatterjee S, Maan L. EBay asks 145 million users to change passwords after cyber attack. http://www. reuters.com/article/2014/05/21/us-ebay-password-idUSBREA4K0B420140521 webcite
• [41]Harris KD. California data breach report. http://oag. ca.gov/ecrime/databreach/reporting webcite
• [42]Ferrero-Alvarez-Rementeria J, Santana-Lopez V, Escobar-Ubreva A, Vazquez-Vazquez M. Quality and safety strategy for mobile health applications: a certification programme. Eur J ePractice. 2013.
• [43]Plachkinova M, Andres S, Chatterjee S. A taxonomy of mHealth apps – security and privacy concerns. In: The 48th Hawaii International Conference on System Sciences (HICSS), 5–8 January 2015. HICSS, Kauai; 2015: p.3187-96.
• [44]Martinez-Perez B, de la Torre-Diez I, Lopez-Coronado M. Privacy and security in mobile health apps: a review and recommendations. J Med Syst. 2014; 39:181.
• [45]Weber RH. Internet of Things – new security and privacy challenges. Comput Law Secur Rev. 2010; 26:23-30.
• [46]Bureau of Consumer Protection. Marketing your mobile app: get it right from the start. http://www. business.ftc.gov/documents/bus81-marketing-your-mobile-app webcite
• [47]Mobile privacy disclosures – building trust through transparency. Federal Trade Commission, USA; 2013.
• [48]Organisation for Economic Co-operation and Development. The OECD privacy framework 2013. http://www. oecd.org/sti/ieconomy/oecd_privacy_framework.pdf webcite
• [49]OWASP Mobile Security Project. Top ten mobile risks – final list 2014. https://www. owasp.org/index.php/Projects/OWASP_Mobile_Security_Project_-_Top_Ten_Mobile_Risks webcite
• [50]Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff (Millwood). 2014; 33:216-21.
• [51]Yang YT, Silverman RD. Mobile health applications: the patchwork of legal and liability issues suggests strategies to improve oversight. Health Aff (Millwood). 2014; 33:222-7.
• [52]Federal Trade Commission. “Acne cure” mobile app marketers will drop baseless claims under FTC settlements. http://www. ftc.gov/news-events/press-releases/2011/09/acne-cure-mobile-app-marketers-will-drop-baseless-claims-under webcite
• [53]Medicines and Healthcare Regulatory Agency. Guidance on medical device stand-alone software (including apps). http://www. mhra.gov.uk/Howweregulate/Devices/Software/index.htm webcite
• [54]Cortez NG, Cohen IG, Kesselheim AS. FDA regulation of mobile health technologies. N Engl J Med. 2014; 371:372-9.
• [55]Takabi H, Joshi JBD, Gail-Joon A. Security and privacy challenges in cloud computing environments. IEEE Secur Priv. 2010; 8:24-31.
• [56]Abbas A, Khan SU. A review on the state-of-the-art privacy-preserving approaches in the e-Health clouds. IEEE J Biomed Health Inform. 2014; 18:1431-41.
• [57]Huckvale K, Car J. Implementation of mobile health tools. JAMA. 2014; 311:1447-8.