IEEE Technology and Society Magazine - Spring 2013 - 41

facility or by its affiliate third party
provider to ensure that there is a sufficiently large subscription base to
support the operation. people in the
rural community can be invited to
subscribe to the micro-health-insurance in exchange for low or no cost
healthcare by community healthcare workers. The money raised
through the insurance premium will
be used to fund both the community
healthcare workers and the central
medical facility.
To ensure perceived value by the
end customers, the quality of community healthcare workers is crucial. The healthcare workers need
to be sufficiently professionally
trained and proactive in reaching out
to patients, especially for preventive
medical services.

Key Risk Exposures
There are many layers of risk exposures associated with the proposed
solution, including technical risks,
human factors, and operationally
related impairments. While technical
issues are important, frequently it is
the latter two risk components that
can lead to premature failures of
a scheme.
With the large number of people and components involved in
a community healthcare system,
there are constant exposures to the
risk components. It is important to
identify the risks early and derive
mitigation and safeguard strategies during system design, and to
factor risks into the evaluation of
the solution.
One of the most fundamental risks
is the acceptance of the solution by the
various stakeholders, including the
people at the central medical facility,
the community healthcare workers,
and the rural community inhabitants.
Without adequate support and buy-in
by all these groups, the solution will
fail. To secure buy-in, it is critical
that the value of the solution is clear
for everyone.
Even if all the stakeholders
embrace the solution, sustainability can only be preserved if the

There are constant exposures to risk
components.
generated revenue is sufficient to
provide reasonable benefits to all.
These include adequate income
for the community healthcare
workers at a fair market pay level
and sufficient compensation to the
central medical facility for running the electronic medical record
system and the rFID medical
card system. In addition, the number of patients participating in the
scheme, the patients' willingness
to pay for the services, and the
quality of healthcare service that
can be provided are key factors
that will determine the long-term
viability of such a community
e-health solution.
The ongoing maintenance of
equipment, continuous training
of healthcare workers, and accurate and safe keeping of personal
health records will determine the
reputation of the scheme and the
support of the community. If any
of these elements breaks down or
if there are any serious errors or
malpractices, it can lead to irreparable, long-term damage to the
mutual trust between the provider
and the community.
Fraud is another risk exposure that may threaten the system.
There are potential cash transfers
within the system; the community
healthcare workers can potentially
bypass the system entirely and take
the full fee from the patients without passing on the agreed share to
the central medical facility. The
community healthcare workers
may even negotiate a lower rate
with the patients to encourage
the patient to undercut the central medical facility and participate in the fraud. In this situation
the healthcare workers will not be
able to update the medical record
of the patient or retrieve medical
records from the central medical
facility. This is a source of revenue

IEEE TECHNOLOGY AND SOCIETY MAGAZINE

SprING 2013

leakage even though it still helps
to ease the loading of the central
medical facility. This revenue leakage is not easy to plug completely
apart from the use of tight supervision and tracking of performance
and impose disciplinary actions
against offending healthcare workers if foul plays are discovered.
Good training together with some
form of competition among the
community healthcare workers or
incentive scheme may help to minimize the temptation of fraudulent
practices and instill a sense of pride
and loyalty. The use of analytics
can also help to identify systematic
fraudulent activities.
privacy and security are valid
concerns when personal health
information is being handled,
transferred, and recorded, especially in the field. Adequate
security measures have to be put
in place to ensure that personal
information is not exposed or
intercepted by third parties during storage or being transmitted.
To this end password protected
access to the mobile rFID device
is of critical importance; adequate
training for the community healthcare workers on ethical practice
would also be useful. Many of
the issues including the custodian
of the personal clinical information, transmission of the record,
storage of the content, the technical approach to security and
authentication, and the party who
authorizes access to the information are of critical importance to
protect the individuals. In addition
to basic security measures, secure
transmission techniques including
secure socket layer for encryption
information over the network or
secure tunnels such as virtual private network or secure shell technology will be appropriate as part
of the implementation.
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Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - Spring 2013