Valerie Watzlaf

Background: Artificial intelligence is expanding into telemedicine and telerehabilitation, yet significant privacy and security concerns persist. Scope: To synthesize empirical evidence on privacy and security approaches in health care, particularly those relevant to distributed home care. Methodology: A systematic review identified 80 studies (2019 to 2025), and Latent Dirichlet Allocation (LDA) topic modeling characterized the privacy and security themes. Results: Sixty-six studies addressed privacy, only seventeen addressed security, and three studies addressed both. LDA identified four themes: patient data privacy, federated learning for medical imaging, encrypted training and secure computation, and healthcare data governance. Most studies emphasized privacy-preserving approaches, like federated learning, encryption, and differential privacy. Almost half were conducted outside healthcare environments, limiting insight into real teleclinical and telerehabilitation workflow. Conclusion: Securing healthcare AI will require a multi‑layered governance framework, broader global representation, and integration of privacy and security protections into routine clinical workflows.

Background: Previous AI literacy studies have been limited to clinical students and professionals and included subjective reporting. This survey study explored the extent of AI knowledge in health information professionals with subjective and objective questions. The objective of the study was to inform the International Federation of Health Information Management Associations (IFHIMA) and national health information bodies about current AI literacy levels and the education needs of their members. Methods: A descriptive survey was adapted from two validated, previously-published study instruments. Survey data were collected between December 5, 2024, and February 28, 2025 using a self-administered Qualtrics (Seattle, WA) online survey link distributed by email to IFHIMA members. The survey link was also distributed on the LinkedIn professional networking platform (LinkedIn Corp; Sunnyvale, CA) by multiple IFHIMA members. Results were analyzed using Chi-square, ANOVA, and Tukey HSD post-hoc tests to assess the associations between the categorical response variables and the subjective survey question measures. Results: A total of 176 participants began the survey. Data were cleaned to exclude 48 incomplete responses, leaving 128 complete and valid responses for analysis. AI knowledge varied by demographics; country of employment or residence and professional association membership were shown to influence familiarity with AI. Many health information professionals reported limited or no AI experience, and those with practical AI experience performed better on foundational AI knowledge questions, suggesting that experiential learning scaffolds AI literacy. Most respondents understood emerging AI-related threats. However, regardless of experiences with everyday AI tools, they struggled with AI modeling and product development. Conclusions: The study results identified a major gap in AI knowledge, and the authors provide input for educators aiming to align educational programs with job market demand by increasing AI knowledge content, addressing gaps through targeted curriculum development and educator training.

Background: Telehealth is a great approach for providing high quality health care services to people who cannot easily access these services in person. However, because of frequently reported health data breaches, many people may hesitate to use telehealth-based health care services. It is necessary for telehealth care providers to demonstrate that they have taken sufficient actions to protect their patients’ data security and privacy. The government provided a HIPAA audit protocol that is highly useful for internal security and privacy auditing on health care systems, however, this protocol includes extensive details that are not always specific to telehealth and therefore is difficult to be used by telehealth practitioners.Objective: The goal of this study was to develop and validate a telehealth privacy and security self-assessment questionnaire for telehealth providers. Methods: In our previous work, we performed a systematic review on the security and privacy protection offered in various telehealth systems. The results from this systematic review and the HIPAA audit protocol were used to guide the development of the self-assessment questionnaire. The draft of the questionnaire was created by the research team and distributed to a group of telehealth providers for evaluating the relevance and clarity of each statement in the draft. The questionnaire was adjusted and finalized according to the collected feedback and face-to-face discussions by the research team. A website was created to distribute the questionnaire and manage the answers from study participants. A psychometric analysis was performed to evaluate the reliability of the questionnaire.Results: There were 84 statements in the draft questionnaire. Five telehealth providers provided their feedback to the statements in this draft. They indicated that a number of these statements were either redundant or beyond the capacity of telehealth care practitioners, who typically do not have formal training in information security. They also pointed out that the wording of some statements needed to be adjusted. The final released version of the questionnaire had 49 statements. In total, 31 telehealth providers across the nation participated in the study by answering all the statements in this questionnaire. The psychometric analysis indicated that the reliability of this questionnaire was high. Conclusion: With the availability of this self-assessment questionnaire, telehealth providers can perform a quick self-assessment on their telehealth systems. The assessment results may be used to identify possible vulnerabilities in telehealth systems and practice or demonstrate to patients the sufficient security and privacy protection to patients’ data.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: A large number of mobile health (mHealth) apps have been created to help users to manage their health or receive health care services. Many of these mHealth apps have proven to be helpful for maintaining or improving their users’ health. However, many people still choose not to use mHealth apps or only use them for a short period of time. One of the reasons behind this lack of use is the concern for their health information security and privacy. Objective: The goal of this project was to determine the relationship between users’ characteristics and their security and privacy concerns, and then to identify desired security features in mHealth apps which could reduce these concerns. Methods: A questionnaire was designed and validated by the research team. This questionnaire was then used to determine mobile app users’ security and privacy concerns regarding personal health data in mHealth apps as well as the security features most users desire. A semi-structured interview was used to identify barriers to and facilitators of adopting mHealth apps. Results: In this study, 117 randomly selected study participants from a large pool took part in the study and provided responses to the validated questionnaire and the semi-structured interview questions. The results indicate that most study participants did have concerns about their privacy when using mHealth apps. They also expressed their preferences regarding several security features in mHealth apps, such as regular password updates, remote wipe, user consent, and access control. An association between their demographic characteristics and their concerns and preferences in security and privacy was identified; however, in most cases, the differences among the different demographic groups were not statistically significant, except for a few very specific aspects. These study participants also indicated the cost of apps and lack of security features in mHealth apps were barriers for adoption, while having free apps, strong but easy to use security features, and clear user protection privacy policies might encourage them to use mHealth apps in their health management. Conclusions: This questionnaire and interview study verified the security and privacy concerns of mHealth app users, identified the desired security and privacy features, and determined specific barriers to and facilitators of users adopting mHealth apps. The results can be used to guide mHealth app developers to create apps that would be welcomed by users.

BACKGROUND A large number of mobile health (mHealth) apps have been created to help users to manage their health or receive health care services. Many of these mHealth apps have proven to be helpful for maintaining or improving their users’ health. However, many people still choose not to use mHealth apps or only use them for a short period. One of the reasons behind this lack of use is the concern for their health information security and privacy. OBJECTIVE The goal of this study was to determine the relationship between users’ characteristics and their security and privacy concerns and to identify desired security features in mHealth apps, which could reduce these concerns. METHODS A questionnaire was designed and validated by the research team. This questionnaire was then used to determine mobile app users’ security and privacy concerns regarding personal health data in mHealth apps as well as the security features most users’ desire. A semistructured interview was used to identify barriers to and facilitators of adopting mHealth apps. RESULTS In total, 117 randomly selected study participants from a large pool took part in this study and provided responses to the validated questionnaire and the semistructured interview questions. The results indicate that most study participants did have concerns about their privacy when using mHealth apps. They also expressed their preferences regarding several security features in mHealth apps, such as regular password updates, remote wipe, user consent, and access control. An association between their demographic characteristics and their concerns and preferences in security and privacy was identified; however, in most cases, the differences among the different demographic groups were not statistically significant, except for a few very specific aspects. These study participants also indicated that the cost of apps and lack of security features in mHealth apps were barriers for adoption, whereas having free apps, strong but easy-to-use security features, and clear user protection privacy policies might encourage them to use mHealth apps in their health management. CONCLUSIONS This questionnaire and interview study verified the security and privacy concerns of mHealth app users, identified the desired security and privacy features, and determined specific barriers to and facilitators of users adopting mHealth apps. The results can be used to guide mHealth app developers to create apps that would be welcomed by users.