Multilevel Privacy Assurance Evaluation of Healthcare Metadata

Round 1

Reviewer 1 Report

The authors carried out an extensive analysis of available healthcare metadata related to the protection of personal data in the Dutch health system and pointed to the importance of the privacy-utility trade-off.

Overall, the manuscript is difficult to read, inserting quotes, inserts, and unnecessary punctuation marks do not help to understand such a complicated test. In some sentences, the authors are also lost. eg: line 877 "11 shows the multi-level privacy assurance evaluation and impact of privacy utility tradeoff on privacy-preserving measures at an individual, inter/intra organizational level, and at third-party metadata processing levels see 11." line 932: "Every event should be linked with a case (individual), an activity, and
933 two-time stamps (one for initiation of the activity and the other for the finalization of the activity). a sequence of events for one case is called a trace." line 909: "n FAIR (i.e. Findable Interoperableteroperable Reusable) " , line 910: reference " [81? ]."

Abbreviations and terms should be all listed at the end of the manuscript and will help to make clear the main text. 

In Figure 4, some data are difficult to read. 

Author Response

Respected reviewer,

Thank you very much for your valuable feedback on the submitted manuscript. We have tried and incorporated all enumerated comments in your review. In the zip folder, you will find three Tex files. One is Old_MDPI, one is Revised_MDPI and the third one is diff tex file with the track changes. The pointers here are enumerated as per the Revised_MDPI tex file. The detailed description is as enumerated below:

1. The mentioned places are corrected and the manuscript is checked for similar revisions as a whole.
2. Abbreviations are added.
3. Figure 4 is corrected.

yours sincerely,

Syeda

Reviewer 2 Report

The paper is devoted to the challenges of providing a multilevel confidentiality assessment of fundamental confidentiality measures for Dutch health metadata, examining the increase / decrease of confidentiality at each level. A multilevel privacy assessment is provided based on "content analysis" using Process Mining in real health event logs. The results of the evaluations are shown using a "Padlock chain model" of e3 value modeling and an "insurance model" of resource event agent (REA) ontology. The resulting structures show the financial aspect with vital stakeholders, their mutual transaction value of data-driven resources in a limited time frame. There are three main contribution points of the proposed research.

1) Data analysis work contributes to the necessary normative and empirical assessment of fundamental privacy practices by dividing each level.

2) The results are illustrated using conceptual modeling models; e3 value models and REA ontology. The article highlights the privacy gaps while closing the gaps between organizational and technical measures, with a particular focus on the monetary aspect of health services.

3) The paper shows the increase / decrease in privacy for Dutch health metadata at every level, with its direct dependence on the trade-off of a confidentiality utility.

Research can be used to correct privacy gaps that deserve attention and immediate fixation before addressing the extensive technical and organizational subtleties related to privacy.

The results of this study provide a multilevel assessment of the confidentiality of fundamental measures to preserve the confidentiality of medical metadata in the Dutch healthcare sector. The authors performed empirical and normative assessments and illustrated the results using e3 value modeling and REA ontology. This paper explores the increase / decrease in privacy at each level of privacy assurance. It has been shown that the compromise between the privacy utility plays a vital role in shaping the increase / decrease in privacy for the sake of improving the usefulness of the data. This utility-oriented metadata processing primarily ensures the seamless sharing of metadata for effective / efficient patient care, which defines a service-based logic in which patients value care. But this ongoing exchange of health metadata also provides financial support to health care enterprises. This is also the fundamental goal of the 2018 GDPR, which is an important contribution to research.

Despite the satisfactory quality of the article, there are some shortcomings that need to be corrected.

1. Figure 2 is difficult to interpret. A lot of different arrows makes it hard to understand the inputs and outputs.
2. Figure 3 is difficult to interpret because of small text inside figure.
3. Text in Figures 4, 5, 6 and 8 is unreadable. It is impossible to find out all connections between blocks.
4. Legend in graph 7 should be bigger size and described in text.
5. I recommend to separate table 1 to three different tables for Fitness, Precision and Complexity. It will allow better interpretation of obtained results.
6. Figure 11 is impossible to read. I recommend to describe Multilevel privacy assurance evaluation and privacy utility tradeoff in more details in text.
7. Discussion should include comparison of obtained numerical results with existing methods.
8. In consequence of current COVID-19 pandemic I highly recommend to include works of on-line data processing of COVID-19 in analysis part.

In summarizing my comments I recommend that the manuscript is accepted after minor revision, including figures quality improvement.

Author Response

Respected reviewer,

Thank you very much for your valuable feedback on the submitted manuscript. We have tried and incorporated all enumerated comments in your review. In the zip folder, you will find three Tex files. One is Old_MDPI, one is Revised_MDPI and the third one is diff tex file with the track changes. The pointers here are enumerated as per the Revised_MDPI tex file. The detailed description is as enumerated below:

1. Figure 2 is adjusted.
2. Figure 3 text is enlarged.
3. Fig. 4, 5, 6, and 8 texts are enlarged.
4. Legend in figure 7 is adjusted.
5. Table 1 is divided into three tables based on fitness, precision, and complexity.
6. Fig. 11 text is enlarged.
7. Discussion is added in the main conclusion.
8. the references regarding PM utilization during the pandemic are added in the state of the art section. 

   Yours sincerely,

Syeda

 

Reviewer 3 Report

The authors provide a valuable framework for privacy-preserving technologies that are of a crucial need in the healthcare field. However, some images and the links to the figures require major revision and elaboration from the authors.

Define the term `consumerism` and make sure you refer to it in a unified style. Then, explain the privacy-preserving techniques and their functionality in more detail. For instance, DP is one of the leading technologies, and there must be more recent information in the literature on its usage for the healthcare domain, among others.

Figure 2 has a different style from others and is difficult to perceive in its current shape. The reference to the figure must contain the reference to its format, e.g. `as shown in Fig. 2`. Would you please check that with the rest of the graphs? Figures 4, 6 are hard to read; please follow the clarity you have in Fig. 10.

Make sure your references do not have question marks as in line 179. 
Lines 624, 625 are missing some letters in-between the sentence, which is split. 

Make `conclusion` a separate section with the key outcomes you have acquired in this study. Consider elaborating more on the results you have achieved in the evaluation phase and your contribution to the research field. 

English spellcheck and improvement of punctuation usage are required. 

Author Response

Respected Reviewer,

Thank you very much for your valuable feedback on the submitted manuscript. We have tried and incorporated all enumerated comments in your review. In the zip folder, you will find three Tex files. One is Old_MDPI, one is Revised_MDPI and the third one is diff tex file with the track changes. The pointers here are enumerated as per the Revised_MDPI tex file. The detailed description is as enumerated below:

1. Consumerism is defined in state of the art under the subheading BDA and Informed Consent at the Expense of Privacy. An example of DP is also added in state-of-the-art.
2. Figure 2 and references are adjusted.
3. Figures 4 and 6 are adjusted.
4. References are checked if they have a question mark or not.
5. Lines 624-625 are adjusted.
6. Main conclusions are added as a separate section with important experiments findings and contributions. 
7. We tried to omit the English spellcheck. 

Yours sincerely,

Syeda

 

Round 2

Reviewer 3 Report

Overall, the comments were taken into account and the quality of the paper has significantly improved. Most of the previous comments were covered in the updated version of the document.

However, I would request the authors to improve the quality of representing their information. Firstly, there is a need to use all images in a unified (vector) format, as for instance, Fig. 8 and 10. Next, Fig. 6 does not look readable itself and the bar diagram must be a separate figure to refer to. 

Besides, English punctuation, spell check, and major changes are required in order to improve the coherence of the sentences.

Author Response

Respected Reviewer,

Thanks a lot for your valuable feedback. The Revised2_MDPI.tex is the improved version of the manuscript. Revised_MDPI.tex is previously improved version. To see the track changes, please see the diff2.tex. Further reactions to the review are enumerated below:

• Pdf as a unified vector format is added for all the figures.
• The legend of figure 6 is separated and magnified.
• The manuscript is exclusively revised for English punctuation, spell check, and sentence coherence.

Kind regards,

Syeda 

Author Response File: Author Response.pdf

Round 3

Reviewer 3 Report

The authors have addressed the requested changes. However, the spelling of words and the consistency of sentences need another review.

Author Response

Respected Reviewer,

Thank you so much for your quick response. As per the paper's required revision, word spelling and sentence consistency are revised gain. To check the revised draft kindly see Revised3_MDPI, to check the older version check Revised2_MDPi and for the version with track changes kindly check the diff3 file.

yours sincerely,

Syeda

Author Response File: Author Response.pdf