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This document notes the potential use of biometrics in e-health and
telemedicine applications, but it is mainly concerned with an examination
of the possible health and safety issues, from the user standpoint,
involved in the use of biometric systems. The subject may have some
significance in the context of arguments about the safe use of biometrics
involving the various players (e.g. trade unions and consumers’
associations). Independent safety testing with published results will
do much to allay user concerns in this area and to promote user acceptance. General interactions between medical issues and biometrics
Before approaching the area of the safety issues of biometrics, defined
in this report as the potential medical threats caused by a biometric
process, we note in passing that biometrics interact with medical
issues in the area of e-health and telemedicine programmes.
Several research or pilot programs, many of them developed in the
framework of the European Community, have suggested the creation
of centralized or distributed archives of patients’ medical
data. The idea is not particularly innovative but (i) the recent
availability and massive adoption of a standard for the exchange
of diagnostic images (Dicom), (ii) the significant decrease of data
storage costs and (iii) the increase of data transfer rates have
given a stimulus to the development of such “telemedicine”
programs.
The secure access to medical information, considered to be very
sensitive data, has always represented a significant obstacle to
the development of centralized archives of patients’ data.
As an enhancement in security in respect to traditional strong authentication
methodologies, several new projects now consider the use of biometrics
which, other than offering the known advantages, has undoubtedly
a strong appeal among many users as an innovative and next-generation
technology.
There are a number of potential problems which are not yet resolved.
For example, problems may arise from patients who cannot provide,
permanently or temporarily, the requisite biometric characteristic
and from the concept of “voluntarism” in providing the
biometric characteristics of patients who suffer from mental disabilities.
Other difficulties arise from the inclusion of so called “emergency
modes” that will allow the availability of medical data to
non-enrolled medical personnel in case of emergency (with associated
legal issues).
It is therefore clear that, in e-health applications, we should
recognise that the proper use of biometrics in this area involves
a trade-off between technical and legal issues and that a series
of agreements or codes of conduct must be created to account for
the lack of explicit rules for data protection.
Biometrics and medical concerns
Safety issues in biometrics, in general terms, make reference to the
potential medical risk associated to the use of biometrics.
Two aspects should be highlighted:
- the potential risk for the body arising from the use of biometrics
- the potential ethical risk arising from the violation of user’s
privacy caused by the revelation of medical data.
The first aspect could be defined as the Direct Medical Implication
(DMI) and the second as the Indirect Medical Implication (IMI).
The direct medical risk associated to the use of biometrics
Biometric techniques rely to the measure of physical/behavioural characteristics
of an individual. In most cases, the measurement is performed by means
of a physical interaction between the subject and the machine:
- The subject performs an action on the machine (e.g. touches
a sensor or “presents” to the sensor the biometric
characteristic),
- The machine responds with an action on the subject (e.g. sends
some radiant energy toward the subject).
Both actions may imply a certain degree of invasiveness for the
subject due to the:
- Contact with an object potentially contaminated by germs
- Absorption of a certain amount of radiant energy.
Realistic significance of the Direct Medical Implication
While it is reasonably possible to measure with good accuracy the
radiant energy, and therefore to assess in an accurate way the (potential)
risk associated to the biometric process, the risk analysis for the
contamination by contact is much more complex due to the similarity
of the risk with other threats produced by very popular objects such
as doorknob or telephone keyboards.
Contamination by contact
A risk of contamination may occur when the body touches a surface
handled previously by other users. Examples include: hand geometry,
two-finger geometry, vein pattern, retinal scanning and, as an extreme
level even fingerprint. Among all these biometric techniques, hand
geometry should be considered the most significant, from the potential
contamination point of view due to the larger surface of contact.
However, it is certainly true that subjects every day touch several
objects or surfaces which potentially may provide the same risks of
contamination (e.g. doorknobs).
In general, it is evident that it is not possible to refute such an
observation. On the other hand, it should be understood that, where
hand geometry is involved, different perceptions may occur than for
the case of touching doorknobs,
- Familiarity: Hand geometry units are not as common
as doorknobs and it is commonly observed that there is often a
general suspicion of new (and for many users, mysterious) objects.
- (potential) Hostility: hand geometry units are often
used in time and attendance applications. In this (“unfriendly”)
role of control of the users, hand geometry units, as well as
other biometric sensors, may have negative connotations which
can affect users’ psychological attitude to the technology.
In short, hand geometry users might show a conscious or unconscious
antipathy towards this technology and may use hygiene concerns as
a starting point for a dispute.
The key factor for a successful implementation of a biometric process
based on “contact” with the sensor is clear information
about the rational potential risk associated with
their use. Users should be informed that any risks that exist are
directly comparable to other contamination risks in everyday life.
In respect of the contamination risk, for example, users may be provided
with plastic gloves, or the biometric unit may be cleaned and disinfected
more a doorknob would be, or interaction with an operator could be
made available so that users can discuss any concerns and keep the
problem in a “rational domain”. These measures will help
to increase the confidence of the users for the system.
IR illumination
A potential cause of concerns in biometrics arises from the use of
radiant energy in the IR spectrum. For correct imaging of the biometric
characteristic, ambient infrared levels are often insufficient and
supplemental illumination is usually needed. Data available (from
vendors) indicates that the IR energy emitted is not harmful under
any conceivable conditions of normal use or even misuse.
A reasonable further step would be to provide verification and validation
of this technical data by accredited laboratories. This would prevent
possible criticism which could arise from the observation that vendors
are not independent, and technical data provided by vendors is therefore
suspect.
The indirect medical risk associated to the use of biometrics
Biometric techniques may potentially reveal medical information. This
concern is often linked to biometric techniques involving the eye.
As previously mentioned, this kind of (potential) threats may be defined
as an Indirect Medical Implication (IMI)
Realistic significance of the Indirect Medical Implication
It is generally a hard task to define realistic scenarios for the
invasion of privacy arising from biometric technologies. Retinal scanning
has frequently been targeted as a technology able to reveal a number
of medical conditions, since it is true that an examination of the
retina may disclose information about the vascular state of the patient
and therefore indicate the state of advancement of the diabetes and
of a hypertension (both very sensitive information). What should be
clearly assessed is if and how this medical information could be accessible
and usable by a fraudulent operator or by others involved in the biometric
process. Retinal scanning, for example, at least in any previously
known form, does not involve capturing the image of the retina. The
information used by the biometric system is limited to a pattern which
is not in any way related to a medical condition.
An effective way to overcome concerns is therefore to ensure that
any data that is displayed or used by the biometric system is not
medically sensitive. This process, often known as “denaturalisation”,
means that any images displayed to the operator of the biometric
system, for example in the enrolment phase, is degraded or modified
to remove any medical information.
Conclusions: potential threats for biometrics and real risk for vendors
Non-cleaned surfaces or IR illumination may potentially represent
a threat but cleaning procedures, laboratory tests and accreditation
processes can provide user assurance.
What may represent a real risk to the vendors and to the biometric
community is casual or intentionally distorted information on medical
risks from biometrics spread indiscriminately by the media. Incorrect
information may have serious effects both on the specific biometric
technique that is the object of the criticism and on biometrics in
general. Users, already reluctant in some cases to use biometric technologies
may become more hostile if rumours abound that a biometric technology
or application may affect their health or infringe their privacy.
Independent safety testing of biometric technologies and publishing
of results is a useful pre-emptive approach to help user confidence
and nip unsubstantiated “scare stories” in the bud.
An informed, aware user is probably one of the key factors contributing
to a successful real-world deployment of biometrics.
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The UK Biometric Working Group, managed by CESG, supports the UK government
and provides advice and information about the implementation and use
of biometric authentication systems.
For further details telephone +44 (0) 1242 221491 extension 34124
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