Intro to ASCLEPIOS Demonstrators – part 3: Privacy-preserving monitoring and benchmarking of antibiotics prescriptions

The article describes one of the three demonstrators of the ASCLEPIOS project. The demonstrator has been developed by the Norwegian Centre for E-health Research.

Antibiotics resistance

Antibiotics are widely used for the treatment and prevention of bacterial infections, and are not effective against viruses such as the common cold or influenza.

Antibiotics resistance is a worldwide problem. The increasing emergence of antibiotics resistance accounts for 700,000 deaths every year worldwide [1]. Unless actions are taken, the number is estimated to increase. There are national and international efforts to fight against antibiotics resistance; the demonstrator aims to contribute to the current efforts.

So, what can we do?

One of the main contributors for antibiotics resistance is high and inappropriate antibiotics consumptions. We need to reduce inappropriate antibiotics prescriptions, which requires behavioral change of clinicians. There are many studies on the effects of different interventions towards behavioral changes of clinicians. Providing feedbacks that compare a clinician’s prescriptions with his/her peers shown to be efficient to change clinicians antibiotics prescription patterns, and, consequently, minimizing inappropriate prescriptions [2,3]. Figure 1 illustrates the feedbacks provided to a clinician.

Figure 1. Comparing antibiotics prescription patterns with peers across multiple health care organizations

In many countries, general practitioners (GPs) are responsible for the majority of antibiotics prescriptions. For example, Norwegian GPs are responsible for approximately 80% of all antibiotics prescriptions for human use [4]. Therefore, the Norwegian Centre for E-health Research has developed a tool for providing feedback to GPs on their antibiotics prescriptions since behavioral changes of GPs have a significant impact on reducing inappropriate antibio­­­­tics prescriptions.

How does the demonstrator work?

Data reuse raises legitimate privacy concerns of patients. Even when the privacy concerns of patients are addressed, clinicians and health care organizations are concerned about their own privacy risks. A health care organization would not like others to know it is prescribing too many inappropriate antibiotics and so does a clinician.

The objective of the demonstrator is to be able to provide feedback to clinicians without revealing their performance to others and at the same time protecting the privacy of their patients and organizations.

Feedbacks to a clinician contain (1) performance indicators of the clinician computed based on the electronic health record (EHR) system of the organization where the clinician works, and (2) the aggregated indicators (e.g., the average performance indicators) of the peers across multiple health care organizations. The performance indicators of a clinician are computed within the organization. As shown in the figure 2, the aggregated indicators are computed using a technique called secure multi-party computation where a statistical function is computed on data distributed across health care organizations without revealing sensitive information apart from the results.

Figure 2. Computing on data distributed across health care organizations while protecting privacy

What does the ASCLEPIOS project add?

The demonstrator will use the encryption techniques developed in the ASCLEPIOS project to ensure the security of the data stored at each health care organization. The access control mechanisms that will be developed in the project will also be used to extend the demonstrator with a possibility for the health care organizations and clinicians to decide on what processing is allowed.

Kassaye Yitbarek Yigzaw, contributor

Dr. Yigzaw is a researcher at the Norwegian Centre for E-health Research


[1]        M. Čižman, The use and resistance to antibiotics in the community, Int. J. Antimicrob. Agents. 21 (2003) 297–307. doi:10.1016/S0924-8579(02)00394-1.

[2]        D. Meeker, J.A. Linder, C.R. Fox, M.W. Friedberg, S.D. Persell, N.J. Goldstein, T.K. Knight, J.W. Hay, J.N. Doctor, Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial, JAMA. 315 (2016) 562–570. doi:10.1001/jama.2016.0275.

[3]        S. Gjelstad, S. Høye, J. Straand, M. Brekke, I. Dalen, M. Lindbæk, Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study), BMJ. 347 (2013) f4403. doi:10.1136/bmj.f4403.

[4]        Ministry of Health and Care Services, Handlingsplan mot antibiotikaresistens i helsetjenesten, Ministry of Health and Care Services, Oslo, Norway, 2015.

Image sources: Physician, Team 1, Team 2