# Multilevel Privacy Assurance Evaluation of Healthcare Metadata
## 3 Multilevel Privacy Assurance Evaluation: Results and Evaluation
### At Inter- and Intra-Organizational Level
#### 3.2.1 Evaluation  
Informed Consent (IC) serves as a starting point for both PbD and privacy by policy. Therefore, it is an integral ingredient of PbD as well as privacy by policy measures in model 2 (see below) because it is obligatory upon lab (biobank and bioregulatory) to take informed consent at the onset of the patient's interaction with the lab or at the beginning of  
Figure 4: Privacy assurance evaluation at inter-organizational level. the contract. The rest of the privacy-preserving procedures serve as succeeding steps to informed consent. International and national standard organizations play a significant role in setting standard ISMS parameters for Dutch private labs in the Dutch healthcare setting. Non-governmental organizations (NGOs) such as the International Organization for Standardization (ISO) and NEN, Dutch Network of standardization, bind labs to follow privacy by policy rules and regulations. An international federation of national standards, ISO, facilitates standardization processes to support the international exchange of goods and services. NEN is the Dutch branch of ISO within the Netherlands for developing and applying standards nationally and internationally. These standard organizations and the national regulator prompt labs to instill privacy in their value network via policy into their system designs. This e3-value model exhibits the value transactions from the organization's (i.e., diagnostic lab) perspective to maintain an equilibrium in safeguarding individuals' fundamental rights while sticking to their business goals. Business goals are the target business objectives of healthcare providers. The given models provide the basis for further research in first analyzing the standard parameters from nominal to ratio-based measurements to provide the standard metrics for key stakeholders to confirm the transfer of privacy as an objective value object within healthcare. An important noticeable factor is the shift of data source from patients to organizations (healthcare providers). The source of data generation shifts from patients to the diagnostic lab when seen from the perspective of value objects and their data transfer. For example, when a patient goes to the diagnostic lab for a blood test, the results make the lab a source-generating point for related information/data. Then, the patient's power reduces in favor of lab management concerning the inflow and outflow of that information/data. Then, the privacy assurance measures such as IC, PbD, and privacy by policy are applied to further the interest of patients. Tackling that information largely depends upon the lab or, in other words, upon the privacy-protecting ontologies of the lab. 2.2 Patients' Un-Anonymized Metadata Share and Privacy Preservation: Conceptual Validation and REA Ontology  
Sepsis Dataset Analysis using Process Mining and Expert's Opinion: The Sepsis event log is analyzed using PM tools (Disco and ProM Lite [63; 64]) that validate the patients' un-anonymized metadata share amongst Dutch caregivers. Furthermore, an infield IT expert validated the veracity and applicability of PM experiments to real healthcare scenarios. IT expert is affiliated with a Dutch diagnostic lab and a local Dutch hospital. Afterward, the REA's Insurance Model (IM) [66] is extended. The model verifies who, how, and what leads to patients' un-anonymized metadata-share amongst the Dutch caregivers and explicates privacy as a materialized claim. PM experiments findings and discussion: The commercial tool Disco (using fuzzy minor algorithm) discovered that there are 16 activities for 1050 cases and 15,214 events/ instances. In Figure 5, the rectangles are the activities or the tests on Sepsis patients by different suborganizations within the hospitals. The black arrows show the patients' metadata-share amongst the horizontally distributed suborganizations within the hospital with respective time stamps. A higher number of patients show thicker arrows and vice versa.