# Multilevel Privacy Assurance Evaluation of Healthcare Metadata
## 2 Materials and Methods
### Privacy Assurance Evaluation at Individual Level  
The first model represents the current state of privacy-protecting metadata sharing between patients and healthcare providers (from the patients' perspective). Based on content analysis, the findings are illustrated using e3-value kit on the guidelines of Padlock Chain Model [68] in a Dutch healthcare setting.  
Why e3-value kit?: e3-value model provides with the web of enterprises where value actors are key stakeholders from the \"creation, execution, and consumption\" of the value objects. Value objects are goods and services that are mutually exchanged between the value actors. Linear relationships emphasize that the value actors undergo value transfers of value objects for a limited time as part of an ideal situation where they trust one another for the timely mutual satisfaction of their individual needs. Thus, trust is a constant in value modeling. Presumably, with the e3-value model, it is easier to unravel the optimal value care, which assures patients privacy with uninterrupted pooling of medical data. Moreover, it becomes easier to utilize the e3-value model for an otherwise complex healthcare ecosystem. This is because it focuses on linear inflow and outflow of the value transfers within a time frame between key-value actors. The linear temporal and spatial transactions facilitate diagnosing the bottlenecks (if any) in performing effectively and efficiently in a value transaction. Value actors are divisible into four main headings that are following:  
1. Principals: value actors who wish to satisfy their prime need;
2. Agent: value actors whom the principal chooses to satisfy his or her prime need;  
Figure 2: Research methodology with data analytical approach.  
3. Regulator: value actors who regulate and give accreditations to the agents provided that the latter satisfies the prerequisites of being privacy-preserving entities;
4. Third Party: value actors who assist and facilitate the agents but are not directly contacting the principal. Similarly, these four main actors perform the following four main (value) activities: 1. Front-end activity: principal undergoes this activity; 2. Counter response: agent responds with the counter response against the front-end activity; 3. Regulation and giving accreditations: regulators and international and national standard organizations regulate and give accreditations; 4. Back-end activity: third party performs back-end activity. The aim is to analyze privacy-preserving measures with simultaneous, uninterrupted, pooling of healthcare data across different domains of healthcare providers. At the individual level, Informed Consent (IC) entails patients' explicit, well-informed, specific, and autonomous consent for his or her healthcare metadata handling. The metadata handling includes data collection, metadata formulation, storage, and processing. The IC must be demonstrated in an easily accessible and understandable manner, with patients' having the right of erasure at any point (GDPR, article 7). For the individual level and specifically for the IC part, no empirical evaluations are conducted because the privacy limitations do not rely upon the procedure of taking informed consent, rather on the follow-up procedures of the metadata pipeline. In addition, IC poses limitations, specifically against clinical research and third-party data processing. Limitations range from data collection to data anonymization/pseudonymization to metadata storage, sharing, and retrieval.