# Multilevel Privacy Assurance Evaluation of Healthcare Metadata
## 1 Introduction  
Big Data Analytics (BDA) of Electronic Health Record (EHR) is a prerequisite in advancing efficient and effective healthcare and clinical research [1]. BDA is the application of advanced analytical methods for big data streams to extract useful value [2]. For example, Big Data Analytics (BDA) is significant in understanding, rationalizing, and utilizing healthcare data for multiple purposes [3]. However, while performing BDA, healthcare providers must avert from data-related ethical issues such as biased decision making, unwanted disclosures, and inaccuracies. In this wake, the healthcare providers ascribe their healthcare data analytics practices to responsible data science [4]. Amongst others, privacy preservation of the sensitive healthcare metadata is one such practice. Here, metadata is data about data or structured data, such as structured patients' data accompanying lab measurements or images. Privacy, in a nutshell, comprises an individual's autonomous decision making and direct or indirect control over his/her personal information [5]. Across nation-states, the privacy preservation of patients' Personally Identifiable Information (PII) is legally ensured using some fundamental multilevel privacy-preserving measures [6; 7; 8; 9]. The fundamental multilevel privacy-preserving measures include the following:  
** The process of privacy-preserving measures initiates with the intake of patients' Informed Consent (IC), concerning patients' information-share, at the onset of their data collection [10; 11; 12; 13]. ;
* Privacy by Design (PbD) measures involve the privacy incorporation into the design specifications of technologies [14; 15]. PbD begins with embedding prime privacy-preserving principles into designing, operating, and managing information processing technologies and systems. PbD then allows the elaboration of those principles as default standards;
* Privacy by policy includes measures where healthcare providers are accountable to and seek accreditation from global/pan-European supra-organizations and local regulators [7; 8; 9; 16]. Information Security Management Systems are evaluated for privacy preservation using policy measures [17];
* The privacy-preserving measures for third-party data processing include the tasks for data controller and processor as per GDPR (General Data Protection Regulation) [18]. Multilevel privacy assurance evaluation is a term coined to attribute the normative and empirical evaluation of (aforementioned) multilevel privacy measures. The focus is on Dutch healthcare metadata handling. Metadata handling includes data collection, storage, processing, and recovery/retention [19]. Here, normative means \"should be\", and empirical means \"as is\" state of affairs [20]. The multilevel privacy assurance evaluation of privacy-preserving measures is divisible into three levels of Dutch healthcare metadata handling that are enumerated below:  
1. Individual level is from the perspective of the individual patient, where the patient's PII is collected, after his or her Informed Consent (IC), at the onset of data collection;
2. Inter/intra-organizational level includes the healthcare information-share amongst horizontally and vertically distributed organizations. The horizontally distributed organizations include the locally located caregivers within a healthcare organization (such as surgeons or radiologists within a hospital or lab professionals within a diagnostic lab). Whereas the vertically distributed organizations include the remotely located caregivers (such as General Practitioners (GPs), hospital, and diagnostic labs) who remotely perform patients' information-share;
3. Third-party metadata processing level includes the patients' information-share with a Trusted Third Party (TTP), who performs data processing for further value extraction of healthcare metadata. TTP usually remotely conducts healthcare research. Figure 1 shows that patients' Electronic Health Record (EHR) is crucial for healthcare providers for quality BDA [1].