The extent to which wireless applications are appreciated varies when it comes to home-monitoring systems. Many patients overestimate the benefits of a home-monitoring system and think that it is possible to receive data from the hospital. The pacemaker or ICD has a built-in alarm that will go off when the RCMI is not functioning properly, for example, when the batteries run low. If the patient is not feeling well or if the pacemaker or ICD has released a shock, the hospital will be called immediately. A home-monitoring system can not decrease or prevent such situations, as some patients think. The cardiologist provided an example where checking your car every day by a garage does not make it drive better. The home-monitoring system is of particular importance for obtaining a global image of heart disease and collecting large-scale data for improving medical care. The main benefit for the patient is that the technical checks can be reduced from twice a year to once a year. If there are any doubts about the performance of the medical implant, for example in the case of vulnerable leads or a battery that runs low too quickly, then the technical checks (even if someone has a home-monitoring system) takes place every three months. When it comes to insulin pumps, all respondents are very pleased with the wireless functionality as it makes it easier for the patient to adjust the insulin. Patients have a better overview of their blood sugar levels because they can upload the data to a web page. The data can also be exchanged with the diabetes nurse, which allows for better collaboration between doctors and patients.

To estimate the extent to which patients are concerned with the protection of their computer, they were first asked if they are protecting their computer with an anti-virus program:

After that, patients were asked whether they always choose a password with letters and numbers longer than six characters:

Finally, patients were asked if they regularly change their passwords:

Most patients say they secure their computer with a password whereby they choose a password using both letters and numbers making sure it’s at least six characters long. The percentage is significantly lower when it comes to patients changing their passwords regularly. Not surprisingly, this last question was answered with a “yes” by all the patients who have ever worked in the ICT sector.

In the interviews, the question has been raised whether respondents think that wireless applications on RCMIs involve additional security risks. Of the fourteen patients, twelve respondents believe this is possible, with the doctors this was three out of four. The producer thinks there are no security risks and Jerome Radcliffe has experienced it for himself that it is possible to hack a RCMI. An interesting finding is that in the patient group, the two respondents who do think that devices that work on a wireless network can be 100% secured have worked in the ICT sector.

Four out of the thirteen patients have read that a RCMI has been hacked. One of the respondents had read about a doctor who broke into a RCMI at a distance of two meters. Another respondent said that he had read somewhere on a web forum that someone in Manhattan invented a device that could let RCMIs explode. None of the respondents mentioned the names of Barnaby Jack or Jay Radcliffe. None of the doctors and the producer had ever read anything about a hacked RCMI. The interviewed security expert Jerome Radcliffe had hacked his insulin pump in such a way that the insulin reservoir could be emptied at once. Respondents who think (or even encountered) that this is possible also believe that all wireless applications are hackable in theory. The fact that attacks on computer systems are increasingly being brought to the attention by the news reinforces this idea. An example that is often mentioned is the cyberattacks on Dutch banks. Banks are an indispensable part of society and respondents reason that if it’s possible to hack a bank, this is also the case for RCMI’s.

Respondents who think that wireless applications impose additional risks on RCMIs consider it more likely someone breaks into a RCMI to illegally acquire medical data than it is to make sure it does not function properly anymore. Six out of seven patients with a pacemaker or ICD who do not have a home monitoring system would like to have one. One respondent would not mind if unauthorized third parties could access his medical data. But in case research showed that RCMIs could be hacked in such a way that it would have life-threatening consequences, he wouldn’t want one. Two respondents emphasize that they do care about how their medical data is handled. One respondent said that the technology used in the hospital is out of date. He mentioned that when they read his ICD, floppy disks are still being used. When I visited the hospital, I have been able to confirm this and asked about it. I was told that this is only the case for some models, but that this does not endanger the quality of the pacemakers and ICD’s. They use the latest models, but due to money issues, they are running behind when it comes to data storage. Some patients think that the technology is not yet advanced enough to protect all devices properly, while others believe that it costs too much money to take proper security measures, and it’s therefore not being done. Nevertheless, all respondents (including security expert Jerome Radcliffe) believe that today’s wireless applications on RCMIs are safe. Three assumptions give a better understanding of why respondents think RCMI’s are safe. Firstly, respondents can hardly imagine someone who is capable of doing something like this. This is illustrated by comments like:

 ‘Why would anyone want to do such a thing?’

And:

“I could not think of such a sick mind, to be honest.”

In the group of patients, some mention employers, police, and insurance companies who may be potentially interested in improper access to their medical data. However, no one could imagine a situation where someone would like to hack their ICD in such a way that it could have life-threatening consequences. Two patients think that only someone who holds a high position may need to worry about the potential vulnerability of their RCMI. Examples that are mentioned are “Shell’s boss” and someone who holds a high position in the criminal world. ‘Ordinary citizens would not be as interesting as a target. Secondly, the limited range of RCMI’s is pointed out (the mentioned distances ranged from a few centimeters to around 2 to 4 meters). Finally, a RCMI hacker must have the necessary technical knowledge to be able to accomplish such a thing. A patient allowed that a medical student tried to hack his ICD with an Ipad. This attempt was not successful. Even though Jerome Radcliffe thinks it’s unlikely a RCMI gets hacked, he thinks it is of utmost importance to have good security. As an example, he mentioned the way people protect their own homes. The likelihood of burglary is relatively small, yet people close their doors and windows to protect their possessions. Security is always important because you do not know in advance if/when someone attempts a burglary. Also, he believes that the wireless applications on his insulin pump are useful, but not indispensable. The added value of wireless applications to RCMIs should be considered and whether they outweigh the risk of RCMI’s being compromised.

In the group of patients, some mention employers, police, and insurance companies who may be potentially interested in improper access to their medical data. However, no one could imagine a situation where someone would like to hack their ICD in such a way that it could have life-threatening consequences. Two patients think that only someone who holds a high position may need to worry about the potential vulnerability of their RCMI. Examples that are mentioned are “Shell’s boss” and someone who holds a high position in the criminal world. ‘Ordinary citizens would not be as interesting as a target. Secondly, the limited range of RCMI’s is pointed out (the mentioned distances ranged from a few centimeters to around 2 to 4 meters). Finally, a RCMI hacker must have the necessary technical knowledge to be able to accomplish such a thing. A patient allowed a medical student to try to hack his ICD with an iPad. This attempt was not successful. Even though Jerome Radcliffe thinks it’s unlikely a RCMI gets hacked, he thinks it is of utmost importance to have good security. As an example, he mentioned the way people protect their own homes. The likelihood of burglary is relatively small, yet people close their doors and windows to protect their possessions. Security is always important because you do not know in advance if/when someone attempts a burglary. Also, he believes that the wireless applications on his insulin pump are useful, but not indispensable. The added value of wireless applications to RCMIs should be considered and whether they outweigh the risk of RCMI’s being compromised.