Conclusion research questions

Although there are patients who can imagine that it is possible to hack a RCMI, all patients assume that current wireless applications on RCMI’s are safe. This trust is partly influenced by the way patients manage trust more in general. The surveys show that patients have a high degree of self-confidence. Most patients put trust in others until this trust is violated. This suggests that patients who have a lot of self-confidence will put trust in others more easily. This attitude reflects the way patients think about the safety and risks of RCMI’s. Some patients assert that they trust the safety of RCMI’s because they have never heard of a RCMI being hacked. This idea is strengthened as patients have good experiences with their RCMI.

How physicians, manufacturers, and security experts value wireless applications on the RCMI’s also influences the ideas of patients. Most patients have a good relationship with their physicians. They trust that their physician wants what’s best for their patients and are well aware of the latest developments. If patients ask about the risks of the wireless applications on RCMI’s, physicians try to reassure them. Their position as an expert and their own belief that RCMI’s are safe making it easier to pass this trust on to their patients. None of the physicians have ever heard or read about a RCMI being hacked. In their training and work as a physician, they were not faced with such risks. Furthermore, physicians have good experiences with the quality of the RCMI’s that they implant and state that RCMI’s are subject to rigorous test criteria before being placed on the market. Both physicians and many patients believe that manufacturers are forced to sell a safe product because of the serious consequences when their product does not work properly. There is considerable variation in the ideas about the motives of manufacturers, but overall, the trust in RCMI’s is high among patients. Most patients have never experienced problems with their RCMI, and in case problems occurred, most patients are satisfied with the help they received. A patient whose insulin pump stopped working, for example, received a new one on the same day by a manufacturer’s representative. Such experiences reinforce the trust that manufacturers take their customers seriously and put a lot of effort into minimizing the risks. Finally, to minimize the security risks, security experts and manufacturers work together. The security expert Jerome Radcliffe, who was interviewed for this research, works with Medtronic to make RCMI’s safer. In his contacts with manufacturers, he notes that the safety of RCMI’s is taken very seriously. However, after this interview, it became known that the manufacturer in question lost interest in paying attention to these kinds of risks because it is not seen as a major problem anymore [50]. This view greatly influences how information is provided about RCMI’s. As long as the risks are not considered to be a serious issue, manufacturers will not mention them in manuals and brochures.

From the answers to the questions in the survey can be derived that respondents are very satisfied with the wireless applications of their RCMI. An interesting finding is that there are misconceptions about the possibilities of wireless functions on RCMI’s. Patients with a home-monitoring system assume that hospitals can use this to access their pacemaker or ICD while they are home. Although this is not (yet) possible, patients do not view this as something to worry about if it was possible. Respondents believe that wireless applications make it easier to get insight into their disease process. Both physicians, the manufacturer, and the security expert think it’s currently unlikely that a RCMI will get hacked. Three assumptions are given to explain this position: (i) People can hardly imagine a scenario in which a malicious third party breaks into a RCMI; (ii) RCMI’s have a limited range; (iii) Malicious people should have the technical knowledge to break into a RCMI. These views are passed on to patients in their contact with the physician. In case patients want to know more about the risks of hacking, they need to look into this by themselves. It is also not a subject that people face in their daily lives. However, there is an increase in risk awareness regarding cybercrime. This awareness is partly because news about cyberattacks is increasingly being brought to the attention of the media.

In conclusion, respondents do not see much danger in the wireless applications of current RCMI’s. It is important to mention, however, that respondents think that the risks increase when wireless applications are extended. An example would be that it becomes possible to link RCMI’s with smartphones. This extension would create significantly more security leaks. More in general, the more complicated a system becomes, the more difficult it is to manage which, in turn, forces people to live with a great variety of risks [Beck et al. 1994/2007].