Park SW, et al. J Korean Med Sci. 2024 Jan;39:e53. https://doi.org/10.3346/jkms.2024.39.e53

Objectives: In the Fourth Industrial Revolution, there is a focus on managing diverse medical data to improve healthcare and prevent disease. The challenges include tracking detailed medical records across multiple institutions and the necessity of linking domestic public medical entities for efficient data sharing. This study explores MyHealthWay, a Korean healthcare platform designed to facilitate the integration and transfer of medical data from various sources, examining its development, importance, and legal implications.Methods: To evaluate the management status and utilization of MyHealthWay, we analyzed data types, security, legal issues, domestic versus international issues, and infrastructure. Additionally, we discussed challenges such as resource and infrastructure constraints, regulatory hurdles, and future considerations for data management.Results: The secure sharing of medical information via MyHealthWay can reduce the distance between patients and healthcare facilities, fostering personalized care and self-management of health. However, this approach faces legal challenges, particularly relating to data standardization and access to personal health information. Legal challenges in data standardization and access, particularly for secondary uses such as research, necessitate improved regulations. There is a crucial need for detailed governmental guidelines and clear data ownership standards at institutional levels.Conclusions: This report highlights the role of Korea's MyHealthWay, which was launched in 2023, in transforming healthcare through systematic data integration. Challenges include data privacy and legal complexities, and there is a need for data standardization and individual empowerment in health data management within a systematic medical big data framework.

Background/Objectives: Gastric cancer is a leading cause of cancer-related mortality, particularly in East Asia, with a notable burden in Republic of Korea. This study aimed to construct and develop machine learning models for the prediction of gastric cancer mortality and the identification of risk factors. Methods: All data were acquired from the Korean Clinical Data Utilization for Research Excellence by multiple medical centers in South Korea. A total of 23,717 gastric cancer patients were divided into two groups by cause of mortality (all-cause of 2664 and disease-specific of 1620) and investigated. We used comprehensive data integrating clinical, pathological, lifestyle, and socio-economic factors. Cox proportional hazards analysis was conducted to estimate hazard ratios for mortality. Five machine learning models (random forest, gradient boosting machine, XGBoost, light GBM, and cat boosting) were developed to predict mortality. The models were interpreted by SHAP, one of the explainable AI techniques. Results: For all-cause mortality, the gradient-boosting machine learning model demonstrated the highest performance with an AUC-ROC of 0.795. For disease-specific mortality, the light GBM model outperformed others, achieving an AUC-ROC of 0.867. Significant predictors included the AJCC7 stage, tumor size, lymph node count, and lifestyle factors such as smoking, drinking, and diabetes. Conclusions: This study underscores the importance of integrating both clinical and lifestyle data to enhance mortality prediction accuracy in gastric cancer patients. The findings highlight the need for personalized treatment approaches in the Korean population and emphasize the role of demographic-specific data in predictive modeling.

Hwang S, et al. Dement Neurocogn Disord. 2023 Oct;22(4):121-129. https://doi.org/10.12779/dnd.2023.22.4.121

Objectives: Brain magnetic resonance imaging (MRI) contains identifiable facial and cranial features, creating privacy risks that can limit secondary research use. This review examines current MRI de-identification technologies, quantitative validation methods, and governance frameworks to identify practical strategies for preserving data utility while protecting patient privacy. Methods: A descriptive narrative review was conducted across technical and policy domains. Studies of facial deidentification were analyzed according to the tools used, validation procedures, and downstream analytic performance. The reviewed approaches included traditional defacing, refacing, and deep-learning-based anonymization. Evaluation frameworks used the structural similarity index measure (SSIM), Dice similarity coefficient (DSC), intraclass correlation coefficient (ICC), and the paired t-test to quantify both privacy preservation and analytic fidelity. A parallel policy analysis compared the Health Insurance Portability and Accountability Act (HIPAA), the General Data Protection Regulation (GDPR), Japan’s Act on Anonymized Medical Information, Taiwan’s Personal Data Protection Act, and South Korea’s Personal Information Protection Act and 2024 Health Data Use Guidelines to assess policy convergence and institutional consistency. Results: Visual inspection studies reported that FreeSurfer preserved cortical anatomy but incompletely removed facial features, whereas FSL_deface overmasked some nonfacial regions. Artificial intelligence (AI)-based recognition tests achieved 28%–38% accuracy on defaced data, confirming measurable residual re-identification risk. Quantitative assessments identified segmentation degradation, including a DSC decrease from 0.970 to 0.918, and regional volumetric variability, including a hippocampal ICC of 0.742, with p < 0.05. Generative adversarial network-based refacing improved perceptual similarity, with SSIM values >0.7, but retained subtle facial geometry. The governance analysis indicated that HIPAA and GDPR provide established standards, whereas South Korea’s Data Review Board oversight remains discretionary and nonuniform, limiting reproducibility across institutions. Conclusions: MRI de-identification requires integrated pipelines that combine AI-based facial masking and metadata cleansing with standardized evaluation metrics and enforceable review protocols.