Clinical professionals
Medical equipment
Personal information and health-relevant data are necessary to record in order to provide regular health service. Meanwhile, personal information and health-relevant data are closely associated with user privacy and confidential information. Therefore, several important privacy protection-related regulations or acts are published to guide health data protection and reuse. Modern data protection law is built on “fair information practice principles” (FIPPS) [ 19 ].
The most referenced regulation is Health Insurance Portability and Accountability Act (HIPAA) [ 4 ]. HIPAA was created primarily to modernize the flow of healthcare information, stipulate how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and address limitations on healthcare insurance coverage. The HIPAA Safe Harbor (SH) rule specifies 18 categories of explicitly or potentially identifying attributes, called protected health information (PHI), that must be removed before the health data is released to a third party. HIPAA also covers electronic PHI, ePHI. This includes medical scans and electronic health records. A full list of PHI elements is provided in Table 2 . PHI elements in Table 2 only cover identity information and do not include any sensitive attribute. That is, HIPAA does not provide guidelines on how to protect sensitive attribute data; instead, the basic idea of the HIPAA SH rule is to protect privacy by preventing identity disclosure. However, other sensitive attributes may still uniquely combine into a quasi-identifier (QI), which can allow data recipients to reidentify individuals to whom the data refer. Therefore, a strict implementation of the SH rule, however, may be inadequate for protecting privacy or preserving data quality. Recognizing this limitation, HIPAA also provides alternative guidelines that enable a statistical assessment of privacy disclosure risk to determine if the data are appropriate for release [ 20 ].
Protected health information defined by HIPAA.
Category | Description |
---|---|
1 | Names |
2 | Locations |
3 | Dates |
4 | Phone number |
5 | Fax numbers |
6 | E-mail addresses |
7 | Social security numbers |
8 | Medical record numbers |
9 | Health plan beneficiary numbers |
10 | Account numbers |
11 | Certificate/license numbers |
12 | Vehicle identifiers and serial numbers |
13 | Device identifiers and serial numbers |
14 | Web Universal Resource Locators (URLs) |
15 | Internet Protocol (IP) address numbers |
16 | Biometric identifiers, including finger and voice prints |
17 | Full face photographic images and any comparable images |
18 | Any other unique identifying number, characteristics, or code |
The Health Information Technology for Economic and Clinical Health (HITECH) Act [ 21 ] was enacted as part of the American Recovery and Reinvestment Act of 2009 to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules. It is complimentary with HIPAA and strengthens HIPAA's privacy regulations. HITECH has also widened the scope of HIPAA through the Omnibus Rule. This extends the privacy and security reach of HIPAA/HITECH to business associates. According to HIPAA and HITECH Act, much of data beyond category 1 in Table 1 is outside of the scope of comprehensive health privacy laws in the U.S.
The Consumer Data Right (CDR) [ 22 ] is coregulated by the Office of the Australian Information Commissioner (OIAC) and Australian Competition and Consumer Commission (ACCC). “My Health Record System” is run to track citizen medical conditions, test results, and so on. The OIAC sets out controls on how health information in a My Health Record can be collected, used, and disclosed, which corresponds to PHR integration. The Personal Information Protection and Electronic Documents Act (PIPEDA) [ 23 ] of Canada applies to all personal health data. PIPEDA is stringent and although has many commonalities with HIPAA; it goes beyond HIPAA requirements in several areas. One such area is in the protection of data generated by mobile health apps which is not strictly covered by HIPAA. PIPEDA runs to protected consumer health data. Under PIPEDA, organizations can seek implied or explicit consent, which is based on the sensitivity of the personal information collected and the reasonable data processing consent expectations of the data subject. The General Data Protection Regulation (GDPR) is a wide-ranging data protection regulation in EU, which covering health data as well as all other personal data, even they contain sensitive attributes. GDPR also has data consent and breach notification expectations and contains several key provisions, including notification, right to access, right to be forgotten, and portability. Under GDPR, organizations are required to gain explicit consent from data subjects, and individuals have the right to restriction of processing and not to be subject to automated decision-making.
China has no specific regulations for health data privacy protection. Several restriction rules to prohibit privacy disclosure scatter in China Civil Code (CCC), Medical Practitioners Act of the PRC (MPAPRC), and Regulations on Medical Records Management in Medical Institutions (RMRMMMI), which make privacy disclosure restrictions to individuals, medical practitioners, and medical institutions, respectively. CCC specifies 9 categories of personal information to be protected, including name, birthday, ID number, biometric information, living address, phone number, email address, health condition information, and position tracking information. RMRMMMI only approves reuse of health data just for medical care, teaching, and academic research. Recently, the Personal Information Protection Law of the PRC (PIPILRC) [ 24 ] is released and will come into force on November 1, 2021. This is the first complete and comprehensive regulation on personal information protection. In this regulation, the definition of sensitive personal information and automatic decision making both involve health data, so, this regulation is applicable to privacy protection of health data. According to this regulation, secondary use of deidentified or anonymized health data for automatic decision making is permitted, and data processing consent from consumers is also required. This regulation, so far as can be foreseen, will greatly stimulate the exploitation and exploration of health big data.
According to the comparison of these data privacy relevant regulations, shown in Table 3 , PIPEDA and GDPR and the newly released PIPILRC can cover both clinical data and consumer health data, and others pay the majority of attention to clinical data. Health data need to be reused for multiple important purposes. In fact, health data processing and reusing are never absolutely prohibited in the regulations mentioned above, as long as privacy protection is achieved as the important prerequisite. In this respect, HIPAA sets Safe Harbor rules to make sure PHI be removed before the health data is released to a third party. Furthermore, PIPEDA and GDPR require consumers' consent for data processing. Regulations from China also encourage health data to be reused in certain restricted areas. As the newcomer, PIPILRC presents a more complete and comprehensive guidance to protect and process health data.
Regulations and corresponding data category.
Regulations | Category 1: clinical data | Category 2: consumer health data |
---|---|---|
HIPAA & HITECH (USA) | ✓ | |
CDR (Australia) | ✓ | |
PIPEDA (Canada) | ✓ | ✓ |
GDPR (EU) | ✓ | ✓ |
MPAPRC & RMRMMMI (China) | ✓ | |
CCC & PIPILRC (China) | ✓ | ✓ |
The exploitation of health data can provide tremendous benefits for clinical research, but methods to protect patient privacy while using these data have many challenges. Some of these challenges arise from a misunderstanding that the problem should be solved by a foolproof solution. There exists a paradox: well deidentified and scrubbed data may lose much meaningful information results in low quality, maintaining much PHI may have high risk of privacy breach. Therefore, a holistic solution, or to say a unified strategy, is needed. Three strategies are summarized in this section. The first is for clinical data and provides a practical user access rating system, and the second is majority for genomic data and designs a network architecture to address both security access and potential risk of privacy disclosure and reidentification. From a more practical starting point, the third tries to share a model without exposing any data. The tree strategies present solutions from different perspectives, therefore can be complementary to each other.
As for clinical data, Murphy et al. proposed an effective strategy to build a clinical data sharing platform while protecting patient privacy [ 6 ]. The proposed approach to resolving the balance between privacy management and data secondary use is to match the level of data deidentification with the trustworthiness of the data recipients, in which the more identified the data, the more “trustworthy” the recipients are required to be, and vice versa. The level of trust for a data recipient becomes a critical factor in determining what data may be seen by that person. This type of hierarchical access rating is similar to the film rating, which can accommodate the requirement and appetites of different types of audiences. Murphy et al.'s strategy sets up five patient privacy levels with three aspects of requirements: availability of the data, trust in the researcher and the research, and the security of the technical platforms. Corresponding to the privacy levels are five user role levels.
The lowest level of user is “obfuscated data user.” For this user, data are obfuscated as it is served to a client machine with possibly low technical security. Obfuscation methods try to add a random number to the aggregated counts instead of providing accurate result [ 25 , 26 ]. The second level of user is “aggregated data user,” to whom exact numbers from aggregate query results are permissible. The third is “LDS data user,” who is granted to access HIPAA-defined LDS (limited dataset) and structured patient data in which PHI must be removed. The fourth is “Notes-enabled LDS data user,” who is additionally allowed to view PHI scrubbed text notes (such as discharge summary). The final level of user is “PHI-viewable data user,” who has access to all patient data.
These access level categories are summarized in Table 4 .
Health data access level categories.
Privacy level of user | Data available | Trustworthiness of user | Technical security |
---|---|---|---|
Obfuscated data user | Users have access to data by client-side application only | Low: only obfuscated aggregate results are available | Low: only client-side application exposed to users |
Aggregated data user | Users have access to HIPAA deidentified data by client-side application only | Low: users can get exact patient counts against deidentified data | Low: but data manager assumes burden of deidentifying data |
LDS data user | HIPAA-defined LDS and deidentified structured data | Medium: users can see LDS as defined by HIPAA | Medium: requires user-facing direct access to the database |
Notes-enabled LDS data user | HIPAA deidentified data and deidentified narrative text | Medium: users see both LDS and narrative text that is mostly deidentified | Medium: requires user-facing direct access to the database |
PHI-viewable data user | All patient data may be accessed | High: users can see all protected health information on patients | High: requires management of encryption keys |
With the guidance of health data access level categories, Murphy et al. implemented five cases in clinical research. In a realistic project, multiple use role or different access privileges must be needed to reconcile different data access requirements. Murphy et al. also provided three exemplar projects and their possible privacy level user distributions. This proposed strategy gave a complete reference for data sensitive project and also implemented a holistic approach to patient privacy solutions in Informatics for Integrating Biology and the Bedside (i2b2) research framework [ 27 ]. The i2b2 framework is the most widespread open-source framework for exploring clinical research data-warehouses and was jointly developed by the Harvard Medical School and Massachusetts Institute of Technology to enable clinical researchers to use existing deidentified clinical data and only IRB-approved genomic data for research aims. Yet, i2b2 does not provide any specific protection mechanism for genomic data.
As for genomic data, two potential privacy threats are loss of patients' health data confidentiality due to illegitimate data access and patients' reidentification and resulting sensitive attribute disclosure from legitimate data access. On the basis of the i2b2 framework, Raisaro et al. [ 15 ] proposed to apply homomorphic encryption [ 28 ] to the first threat and differential privacy [ 29 ] to the second threat. Furthermore, Raisaro et al. designed a system model, consisting of two physically separated networks, from the perspective of architecture. The network architecture is shown in Figure 1 . This network architecture is aimed at isolating data that is used for clinical/medical care and that is used for research activities by a few trusted and authorized individuals.
Network architecture of privacy protection for health data including genomic data.
The clinical network is used for hospital's clinical daily activities, containing clinical and genomic data of patients. This network is very controlled and protected by a firewall that blocks all incoming network traffic. Authorized users are permitted to log in.
The research network hosts i2b2 service used by researchers in their research activities. The i2b2 service is composed of an i2b2 server and a proxy server, in which a homomorphic encryption method and a differential privacy method are implemented and deployed. The i2b2 server can receive deidentified clinical data and encrypted genomic data from the clinical network and perform security data query and computation. The proxy server is devoted to support the decryption phase and the storage of partial decryption keys for homomorphic encryption. Through the research network, researchers can get authorized data via query execution module by the sequential five steps: query generation, query processing, result perturbation, result partial decryption, and result decryption at the final user-client side.
This network architecture and its privacy-preserving solution have been successfully deployed and tested in Lausanne University Hospital and used for exploring genomic cohorts in a real operational scenario. This application is also a practicable demonstration for similar scenario. It is not a unique instance but has its counterpart. Azencott reviewed how breaches in patient privacy can occur, and recent developments in computational data protection also proposed a similar secure framework for genomic data sharing around three aspects, which includes algorithmic solutions to deidentification, database security, and user trustworthy access [ 3 ].
Since the new paradigm of the machine learning method, namely, federated learning (FL), was first introduced in 2016 [ 30 ], has achieved a rapid development, and become a hot research topic in the field of artificial intelligence, its core idea is to train machine learning models on separate datasets that are distributed across different devices or parties, which can preserve the local data privacy to a certain extent. This development mainly benefits from the following three facts [ 31 ]: (1) the wide successful applications of machine learning technologies, (2) the explosive growth of big data, and (3) the legal regulations for data privacy protection worldwide.
The idea of federated learning is to only share the model parameters instead of the original data. By this way, many of these initiatives are based on federated models in which the actual data never leave the institution of origin, allowing researchers to share models without necessarily sharing patient data. Federated learning has inspired another important strategy to develop smart healthcare based on sensitive and private medical records which exist in isolated medical centers and hospitals. As shown in Figure 2 , federated learning offers a framework to jointly train a global model using datasets stored in separate clients.
Architecture for a federated learning system.
Model building of this kind has been used in real-world applications where user privacy is crucial, e.g., for hospital data or text predictions on mobile devices, and it has been stated that model updates are considered to contain less information than the original data, and through the aggregation of updates from multiple data points, original data is considered impossible to recover. Federated learning emphasizes the data privacy protection of the data owner during the model training process. Effective measures to protect data privacy can better cope with the increasingly stringent data privacy and data security regulatory environment in the future [ 32 ].
Under the strategies of health data protection, specific tasks and methods about privacy and data processing can be employed and deployed. The tasks and methods can be viewed at three progressive levels. Methods in the first level are aimed at mitigating the risk of privacy disclosure, from four aspects. Methods in the second level target on data mining or knowledge extraction from deidentified or anonymized health data. No need to share health data, methods in the third level try to build a learning model or extract knowledge in a distributed manner, then share the model or knowledge.
There are two widely recognized types of privacy disclosure [ 33 ]: identity disclosure (or reidentification) and attribute disclosure. The former occurs when illegitimate data users try to match a record in a dataset to an individual, and the latter occurs when illegitimate data users try to predict the sensitive value(s) of an individual record. According to Malin et al. [ 34 ], methods of mitigating the risk of two types of privacy disclosure can be divided into four classes: suppression, generalization, randomization, and synthetization. This perspective of method categories expects to well summarize the recent research on risk-mitigation methods.
Suppression methods are aimed at scrubbing (remove or mask) 18 PHI defined in HIPAA, which is the most important deidentification method. Before PHI scrubbing, the major task is to identify the PHI from health data. For structural data, PHI identification can be done easily according to data schema. For narrative data or free text, such as discharge summary or progress note, natural language processing (NLP) is the preferred technology for PHI identification. Specifically, named entity recognition (NER) is the mainstream technology used in clinical data for deidentification and medical knowledge extraction. The 18 PHI are regarded as predefined entity types, and machine learning is employed to annotate type tags for each word in a sentence, then those tags are merged, and finally, the position and type of PHI can be identified. Conditional random fields (CRFs) are the classic sequential tagging model for NER and are often applied for deidentification [ 35 ]. Meystre et al. made a systematic review of deidentification methods [ 36 ], and Uzuner et al. [ 37 ] and Deleger et al. [ 38 ] both conducted some evaluations on a certain human-annotated dataset. The identified PHI values are then simply removed from or replaced with a constant value in the released text documents, which may be inadequate for protecting privacy or preserving data quality. Li and Qin proposed a new systematic approach to integrate methods developed in both data privacy and health informatics fields. The key novel elements of the proposed approach include a recursive partitioning method to cluster medical text records and a value enumeration method to anonymize potentially identifying information in the text data, which essentially masks the original values, to improve privacy protection and data utility [ 20 ].
For genomic data, homomorphic encryption [ 28 ] is applied to encrypting genomic data, and then, encrypted data can be shared for secondary use. Raisaro et al. employed homomorphic encryption to build a data warehouse for genomic data [ 15 ]. Kamm et al. [ 39 ] also proposed a framework for generating aggregated statistics on genomic data by using secure multiparty computation based on homomorphic secret sharing. Several other works [ 28 , 40 , 41 ] proposed using homomorphic encryption to protect genomic information in order to allow researchers to perform some statistics directly on the encrypted data and decrypt only the final result.
These methods transform data into more abstract representations. The much easier implementation is abbreviation. For instance, the age of a patient may be generalized from 1-year to 5-year age groups. Based on this type of generation, sensitive attributes can be generalized subgroup and be anonymized to some extent, which is the back idea of k -anonymity and its variations. k -anonymity seeks to prevent reidentification by stripping enough information from the released data that any individual record becomes indistinguishable from at least ( k − 1) other records [ 42 ]. The idea of k -anonymity is based on modifying the values of the QI attributes to make it difficult for an attacker to unravel the identity of persons in a particular dataset while the released data remain as useful as possible. This modification is a sort of generalization, by which stored values can be replaced with semantically consistent but less precise alternatives [ 43 ]. For example, let us consider a dataset in which age is a quasi-identifier. While the three records {age = 30, gender = male}, {age = 35, gender = male}, and {age = 31, gender = female} are all distinct, releasing them as {age = 3∗, gender = male}, {age = 3∗, gender = male}, and {age = 3∗, gender = female} ensures they all belong to the same age category and the anonymity is 3-anonymity. Based on k -anonymity, l -diversity [ 44 , 45 ] were proposed to address further disclosure issues of sensitive attributes.
Randomization can be used for attribute-level data. In this case, original sensitive values are replaced with similar but different values, with a certain probability. For example, a patient's name may be masked by a randomly selected made-up name. This basic approach may result in worse data quality. Li and Qin proposed to obtain value via a clustering method [ 20 ].
Randomization can further be used for aggregation operation. Obfuscation is a sort of such randomization. Numerous repetitions of a query by a single user must be detected and interrupted because they will converge on the true patient count making proper user identification absolutely necessary for the methods to function properly [ 6 ]. Aiming to deidentify aggregated data, obfuscation methods include the addition of a random number to the patient counts that has a distribution defined by a Gaussian function.18. Obfuscation is applied to aggregate patient counts that are reported as a result of ad hoc queries on the client machine [ 26 ]. Another protection model for preventing reidentification is differential privacy [ 10 , 46 ]. In this model, reidentification is prevented by the addition of noise to the data. The model is based on the fact that auxiliary information will always make it easier to identify an individual in a dataset, even if anonymized. Instead, differential privacy seeks to guarantee that the information that is released when querying a dataset is nearly the same whether a specific person is included or not [ 46 ]. Unlike other methods, differential privacy provides formal statistical privacy guarantees.
Synthetization is compelling for two main reasons: preserving confidentiality and valid inferences for various estimates [ 47 ]. In this case, the original data are never shared. Instead, general aggregate statistics about the data are computed, and new synthetic records are generated from the statistics to create fake, but realistic-like, data. Exploiting clinical data for building an intelligent system is one of the scenarios. Developing clinical natural language processing systems often requires access to many clinical documents, which are not widely available to the public due to privacy and security concerns. To address this challenge, Li et al. proposed to develop methods to generate synthetic clinical notes and evaluate their utility in real clinical natural language processing tasks. Thanks to the development of deep learning, recent advances in text generation have made it possible to generate synthetic clinical notes that could be useful for training NER models for information extraction from natural clinical notes, thus lowering the privacy concern and increasing data availability [ 48 ].
Data mining is also synonymously called knowledge discovery from data (KDD), which highlights the goal of the mining process. To obtain useful knowledge from data, the mining process can be divided into four iterative steps: data preprocessing, data transformation, data mining, and pattern evaluation and presentation. Based on the stage division in the process of KDD, Xu et al. developed a user-role-based methodology and identified four different types of users in a typical data mining scenario: data provider, data collector, data miner, and decision maker. By differentiating the four different user roles, privacy-preserving data mining (PPDM) can be explored in a principled way, by which all users care about the security of sensitive information but each user role views the security issue from its own perspective [ 49 ]. In this research, PPDM is explored from the view of a data miner role, that is, from the data mining stage of KDD.
Privacy-preserving data mining is aimed at mining or extracting information, via a certain machine learning-based model, from privacy-preserving data in which the values of individual records have been perturbed or masked [ 50 ]. The key challenge is that the privacy-preserving data look very different from the original records and the distribution of data values is also very different from the original distribution. Researches for this issue have started very early. Agrawal and Srikant proposed a reconstruction procedure to estimate the distribution of original data values and then built a decision-tree classifier [ 50 ]. Recent studies on PPDM include privacy-preserving association rule mining, privacy-preserving classification, and privacy-preserving cluster.
Association rule mining is aimed at finding interesting associations and correlation relationships among large sets of data items. For PPDM, some of the rules may be considered to be sensitive. For hiding these rules, the original data need to be modified to generate a sanitized dataset from which sensitive rules cannot be mined, while those nonsensitive ones can still be discovered [ 51 ]. Classification is a task of data analysis that learns models to automatically classify data into defined categories. Privacy-preserving classification evolves decision tree, Bayesian model, support vector machine, and neural classification. The strategies of adapting the classification method to a privacy-preserving scenario can simply be described as two aspects. The first is learning the classification model based on data transformation, since the transformed data is difficult to be recovered [ 52 , 53 ]. The second is learning the classification model based on secure multiparty computation (SMC) [ 54 ], where multiparties collaborate to develop a classification model from vertically partitioned or horizontally partitioned data, but no one wants to disclose its data to others [ 55 , 56 ]. Cluster analysis is the process of grouping a set of records into multiple groups or clusters so that objects within a cluster have high similarity but are very dissimilar to objects in other clusters. This process runs in an unsupervised manner. Similar to classification, current researches on privacy-preserving clustering can be roughly categorized into two types, based on data transformation [ 57 , 58 ] and based on secure multiparty computation [ 59 , 60 ].
For the distributed or isolated data, distributed data mining is the research topic. Distributed data mining can be further categorized into data mining over horizontally partitioned data and data mining over vertically partitioned data. Research on distributed data mining attracts much attention. To overcome the difficulty of data integration and promote efficient information exchange without sharing sensitive raw data, Que et al. developed a Distributed Privacy-Preserving Support Vector Machine (DPP-SVM). The DPP-SVM enables privacy-preserving collaborative learning, in which a trusted server integrates “privacy-insensitive” intermediary results [ 61 ]. In medical domain, much raw data can hardly leave the institution of origin. Instead of bringing data to a central repository for computation, Wu et al. proposed a new algorithm, Grid Binary LOgistic REgression (GLORE), to fit a LR model in a distributed fashion using information from locally hosted databases containing different observations that share the same attributes [ 62 ].
It is worth to note that learning (classification or clustering) on secure multiparty computation is an important distributed learning strategy, by which privacy disclosure concern can be much reduced since data need not to be shared out. This research topic probably inspired federated machine learning [ 30 , 32 ]. Today's AI still faces two major challenges. One is that data exists in the form of isolated islands. The other is the strengthening of data privacy and security. The two challenge is much severer in the healthcare domain. Federated machine learning is aimed at building a learning model from decentralized data [ 30 ]. Federated learning can be classified into horizontally federated learning, vertically federated learning, and federated transfer learning based on how data is distributed among various parties in the feature and sample ID space [ 32 ]. Horizontal federated learning, or sample-based federated learning, is introduced in the scenarios that datasets share the same feature space but different in samples. At the end of the learning, the universal model and the entire model parameters are exposed to all participants. Vertical federated learning or feature-based federated learning is applicable to the cases that two datasets share the same sample ID space but differ in feature space. At the end of learning, each party only holds the model parameters associated with its own features; therefore, at inference time, the two parties also need to collaborate to generate output. Federated transfer learning (FTL) applies to the scenarios that the two datasets differ not only in samples but also in feature space. FTL is an important extension to the existing federated learning systems and is more similar to vertical federated learning. The challenge of protecting data privacy while maintaining the data utility through machine learning still remains. For a comprehensive introduction of federated privacy-preserving data mining, please refer to the survey based on the proposed 5 W-scenario-based taxonomy [ 31 ].
Privacy protection is the indispensable prerequisite of secondary usage of health data. As discussed above, risk-mitigation methods are aimed at anonymizing private or sensitive information so as to reduce the risk of reidentification. Methods about privacy-preserving data mining target to process the privacy-scrubbed data and extract knowledge and even build AI systems. If absolute privacy safe is pursued, the scrubbed data is definitely useless, since the data quality is severely corrupted. With the poor-quality data, accuracy and effectiveness of data utilization are extremely affected. Therefore, in a practical scenario, a certain tradeoff or compromise between privacy and accuracy must always be made. The tradeoff can be tuned to provide more or less privacy resulting in less or more accuracy, respectively, according to the requirements of privacy level and utility level. Federated privacy-preserving data mining sheds light on the new direction to compromise, even to balance, the privacy and accuracy. No need to share data out, federated privacy-preserving data mining first processes the original health data within institutions, and the conduct federated mining or learning. This type of method is expected to reconcile privacy and accuracy with more elegant style and more acceptable way.
Clinical data, genomic data, and consumer health data are the majority of health big data. Protection and reuse always gain much focused research topics. In this review article, the type and scope of health data are firstly discussed, followed by the related regulations for privacy protection. Then, strategies for user-controlled access and secure network architecture are presented. Sharing trained model without original data leaving out is a new important strategy and gains more and more focus. According to different data reuse scenarios, tasks and methods at three different levels are summarized. The strategies and methods can be combined to form a holistic solution.
With the rapid develop health information technology and artificial intelligence, the capability of privacy protection will impede the urgent demand of reusing health data. Some potential research directions may include (1) applying modern machine learning to deidentification and anonymization for multimodal health data while ensuring its data quality; (2) learning model construction and knowledge extraction based on anonymized data to leverage secondary use of health data; (3) federated learning on isolated heath data can both protect privacy perfectly and improve the efficiency of data transferring and processing, being deserved more attention; (4) research on alleviating reidentification risk, such as linkage or inference, from a trained model.
This study was funded by the China Postdoctoral Science Foundation Grant (2020M671059) and the Fundamental Research Funds for the Central Universities (2572020BN02).
The authors declare that they have no conflicts of interest.
12 Pages Posted: 28 Feb 2022
Nigerian Law School, Lagos
Date Written: January 7, 2022
With the continuous advancement in technology and massive increase in internet usage, the concepts of data privacy and data protection is a hugely debated topic. This is because, the service providers who manage the websites, applications and social media platforms often collect and store user’s personal data with the objective of providing adequate services to best suit each user’s preference. Usually, these digital service companies are saddled with the responsibility of protecting the personal data of the users from unauthorised access and against all vulnerabilities. However, instances arise where these platforms fail to adequately place safeguards to protect the data collected and this results to a data breach and exposure of users sensitive data to unauthorised parties who can use the personal data to defraud and harass the users or to send unwanted adverts without the users consent. Thus, infringing on the users’ fundamental right of privacy and freedom to freely express themselves. Hence, the need for companies to adopt defensive mechanisms to ensure an adequate protection of users’ personal data and also awareness by the users that they have a right of control over which personal data to share and with whom it is shared. This paper is divided into three parts with the first discussing the rights of users and responsibilities of companies as well as the established regulations in the protection of data. The second part of this work considers the issues surrounding data privacy and data protection and the challenges faced in ensuring the safety of users’ personal data. Finally, the last part offers a series of recommendations and conclusion.
Keywords: Data Privacy, Data Protection, User, Data Breach, Privacy Policy, General Data Protection Regulation (GDPR), Nigerian Data Protection Regulation (NDPR), California Consumer Privacy Act (CCPA)
JEL Classification: K24, C8, O3
Suggested Citation: Suggested Citation
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Table of Contents
Data protection issues in research remain at the top of researchers’ and institutional awareness, especially in this day and age where confidential information can be hacked and disseminated. When you are conducting research on human beings, whether its clinical trials or psychological inquiries, the importance of privacy and confidentiality cannot be understated. In the past, it was as easy as a lockable file cabinet. But now, it’s more and more challenging to maintain confidentiality and data protection in research.
In this article, we’ll talk about the implications of confidentiality in research, and how to protect privacy and confidentiality in research. We’ll also touch on ways to secure electronically stored data, as well as third-party data protection services.
How can you protect privacy and confidentiality in research? The answer, in some ways, is quite simple. However, the means of protecting sensitive data can often, by design, be complex.
In the research time, the Principal Investigator is ultimately responsible for the integrity of the stored data. The data protections and confidentiality protocols should be in place before the project starts, and includes aspects like theft, loss or tampering of the data. The easy way to do this is to limit access to the research data. The Principal Investigator should limit access to this information to the fewest individuals possible, including which research team members are authorized to manage and access any data.
For example, any hard-copies of notebooks, questionnaires, surveys and other paper documentation should be kept in a secure location, where there is no public access. A locked file cabinet, away from general access areas of the institution, for instance. Names and other personal information can be coded, with the encoding key kept in a separate and secure location.
It is the Principal Investigator’s responsibility to make sure that every member of the research team is fully trained and educated on the importance of data protection and confidentiality, as well as the procedures and protocols related to private information.
Check more about the Team Structure and Responsibilities .
Even if paper copies of questionnaires, notes, etc., are stored in a safe, locked location, typically all of that information is also stored in some type of electronic database. This fulfills the need to have data available for statistical analysis, as well as information accessible for developing conclusions and implications of the research project.
You’ve certainly heard about the multitude of data breaches and hacks that occur, even in highly sophisticated data protection systems. Since research projects can often involve data around human subjects, they can also be a target to hackers. Restoring, reproducing and/or replacing data that’s been stolen, including the time and resources needed to do so, can be prohibitively expensive. That doesn’t even take into consideration the cost to the human subjects themselves.
Therefore, it’s up to the entire research team to ensure that data, especially around the private information of human beings, is strongly protected.
Frankly, it’s easier said than done to ensure confidentiality and the protection of research data. There are several well-established protocols, however, that can guide you and your team:
Check more about: Why Manage Research Data?
If your institution does not have built-in systems to assure confidentiality and data protection in research, you may want to consider a third party. An outside information technology organization, or a team member specifically tasked to ensure data protection, might be a good idea. Also look into different protections that are often featured within database programs themselves.
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BMC Public Health volume 24 , Article number: 2317 ( 2024 ) Cite this article
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Loss to follow-up in long-term epidemiological studies is well-known and often substantial. Consequently, there is a risk of bias to the results. The motivation to take part in an epidemiological study can change over time, but the ways to minimize loss to follow-up are not well studied. The Citizen Science approach offers researchers to engage in direct discussions with study participants and to integrate their opinions and requirements into cohort management.
Guided group discussions were conducted with study participants from the KORA cohort in the Augsburg Region in Germany, established 40 years ago, as well as a group of independently selected citizens. The aim was to look at the relevant aspects of health studies with a focus on long-term participation. A two-sided questionnaire was developed subsequently in a co-creation process and presented to 500 KORA participants and 2,400 employees of the research facility Helmholtz Munich.
The discussions revealed that altruistic motivations, (i.e. supporting research and public health), personal benefits (i.e. a health check-up during a study examination), data protection, and information about research results in layman’s terms were crucial to ensure interest and long-term study participation. The results of the questionnaire confirmed these aspects and showed that exclusively digital information channels may be an obstacle for older and less educated people. Thus, paper-based media such as newsletters are still important.
The findings shed light on cohort management and long-term engagement with study participants. A long-term health study needs to benefit public and individual health; the institution needs to be trustworthy; and the results and their impact need to be disseminated in widely understandable terms and by the right means of communication back to the participants.
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In a long-term prospective cohort study, the motivation of people to participate over an extended period and trustfully share their health data is essential to investigating causal relationships between health and disease in constantly changing environments. However, loss-to-follow up, i.e. declining willingness to take part in follow-up examinations and questionnaires, is a major problem in all long-term prospective cohort studies [ 1 , 2 , 3 ], raising questions about the generalizability of results [ 4 ]. Information on the reasons to participate is often gathered at the initial sign-up of the study by short non-participant questionnaires [ 5 , 6 , 7 ], satisfaction polls after the study examination for internal conduct improvement, witness statements [ 8 ] or by chance when study participants comment to staff or leave remarks in questionnaires. Non-participants often report acute health problems or stressful life-events, but also unspecific reasons like lack of interest or time constraints. In good epidemiological practice, efforts to characterize the loss of follow-up during analysis are made [ 9 ] and particular groups can be identified, e.g. less educated groups or middle-aged men, depending on the cohort [ 10 , 11 ]. However, cohort management should seek to maximize participation in follow-up studies in the first place by trying to meet participants’ expectations. Personal attitudes towards data sharing may change during long-term studies, particularly in the light of the experience of the COVID-19 pandemic. To our knowledge, systematic research into cohort management strategies in long-term epidemiological studies is rare.
Citizen Science, also called “participatory research,” has increasingly been supported by public organizations in and outside of academic institutions to meet information requirements, increase transparency, and improve people’s attitudes towards science [ 12 ]. In 2022, the White Paper “Citizen Science Strategy 2030 for Germany” was published that comprehensively informs about Citizen Science, action areas, networking, funding, volunteer management, and many other aspects [ 13 ]. Meanwhile, a wide range of scientific projects covering all areas of interest are offered to the public [ 14 , 15 , 16 ]. Participatory research strategies have been introduced into health research in various initiatives (e.g. [ 17 ]) with the overarching goal “to reduce concerns about the use of data through intensive exchange with interested citizens and to demonstrate the opportunities it offers” [ 18 ]. Citizen Science in public health can be characterized by typology according to aim, approach, and size, depending on the level of engagement with the community [ 19 ].
Recently, Marcs et al. published a scoping review on Citizen Science approaches in chronic disease prevention where they used Citizen Science to identify problems from the perspective of community members, generate and prioritize solutions, develop, test and/or evaluate interventions, and/or build community capacity [ 20 ]. Frameworks for a systematic development of participatory epidemiology have also been proposed [ 21 ].
Our aim was to employ Citizen Science approaches to engage in direct discussion with study participants from a well-established epidemiological study to evaluate how to maximise study participation long-term by high response rates and low subsequent withdrawal of consent. We were particularly interested in the reasons for continuing to take part in follow-up studies as well as concerns and wishes regarding the collection and use of health data. The research methods combined Citizen Science approaches like qualitative research and co-design elements with a classical quantitative approach in a nested but work-efficient study design. The project was conducted in a randomly selected subgroup of participants of a long-term prospective cohort study and, for comparison, a group of independent citizens and employees of a large health research institution.
The Citizens Science project was embedded in the KORA study (Cooperative Health Research in the Region of Augsburg), an adult population-based prospective cohort study established in 1984 in the City of Augsburg and the adjacent rural counties Augsburg and Aichach-Friedberg in Southern Germany [ 22 ]. Briefly, the KORA-study consists of four cross-sectional baseline surveys (S1 from 1984/85 with N = 4,022 (response: 79.3%); S2 from 1989/90 with N = 4,940 (response: 76.9%); S3 from 1994/95 with 4,856 (response: 74.9%); and S4 from 1999/2001 with 4,261 (response: 66.8%)). The participants were randomly selected from population registries aged 25–74 years (S1: 25–64 years). The KORA study is still in active follow-up with a KORA study centre located in the City of Augsburg. A general health survey was sent out in 2021 to all S1 to S4 participants still living in the study area and with consent for recontact. 6,070 out of 9,109 participants answered the survey (66.6%).
The starting point of the project was qualitative research with three guided discussion groups: two with KORA study participants and one with newly recruited citizens. In a co-creation process at a subsequent meeting, a questionnaire was developed with a smaller group of volunteers from the discussion groups. For the quantitative part of the study, this questionnaire was mailed to participants of the KORA study and distributed to all employees of Helmholtz Munich.
During the preparation of the study setup, a pilot discussion group was conducted with seven acquaintances of the involved scientists. For the two discussion groups with KORA volunteers, 183 KORA study participants were selected (criteria: 50% women, 50% participants of the latest KORA general health survey 2021 with online survey completion and 50% paper-based completion, born 1949–1969, residing in Augsburg or nearby). They were invited in writing by post and contacted by telephone. Citizens were recruited via a newsletter advertisement of the Volunteer Centre Augsburg [ 23 ], and posters and flyers that were distributed in shops, restaurants, the library, the University Hospital Augsburg, and other public places in Augsburg. To compensate expenses, e.g. for travelling, we paid a small expense allowance.
The discussions took place between May and June 2023 in the KORA Study Centre in Augsburg. Following a short impulse presentation on the KORA study, the attendees were asked to note their motivations, concerns, and wishes regarding the participation in a long-term observational health study separately on index cards. The number of cards was not specified. The participants had the opportunity to present each card to the group before it was displayed on a whiteboard sorted by the respective category. Guided by two moderators, the raised aspects were discussed in greater depth along with a set of prepared questions. To provide more information on data privacy and protection in the KORA study, the consent form and study information from the most recent KORA general health survey in 2021 were distributed. Each discussion group lasted about 90 min and was rounded up with a little get-together at the end. The discussions were audiotaped with Audacity ® 3.2.5 and a microphone of the conference system Logitech CC3000e ConferenceCam and transcribed subsequently. In the aftermath, the index cards were coded according to reoccurring themes. One of the authors, who was part of all three discussion groups, developed a coding scheme with the help of the audiotapes. The scheme was reviewed by another author who was not present at the discussions, and consensus was found in terms of discrepant interpretation. Anonymized quotes were selected and translated for publication purposes.
The discussion group participants were invited to a subsequent meeting to develop the questionnaire together with the researchers in a co-creation process. The aim was to recruit six volunteers (two per group) to discuss a prepared questionnaire draft in the light of the results from the discussion groups. The questionnaire was designed for mailing to the KORA study participants first and modified slightly for the employees of Helmholtz Munich thereafter. It consisted of questions on the three pre-defined categories motivations, concerns, and wishes and a section on personal data such as sex, age, and school education. Many of the questions were formatted as 5-point Likert scales.
The questionnaire was piloted at the Institute of Epidemiology, and the final version was also translated into English for the Helmholtz Munich employees (Supplement).
The paper version was posted to 500 selected KORA participants, equally balanced by sex. They were randomly chosen from the KORA S1-S3 studies from a total of N = 2,933 participants born between 1964 and 1945, still living in the study area, and with consent for recontact. 400 of them had taken part in the latest KORA general health survey in 2021, while 100 had not. The approximately 2,400 Helmholtz employees were invited to complete the questionnaire personally on paper in the canteen on campus or online (in PDF format).
All discussion group participants gave their written informed consent to take part in the discussions. The questionnaire was conducted anonymously, and no written informed consent was required. This study protocol was approved by the ethics committee of the Bavarian Medical Association (EC 23010).
The data from the completed questionnaires was transferred to a database and analyzed primarily with R and RStudio (Boston, MA, USA). Characteristics of the qualitative study groups were reported with absolute numbers, and characteristics of the quantitative questionnaire study population with numbers and percentages. The R-package „Likert“ was used to create Likert scale charts (Figs. 1 and 2 ). Percentages were calculated to sum the two categories “not important” and “not very important”, and the two categories “important” and “very important”, respectively. The category “neutral” was also visualized, and the percentages were given. Figure 3 was set up in Excel. Percentages were calculated and displayed by education level after exclusion of participants with missing information on education ( N = 1) and those who had no school-leaving certificate ( N = 2). Significance tests were not performed because the statistics were descriptive and not adjusted for confounding factors.
Reasons to participate in the KORA study or a long-term health study. Percentages on the left represent purple responses, percentages on the right represent green responses
Concerns about data protection, linkage of study data with secondary health information, and use for non-public research. Percentages on the left represent green responses, percentages on the right represent red responses
Preferred information channels to disseminate research results of the KORA study, stratified by school education
Twenty-four people participated in the three discussion groups (17 probands of the KORA study, 7 citizens, 11 women, and 13 men). Their age range was 42 to 78 years (mean age: 65 years). 14 people reported high (12–13 years), 9 intermediate (10 years), and one person low (9 years) school education.
Table 1 shows the results of the group discussions stratified by category. There was no major difference between KORA participants and the citizen group. Most ideas were raised in the category motivations, followed by wishes and concerns. We excluded statements that went beyond the scope of a health study (concerns: general criticism of the health system (3x) and study staff would not listen (1x); wishes: individual health advice (8x) and contact between participants (2x)).
The number of people who referred to one of the aspects listed in the table is depicted in column N.
For many volunteers, a motivation to take part in the KORA study or a health study in general was the free preventive medical check-up in the form of the study examinations.
Discussion Group 1 , KORA participant: “So , my motivation to join was to get information about my health that I wouldn’t have gotten otherwise.”
Additionally, the discussants placed great importance on the benefits for the public, their contribution to health research, and their interest in it.
Discussion Group 3 , KORA participant: “In terms of motivation , the focus is , of course , quite clearly on the fact that the benefit is for the general public.” Discussion Group 1 , KORA participant: “And then , of course , that one contributes to general research.”
The professional conduct of the study was also mentioned several times.
The participants raised fewer issues in the category concerns than in the categories motivations and wishes. The main aspects were protection and security of health data in KORA or generally in health studies.
Discussion Group 1 , KORA participant: “My concerns are (…) data protection and data usage. Not particularly in relation to Helmholtz Munich , but the overall (…) misuse , data hackers , cybercrime , all that stuff. And that will increase even more in the future.” Discussion Group 2 , Citizen: “…it is always difficult with data protection in an international comparison. We have very high standards here , but can we maintain them in the long term? Because , of course , we also create barriers that are incomprehensible to others.”
Some of these concerns were not directed at the discussants themselves but rather at younger people who might suffer greater harm through misuse. Discrimination in professional life or when taking out insurance were mentioned as examples in this context.
Discussion Group 1 , KORA participant: “Personally , I wouldn’t mind (…) , but with younger , working people , I would probably have a different opinion. Because today , you can supposedly already say that people might get certain diseases at some point. (…) And I think that is dangerous if this information goes to the insurance companies or to the employers themselves (…).”
The participants did express their trust in Helmholtz Munich as a publicly funded research institution, and the consent form and study information were considered informative and clear; some participants even found them too detailed.
A minority of the participants had no worries whatsoever.
Discussion Group 3 , KORA participant: “I really can’t say anything about concerns. If my data were published with my name , I wouldn’t care at all.”
In the category wishes, the participants pointed out that more communication on study results and their translation into the health care system would motivate them long-term to participate in a study.
Discussion Group 2 , Citizen: “(…) the research results must be disseminated more widely. In my opinion , they have primarily been intended for experts.” Discussion Group 2 , Citizen: “I find the contributions on the Internet (…) terrible. The layperson gets all mixed up. You’d have to clean up that mess , too.”
Many participants indicated that simple, brief, and comprehensible communication was appreciated. Some discussants preferred digital formats, while others explicitly stated that they wanted paper-based communication only. Overall, the discussion group participants were open to health research and were interested in more frequent examinations and additional study offers.
A two-page questionnaire was developed in a meeting between two out of the 24 discussion group participants and two researchers. The participants pointed out some complicated questions and assessed the overall comprehensibility.
The survey was completed by 278 KORA participants (response rate: 67% in those who had participated in the latest KORA follow-up and 9% in those who had not participated) and 285 Helmholtz Munich employees (response rate: about 12% as the exact number of employees was not available), resulting in a total study population of 563 people. The characteristics of the study population are displayed in Table 2 . Approximately the same number of women and men took part in the survey. The KORA study participants were between 58 and 78 years old (mean age: 67.9 years). The Helmholtz Munich employees were younger, mostly between 20 and 50 years old (mean age: 39.8 years). About one-third of the KORA participants had low (9 years), intermediate (10 years), and high (12–13 years) levels of school education. In contrast, most of the Helmholtz Munich employees (89.2%) had a high level of education. 71.4% of the Helmholtz Munich employees worked scientifically, and 70.4% had German citizenship.
In the questionnaire, participants were asked how important they rated the three listed reasons to participate in the KORA study or a long-term health study (Fig. 1 ). The answers of the KORA study participants and the Helmholtz employees were very similar. A majority of about 90% deemed “contributing to health research” and “benefits for the general public” as very important or important. “Free comprehensive medical check-ups” were also seen as important or very important by about 70%, while about 20% took a neutral position on this aspect.
Differences between the two participant groups were found regarding questions about concerns in relation to data protection and data linkage (Fig. 2 ). Only a small proportion of the KORA study participants had reservations about data protection in the KORA study (3%). Concerns or strong concerns increased with regards to linking their study data to secondary health data such as diagnoses by their physicians (7%), prescription and treatment data by their health insurance (14%), but it decreased with regards to the cause of death sometime in the future (7%). In comparison, 35% of the Helmholtz Munich employees had concerns or strong concerns about data protection in a long-term health study. Data linkage was seen critically by 35% regarding study and physician diagnosis data, by 41% regarding study and health insurance data, and by 17% regarding study and death certificate data.
A larger proportion in both groups (29% of the KORA participants and 57% of the Helmholtz Munich employees) indicated concerns or strong concerns about the utilization of their health data by non-public research organizations.
The KORA participants were asked how they would like to be informed about the research results of the KORA study. Multiple selections were allowed. Figure 3 shows the percentages stratified by school education. Participants with a high level of school education preferred digital channels such as electronic newsletters and websites, in contrast to participants with low or intermediate school education, who preferred information, i.e. newsletters by paper mail. About 20% of each group indicated that they would appreciate coverage of scientific research results via newspapers, radio, and TV, while books were only interesting for a small proportion of participants. Less than 10% did not wish for any information. Of the 147 participants who chose a newsletter by paper mail, 20% also selected a newsletter by email, and 4% also selected the website category – thus, 77% of those who chose paper mail wanted no digital information.
Using Citizen Science approaches, this project examined the motivations, concerns, and wishes of research participants to help slow down the decline in follow-up study participation. The KORA study was established almost four decades ago and is still in active follow-up with relatively high response rates, e.g. 64% in an examination in 2018/19 [ 24 ] and 66.7% in a general health survey in 2021. Longitudinal data is particularly informative for life-course health research, but few studies exist on how to keep up motivation in follow-up studies. The findings from the discussion groups and the questionnaire survey showed that participants can be motivated to provide their personal health data for scientific purposes over long periods of time if their expectations are met. Three main reasons to participate in a long-term health study were identified: the benefit to the public, scientific progress, and personal health. Those findings are consistent with a previous study led by KORA scientists in 2010 on the public perceptions of cohort studies and biobanks during the recruitment phase of the German National Cohort (NAKO) [ 25 ]. They found that in general, citizens approve epidemiological research based on expectations for communal and individual benefits (e.g., health check-ups and health information). This shows that the basic motivation for study participation does not change between study initiation and long-term follow-up. Collaboration with science [ 26 ], making a contribution to society [ 27 ], and receiving information about personal health [ 28 ] have also been known as motivations for study participation in clinical studies. In a recent study on retaining participants in longitudinal studies of Alzheimer’s disease, altruism and personal benefit were the factors associated with continued study participation as well [ 29 ].
In the discussion groups, data protection did not come up as a major concern and was not necessarily directed at the KORA study. In the questionnaire, participants had no strong concerns about their data in the KORA study, even for data linkage. This is in line with the findings by Bongartz et al. that the trustworthiness of those conducting research appeared to be most important for the decision to participate in a health-related study [ 30 ]. However, Helmholtz Munich employees expressed more concerns with regards to data protection and data linkage. A likely interpretation for this difference is that KORA participants referred to a specific study that they had a lot of experience with, while Helmholtz employees imagined some theoretical long-term health study. Moreover, the Helmholtz employees were, on average, younger, higher educated, and probably more informed about data protection and data security risks. Our findings showed that institutional trust is essential for long-term participation in a health study. Once trust is gained at initial sign-up, it is important to maintain it. The comprehensive study by Tommel et al. also supports the importance of trust [ 31 ]. They explored citizens and healthcare professionals’ perspectives on personalized genomic medicine and personal health data spaces in questionnaires and interviews. Cohort management can help maintain trust, but overall satisfaction with the health system, public health policy, or pandemics is outside its scope.
About one-third of the KORA participants and about two-thirds of the Helmholtz Munich employees expressed concern about sharing data with non-public research organizations. This is in line with findings that people are generally prepared to participate in epidemiological research if it is conducted by a trusted public institution, but that there is widespread distrust of research conducted or sponsored by pharmaceutical companies [ 32 , 33 ]. However, this degree of concern in both groups was somewhat surprising, as most KORA participants had given consent to sharing their data with industry previously, and Helmholtz Munich contributes to the translation of research into medical innovation with commercial partners.
The discussion group participants wished to be informed about the results and impact of the research in a generally understandable format. The information should be addressed to them personally, such as through a newsletter, rather than in the press, TV, or the internet. A notable proportion of the KORA participants wished to be informed via non-digital means. This is an important finding for those running population-based studies such as the German National Cohort [ 34 ] and their financing bodies. While the finding may be specific to the setting in Southern Germany and a long-term cohort study with aged participants, it is important to monitor the information preferences. In addition to digital tools, paper-based methods are still needed for many more years to not lose large groups of the general population. Future research should focus particularly on the digital readiness of older citizens, so that cohort management strategies can engage participants at their level. In long-term health studies, morbidity and mortality are often relevant health outcomes. Public health policies that enable secondary data linkage could also compensate for loss to follow-up and limit selection bias.
A strength of this project is its diverse group of participants, which includes stakeholders from a long-term epidemiological study, independent citizens, and staff from a research institution earning their living in health science research.
The discussion groups were structured but allowed participants to explain their own narratives and introduce new issues. The questionnaire was administered to two very different groups of participants, and in part, similar results were obtained that confirmed each other (i.e., important motivations to take part in health research (Fig. 1 )).
With respect to limitations, a Citizen Science project depends on participants who are interested and motivated to take part. It is quite difficult to find enough participants, and only 24 discussion group volunteers do not necessarily represent the “general” public, especially as discussants with low education were underrepresented. Participants living in rural areas were completely absent due to the recruitment strategy that they had to live in a reasonable travel distance from the KORA study center. The dates and times of the discussion groups were fixed by the researchers and probably discouraged very busy people. However, the small fee and snacks seemed to motivate some of the participants with lower economic status to take part.
In addition, it cannot be ruled out that the ideas of the discussants as well as the answers of the questionnaire survey were influenced by social desirability, perhaps on a subconscious level, and people might thus act somewhat differently in real life than they indicated they would in a theoretical setting. In a group discussion, participants may give answers that they believe to be expected and that will please the interviewer or moderator. Social desirability bias was certainly less of an issue in the questionnaire survey as it was anonymous. However, the outcomes of the discussion groups generally agreed with the responses to the questionnaire given to KORA participants. This questionnaire represents the views of a pre-selected group of people who were recruited up to forty years ago and who still consent to be contacted again for follow-up research. The response to the questionnaire by the KORA participants was as expected: It was high among those who had participated in the latest KORA general health survey in 2021, but it was very low in those who did not participate at the time. This shows that participants who are lost to follow-up are difficult to re-engage.
Finally, the development of the questionnaire was intended to be a co-creation process between selected discussion group participants and scientists. However, the interest of the discussion group members in co-creation was low, and only two participants were willing to take part in this process. They improved the comprehensibility of the questionnaire draft but saw themselves clearly as contributors rather than co-creators. A successful co-creation process requires more capacity building than was possible in this project. As Laird et al. pointed out, Citizen Science approaches often face barriers like building up longer-term collaborative relationships, and their implementation is often time and resource constrained [ 35 ].
The Citizen Science approach opens a new possibility to get in touch with study participants more closely and to integrate their opinions and requirements into cohort management.
On the one hand, people are altruistically motivated when they decide to take part in a long-term health study, and they enjoy the possibility to contribute to public benefit and scientific progress. On the other hand, they also see benefits for their personal health. Concerns do not seem to prevail. Feedback in layman’s terms on the long-term results of the study is highly appreciated and should be addressed to the participant personally.
Cohort management should include regular feedback of results as a thank you for the data donation and contribution to society.
In other words, a long-term health study needs to benefit public and individual health, to be trustworthy regarding data protection and data use, and to provide long-term research results in generally understandable terms and in the preferred communication mode back to the participants.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request via the application tool KORA.passt ( https://helmholtz-muenchen.managed-otrs.com/external/ ).
Cooperative Health Research in the Region of Augsburg
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We thank all participants of the discussion groups and the questionnaire survey for their contributions, the staff for data collection and research data management, and the members of the KORA Study Group (https://www.helmholtz-munich.de/en/epi/cohort/kora) who are responsible for the design and conduct of the KORA study.
The KORA study was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Data collection in the KORA study is done in cooperation with the University Hospital of Augsburg. The project was supported by the NFDI4Health (National Research Data Infrastructure for Personal Health Data) citizen-science 2023 initiative to support participatory research ( https://www.nfdi4health.de/community/citizen-science.html ).
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Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Munich, Germany
Ina-Maria Rückert-Eheberg, Margit Heier, Markus Simon, Monika Kraus, Annette Peters & Birgit Linkohr
KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
Margit Heier
German Centre for Cardiovascular Research (DZHK e.V.), Munich Heart Alliance, Munich, Germany
Monika Kraus, Annette Peters & Birgit Linkohr
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
Annette Peters
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IMRE contributed to the conception, design, and conduct of the study, analyzed and interpreted the data, and drafted the manuscript. MH contributed to the conception, design, and conduct of the study, interpreted the data, and revised the manuscript. MS contributed to the design and conduct of the study, interpreted the data, and revised the manuscript. MK contributed to the design and conduct of the study, interpreted the data, and revised the manuscript. AP contributed to the conception and design of the study, interpreted the data, and revised the manuscript. BL contributed to the conception, design, and conduct of the study, interpreted the data, and drafted the manuscript. All authors read and approved the final manuscript. They agree to be accountable for their own contributions and that questions that may arise on the accuracy or integrity of the work will be appropriately investigated, resolved, and documented.
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Rückert-Eheberg, IM., Heier, M., Simon, M. et al. Public attitudes towards personal health data sharing in long-term epidemiological research: a Citizen Science approach in the KORA study. BMC Public Health 24 , 2317 (2024). https://doi.org/10.1186/s12889-024-19730-0
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The integration of the metaverse into the real estate and construction industry reveals various potentials, but also challenges. The increasing digitization in the architecture, engineering, construction, and operation (AECO) sector requires a critical examination of aspects such as the metaverse. This paper is dedicated to examining the impact of the metaverse on the real estate and construction industry. The following specialist article is primarily aimed at the target group of the AECO sector, with the aim of gaining an initial overview of the opinions within this sector. The methodology used includes an in-depth literature review and a representative survey. Respondents from different age groups and areas of activity within the construction and real estate industry took part in this survey. The research questions of this paper are aimed at identifying the range of metaverse applications in the AECO industry, assessing their potential impact on business potential and challenges. The aim is to develop initial definitions and use cases and to create an overview of opinions in the industry. In this context, potential opportunities and risks will be examined to derive recommendations for an effective integration of the metaverse into the AECO industry. The results of this paper conducted indicate that there is still considerable uncertainty in the construction and real estate industry. It appears that the term “metaverse” and the associated potential through targeted use cases are not yet widespread in this industry. The survey participants recognize a potential for 3D visualizations in the metaverse that extends over the entire life cycle of buildings. An exemplary scenario for this is the use of 3D visualizations both during the planning phase and in marketing. The challenges identified shed light on uncertainties relating to data protection, privacy, and the influence of the internet. The results of the study reveal a high level of uncertainty and ignorance within the industry when it comes to understanding the metaverse. Based on the results, further studies are needed to establish the understanding and real potential of the metaverse in the industry. Conducting workshops specifically aimed at the AECO sector can help to deepen understanding of the potential of possible use cases.
Analysis of potentials and challenges of metaverse in architecture, engineering, construction, and operations (AECO)
Methodology comprises literature review, workshops and a representative survey
Results show a high level of uncertainty and ignorance of the construction industry regarding the metaverse
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The onset of the twenty-first century heralded an era of unprecedented digital transformation across various industries. Among these, the construction industry, a vital component of global economic infrastructure, stands on the brink of a potential change with the integration of metaverse technologies in architecture, engineering, construction, and operations (AECO). This paper aims to explore the burgeoning role of the metaverse in AECO, analyzing the attitude of the construction industry towards its impact on enhancing digital capabilities and reshaping industry dynamics.
The concept of the metaverse, a collective virtual shared space created by the convergence of virtually enhanced physical reality and persistent virtual spaces, offers untapped potential for the AECO sector. Its implications are vast, ranging from virtual design and collaboration to enhanced project management and operations, but also real estate marketing. The integration of these virtual elements into the physical processes of construction signifies a paradigm shift in how industry professionals envision, design, and execute their projects. However, despite the promise of these innovations, the construction industry has faced challenges in adopting digital transformation at a pace comparable to other sectors. A pivotal study by [ 1 ] highlighted the slow adoption of digital technologies in the construction industry, while noting significant advancements in sustainability practices. This dichotomy underscores the need for a balanced approach that leverages technological advancements while addressing the industry's unique challenges and opportunities. Furthermore, the European Commission's 2021 analytical report on digitization in the construction sector provides a comprehensive overview of the current state of digital transformation in this field [ 2 ]. It underscores the critical need for integrating advanced technologies like the metaverse to stay competitive and efficient. Various countries already have metaverse strategies. In the European Union, such a strategy is currently discussed.
Analyses by PwC and the European Commission underscore the urgent need to advance the digital transformation in the construction and real estate industry. These publications identify digitization as a crucial lever for future success and value creation. The metaverse represents just one aspect of the digital transformation in the AECO sector that will be examined in this paper. The lack of comprehensive and representative studies on the integration of the metaverse into the AECO sector highlights the relevance and urgency of conducting initial scientific investigations in this area. These studies are essential for gaining a better understanding of the opportunities and challenges, thereby creating greater transparency. Furthermore, there are currently neither standardized definitions of the metaverse nor specific definitions for its application in the AECO sector. This results in inconsistent understanding and application within the industry. [ 3 ] Given the current state, where the metaverse is scarcely integrated into the AECO sector and no standardized definitions exist, the central research question of this paper is formulated as follows: What challenges and opportunities, as well as specific use cases, arise from the integration of the metaverse to advance the development and progress of the AECO sector? The problem, therefore, lies in the lack of knowledge and standards within the industry on this topic. The aim of this paper is to establish a comprehensive foundation for the integration of the metaverse into the real estate sector, familiarize stakeholders with this topic, and lay the groundwork for further in-depth studies. This includes considering all lifecycle phases of a building and identifying key issues such as challenges, opportunities, use cases, and future research needs. In order to approach this topic, a literature analysis is chosen at the beginning to explain basic concepts and provide theoretical insights into the current situation of the metaverse. Workshops will then be held with selected stakeholders in order to gain an initial opinion directly from the industry. Building on this, an online survey will be conducted in order to comprehensively record the content of the literature analysis and the results of the workshops for the broad mass of the industry. In this way, initial sentiments of the industry as well as opportunities and challenges can be presented.
The remainder of this paper is organized as follows: First, we are going to present the state of the art of digital transformation in AECO covering relevant digital technologies exemplarily, introduce several definitions of the metaverse, and cover especially regarding extended reality (XR) technologies in the construction industry. We are then going to describe our methodology, incorporating expert workshops and various use cases. These considerations led us to a list of challenges, that we incorporated into an online questionnaire answered by 291 participants. After a discussion of our key findings, we are going to provide a conclusion and an outlook.
Several current research areas are relevant to this article. First, we give a general overview of AECO and digitization before going deeper into the aspects of Building Information Modeling (BIM), XR technology and the applications of metaverse in the AECO sector. Finally, we present some examples of use cases for metaverse in the AECO sector.
In the AECO sector, the digital transformation and digitization actually disrupts the way, the projects are executed by the various stakeholders throughout the lifecycle [ 4 , 5 , 6 ]. Therefore and to maintain the growth of the AECO sector, the adaption of digital tools as well as associated methods and processual, organizational aspects and change management are vital [ 7 , 8 ]. The AECO sector thereby uses and combines various technologies, that aim especially to improve sustainability (e.g. by optimizing the building performance or reducing material and waste) and the cross-lifecycle data exchange (e.g. transferring as-built-data to the facility management and material passports) as well as support the efficiency in the design and construction process (e.g. avoid time delays, cost increases and safety risks) [ 9 , 10 , 11 , 12 , 13 ].
There are multiple relevant digital technologies for the digital shift in the AECO sector, namely Building Information Modeling, robotics and automation, big data, artificial intelligence, IoT, and XR. In this section, BIM is used as an example to show the challenges that occurred during the implementation of the technologies, to find derivations for the challenges for the implementation of the metaverse in the AECO sector.
Building Information Modeling is a systematic method that enables the comprehensive exchange of data and information through the targeted use of a variety of technologies and processes, resulting in a digital building model during planning and construction [ 14 ]. Special data exchange formats are used to seamlessly integrate data from different disciplines, such as architecture and technical building services. [ 15 , 16 ] This data, which is generated from building planning through to utilization, is represented in a digital, three-dimensional building model [ 17 ]. BIM models are used in the areas of design coordination, construction planning and facility management, as they contain comprehensive information on the design, construction, and operation of a building [ 18 ]. It represents a life cycle model for real estate [ 19 ]. Semantic information about the building context is provided, covering aspects such as geometry and properties of facilities, spatial relationships, proximity, and connectedness [ 20 ]. The digital building model derived from BIM has the potential to evolve into a real-time information model by integrating measurements and metadata from IoT (Internet of Things) sensors [ 21 , 22 ]. The AECO industry recognizes BIM as a significant opportunity and sees it as the key to digitization and achieving technological leadership in the industry [ 23 ]. The application of the BIM methodology is undergoing a revolutionary development through experience-oriented communication with numerous sensory perceptions [ 24 ].
The challenges and limitations of Building Information Modeling are one of the key research issues. In recent years, especially the challenges for emerging topics in the field of BIM, as the combination of BIM with AI (e.g., large language models like ChatGPT), Lifecycle Assessment or augmented reality, were researched [ 25 , 26 , 27 , 28 , 29 , 30 ]. By conducting a literature review, five aspects of challenges could be indicated:
Skills and educational barriers—especially in the early years of BIM a lack of education and training in BIM could be observed, what lead to a lack of skilled BIM users and authors at the beginning [ 31 ]. Also the courses at the university increased in recent years, the lack of skilled users and authors as well as developers is still a relevant key success criterion for the implementation of BIM [ 32 ]. Especially the combination of practical and theoretical education of students is one main challenge, due to highly volatile software landscape and influences on the BIM education [ 33 ].
Technology barriers—in current practice, proprietary data exchange formats are missing. Although, there are vendor-neutral standards (such as IFC or COBie), the software vendors do not implement them neutrally [ 34 , 35 ]. In addition to that there exist licensing problems, so that some stakeholders of the AECO industry need various software products to work in different projects (e.g., in project A software X is needed, while in project B software Y is needed, due to the requirements of the owner, general planner or general contractor) [ 36 , 37 ]
Financial barriers—the implementation of BIM often causes high implementation costs, which is stated as one barrier for the implementation [ 38 ]. On one hand, these implementation costs are caused by the purchase of soft- and hardware, as IT-tools (e.g. authoring tools, the implementation of Common Data Environments or cloud services) [ 39 ]. On the other hand, the employees need to be trained in BIM, due to a lack of knowledge [ 39 ]. In addition to that, after implementation high ongoing investments are necessary to provide the BIM infrastructure [ 40 ]. Therefore, it is necessary to keep the focus on the ROI, which could be made in a short number of years, but various factors, as the real productivity improvement, intangible returning factors and the lack of industry standards, need to be taken into account [ 41 , 42 ].
Legal barriers—still the legal rules for the implementation of BIM in the AECO industry (e.g., ownership of the model, liability for software and operator errors) are in its infancy and need further refinement. Especially the handling of contractual aspects (such as Employers Information Requirements or BIM Execution Plans) are still not fully implemented and unclear [ 43 ], although there already exist rules and standards, others still being developed and installed.
The example of BIM shows, that in the AECO industry there is a traditional resistant to change existing structures and social aspects are more important, then in other industries [ 44 , 45 ].
2.2.1 origin of the metaverse.
The origins of the term “metaverse” can be traced back to 1992, when American science fiction author Neal Stephenson published his work “Snow Crash.” [ 46 ] In this literary creation, the author designed a virtual reality that enabled parallel interplay and interactive experiences with the physical world. This novel utopian concept explored social emotions and sought to transcend the boundaries of time. [ 47 ] The metaverse which is discussed in this paper is currently in the development phase [ 48 , 49 ]. For this reason, the exact definition of the metaverse has not yet been clarified in scientific research [ 50 ]. The term metaverse is made up of the components “meta”, which comes from the Greek and means a kind of “transcendence”, and the English word “universe” [ 51 ]. In the discipline of computer science, continuous innovations register significant added value for users in terms of their interaction and action possibilities in the context of digital and virtual worlds [ 52 ]. However, there is currently a lack of entities and transparent standards to guide the design of the metaverse. Systematic approaches to data protection and private sites are still needed. More intense competition is underway between companies as they strive to develop closed and proprietary hardware and software solutions to establish themselves as leading players in the metaverse. [ 52 ] The lack of standards is also reflected in the fact that there is no universally valid and clear definition of the metaverse yet. Due to this fact, there is no single metaverse. Instead of this, there are different platforms and technologies. Each of these can be seen as a separate metaverse. [ 53 ] Examples include Decentraland, Second Life, Minecraft, Roblox and the Sandbox [ 54 ].
In 2020, the global Covid-19 pandemic led to significant changes in our society. They presented us with new challenges that required innovative solutions. The introduction of new working models such as remote work acquired unprecedented importance in society at this time. At the same time, the metaverse and certain technological innovations came into greater focus. The metaverse showed its potential to bridge the divide between working from home and working in the office. From an industrial innovation perspective, the metaverse has the potential to overcome the established physical norms to which people have become accustomed. It can stimulate the development of industrial technologies in a revolutionary way, promoting widespread integration of different sectors of the economy. This can accelerate change and modernization in relevant industries through the introduction of new concepts and formats. The metaverse is often referred to as the coming evolutionary stage of the Internet. [ 47 ]
The metaverse represents an immersive digital environment where users can explore the three-dimensional internet, serving as a link between our physical reality and the virtual sphere [ 55 ]. Components of the metaverse can be individualized avatars. This allows users to move freely in the metaverse and pursue various activities. [ 48 , 56 ]
According to Radoff [ 57 ], the metaverse concept consists of seven layers. The initial level refers to the "experience". This refers to the dematerialization of concrete places. Examples of this are events such as concerts, live events, and travel, which can be experienced within the metaverse. The second layer focuses on the aspect of "Discovery". The focus here is on determining real-time information and status messages. The third layer in the metaverse focuses on the "creator economy". Innovators, engineers, and creatives can benefit from the resources of the metaverse and enrich their activities as a result. The metaverse can be seen as a virtual trading platform on which these players can exchange their works and services. The fourth layer of the metaverse focuses on "spatial computing". Within this digital environment, a spatial context is created that grants the user access and enables them to interact and act. This spatial context can lead to a three-dimensional environment using XR technologies. The fifth layer of the metaverse focuses on "decentralization". The structure of this digital platform is characterized by a decentralized design, which means that no single person exercises unlimited control over it. Users can conduct experiments and promote their growth to an extent of their choice. The sixth layer in the metaverse comprises the "human interface". In the current era, mobile devices are increasingly focused on powerful features to integrate the applications and experiences of the metaverse. In the future, we can expect to see smart glasses on the market that can perform all the functions of a cell phone as well as applications for augmented reality (AR) and virtual reality (VR). The last layer in the metaverse, the "infrastructure", forms the backbone that connects our devices to the network and enables the transfer of content. A significant improvement in bandwidth and a drastic reduction in network latency can be expected as 5G networks come to the fore. In the next phase, 6G is expected to significantly increase speed again. This concept results in a so-called metaverse value chain. [ 57 ]
In the publication by Buchholz et al., seven characteristic features of the metaverse were identified. These seven characteristics include: the fusion of real and virtual worlds, the design as a social medium in which people can communicate, trade and own property, the persistent and long-lasting existence of the metaverse, the integration of extended reality technologies into the system, key actions such as recording the state of users and their real environment, multimodality and a close connection with physical reality. [ 55 ]
Similarities to this definition can be seen in the concept of the metaverse formulated by Steve Benford. He coined five characteristic features for the metaverse, which are as follows: The metaverse is understood as a virtual world, the relevance of virtual reality technologies is essential for its realization, it functions as an independent social network within which interaction takes place by means of individual avatars, the metaverse is characterized by its permanence and is closely linked to our real world. [ 58 ]
In terms of application areas, the metaverse will continuously support the advancement of technology and industrial maturity. The metaverse has the potential to fundamentally transform the economy, education, public service, and social interaction sectors. [ 52 ] Of course, there are various risks associated with the metaverse, including data protection aspects, ethical issues such as fairness considerations and the user-friendliness of the user interface [ 48 ]. In particular, the handling of highly sensitive data underlines the essential importance of a reliable and precise data basis [ 59 ]. The subject of this paper is the following precise definition of the metaverse: The metaverse forms a link between physical reality and a virtual world in which extended reality technologies enable the creation of immersive experiences. Due to its permanence, the metaverse offers society the prospect of making work, trade, and communication activities independent of time and space. The imagination experiences boundless expansion within the metaverse, as it extends into an infinite expanse unrestricted by the physical limitations of reality. In contrast to the transience of the physical world, the digital counterpart of the metaverse exhibits remarkable persistence and longevity. However, it is important to emphasize that the metaverse is more than a simple replica of reality. It has its own characteristic features, which manifest themselves particularly in the personal level of interaction. There is a clear difference between the two worlds: The metaverse struggles to fully replicate the subtleties of human experience, from the tactile sensations of touch to the complex nuances of human emotion. Interpersonal relationships in this virtual sphere often pale in comparison to their real-life counterparts. Section 2 .3 addresses the numerous metaverse applications for the AECO industry and thus the challenges and opportunities.
The developments in extended reality, also known as XR, aim to make the metaverse accessible and tangible for users. The technology influences how people perceive their sensory impressions. Extended reality includes technologies such as augmented reality (AR), virtual reality (VR) and mixed reality (MR), each of which enables immersive experiences and describes the spectrum between reality and virtuality [ 60 ]. The experience factor is intensified using AR or VR glasses. Nevertheless, the metaverse can also be explored using conventional devices such as smartphones or laptops [ 61 ]. XR systems allow interactive user participation in virtual content through motion control. These motion controls are in the form of hand-held devices equipped with grips, buttons, triggers, and thumb drives. This allows users to touch, manipulate, operate, and grasp virtual objects [ 62 ]. Users do not need to be stationary when using these technologies. They use the whole body during the application. The transmission of physical movements in XR environment is done by tracking positions and rotations [ 63 ].
Table 1 explains the individual terms used under XR technology.
In a comprehensive analysis, McKinsey ascertained that ''95% of business leader expect a positive impact on their industry within 5 to 10 years'' [ 70 ]. This results in a significant impact of metaverse applications on various aspects of daily life, both in private and professional contexts. As a result, McKinsey calls on companies to actively pursue the development of the metaverse business. [ 70 ]
The integration of the metaverse offers numerous application possibilities in the architecture, engineering, construction, and operations (AECO) sector [ 24 ]. Nevertheless, the practical application of the metaverse in the AECO sector or in the BIM methodology has not yet been proven. This implies the need for further research into potential fields of application and the integration of the metaverse into the life cycle of buildings [ 24 ].
Metaverse applications can be an enrichment for customers, particularly in architecture. Through virtual tours, customers can gain realistic impressions of the property that is yet to be realized. [ 71 ] The metaverse options extend across various platforms where users can interact, trade, market their products and offer services. Additionally, it enables virtual meetings by customized 3D avatars. For instance, corporates may strategically devise virtual assets within the metaverse for promotional purposes. [ 72 ] Well-known platforms for this include The Sandbox and Decentraland [ 73 ].
Nieradka has found out that VR technology can have a positive impact on real estate sales methods by enabling multi-sensory presentations. On the one hand, this leads to an increase in user-friendliness and innovative ability, and, on the other hand, it influences the personal feeling towards the property. By strengthening imagination, this can lead to more emotional perception. [ 74 ] A study by Brenner analyzed the impact of VR application on potential property buyers. The results suggest that the metaverse has the potential to significantly change the processes by VR technologies. Such a development can lead to an increase in property sales. [ 75 ] In the real estate marketing sphere, the supportive use of VR technology can create a unique experience for buyers and agents by simulating properties in different geographical locations [ 76 ].
By using the metaverse, various scenarios of real situations can be simulated, whereby the data generated can help to assess and understand the feasibility and sustainability of the physical property more accurately [ 77 ]. This gives the user the opportunity to relive digital experiences regarding certain events, allowing precise recommendations for action to be derived for the real world [ 78 , 79 ].
The existing situation illustrates a current underrepresentation of verifiable studies that analyze the interaction between the metaverse and the construction industry in depth [ 3 ]. However, there are already initial attempts at VR applications in the construction industry [ 80 ]. Key indicators of success in construction management are manifested through the quality achieved, time management and cost management. In his recently published paper, Oz highlights that construction management can reap significant benefits from the integration of the metaverse. This extends to multi-faceted areas such as design planning, work planning, risk management and resource management. [ 3 ] The metaverse enhances the quality of decision-making processes, facilitates operational workflows, and promotes a sense of teamwork by removing barriers to communication [ 81 ].Throughout the entire construction project cycle, the metaverse provides valuable tools for monitoring and maintaining projects. The integration of data from sensors into the metaverse enables continuous monitoring of construction progress, equipment usage and resource allocation in real time. This enables the parties involved to identify potential bottlenecks, monitor the progress of project milestones, and make necessary adjustments at an early stage to ensure a successful project. [ 82 ]
In addition, design and visualization skills are proving to be fundamental to success in the construction industry in the metaverse. This provides immersive access to advanced 3D modelling and visualization tools. Through these tools, stakeholders can create, adapt, and visualize designs in a virtual environment, enabling both realistic and immersive representation. [ 81 , 83 , 84 ] Visualizing designs in the metaverse makes it easier to understand and evaluate design decisions. Defects and conflicts can be identified more efficiently, which leads to improved interdisciplinary communication and minimizes the risk of potentially costly design errors. [ 81 , 85 , 86 ] Furthermore, the metaverse facilitates the external management of assets and enables facility managers to monitor and maintain buildings in an efficient manner. This helps to reduce operating costs and extend the life of constructed assets. [ 81 ] It is also possible for individuals to acquire digital real estate and rent it out in a yield-oriented approach. This practice opens prospects for investment. A development that can already be observed is currently manifesting itself, with various events such as exhibitions, music festivals and concerts taking place in the metaverse. [ 56 , 78 ] Successful establishment of the metaverse in the real estate and construction industry requires acceptance on the part of interested parties, with a positive user experience being an essential concomitant. [ 87 , 88 ]
The key components of the metaverse's success in the construction industry undoubtedly lie in its ability to scale and adapt. An essential aspect is that the metaverse can efficiently support construction projects of varying size and complexity. The scalability of the metaverse platform is central to this, as it should enable the seamless integration of multiple projects and keep pace with the growth of data volumes as projects progress. This ensures that the platform is flexible enough to meet the diverse requirements of the construction industry. [ 81 , 89 , 90 ] Through an adequate adaptability of the platform, it becomes possible to flexibly respond to evolving project requirements, thereby enabling the integration of various new technologies and functionalities. The assurance of adaptability and scalability thus forms the foundation for the long-term performance of the metaverse within the construction industry. [ 91 ] The integration of the metaverse into the construction industry requires meticulous consideration of regulatory and legal aspects. To ensure compliance and protect the interests of stakeholders, it is essential to establish a precise definition of data protection. [ 81 , 92 , 93 ] A solid technological foundation is also essential for the successful implementation of the metaverse. This includes a powerful internet connection, hardware that supports virtual and augmented reality applications and scalable cloud computing resources. Only with this foundation can smooth and continuous interaction in the metaverse with all project participants be guaranteed. [ 94 ] The realization of effective communication and collaborative cooperation in the metaverse for the real estate and construction industry is only possible under certain conditions. The metaverse gives involved parties the ability to participate in real-time conversations, convey project messages and share information seamlessly. Virtual conferencing, shared workspaces and instant messaging facilitate effective communication and strengthen collaboration between team members, regardless of their physical presence. [ 95 , 96 ]
To evaluate the possible effects, approaches as well as advantages and disadvantages for the AECO industry, this study uses a multi-step approach. This approach is shown in Fig. 1 . The approach allows a quantitative and qualitative survey. It was chosen as methodology, because it enables an analysis and comparison of early adopters in qualitative workshops and the perspectives of the masses in the AECO industry.
Methodology of this paper
In step 1 a literature review was conducted. In this literature review, the key words “metaverse”, “construction”, “facility Management”, “Architecture”, “Digitization”, “XR” and “building” were searched in various combinations in abstracts, headings and texts. Hereby scopus, google scholar, ScienceDirect and Springerlink were used (see Sect. 2 ). A comprehensive literature analysis was conducted, considering over 90 scientific sources. The focus was on analyzing recent research findings, primarily from publications dated 2019 or later. Predominantly, English-language sources were used to ensure an international perspective and access to the latest developments and discussions in the research field. The literature review encompassed a variety of renowned journals that significantly contribute to the scientific discourse in the fields of construction and information technology. Notable journals considered include Journal of Information Technology in Construction, International Journal of Construction Management, Journal of Civil Engineering and Construction, Journal of Building Engineering and International Journal of Information Management.
In step 2 workshops were conducted with various stakeholder. The workshops aimed to find out challenges and opportunities of the implementation in the AECO industry. Furthermore, they aimed to evaluate a status quo in the practical application of the metaverse. All in all, 4 workshops were conducted between November 2022 and January 2023. The workshops were held with project developers, Planner, Constructors and Facility Management companies, whereas respectively 9 experts took part in the workshops. The experts were selected based on their experience with the metaverse as well as due to plans in the implementation of a metaverse strategy. This should ensure that experts who are pioneers in the implementation of the metaverse are included, as well as companies that have so far only dealt with the implementation of a metaverse strategy in theory. These were moderated workshops in which different perspectives on challenges and opportunities were discussed. Based on this a further analysis of literature and use cases was done to validate and compare the results of the literature review and the practical experiences (see Sect. 4.1 ).
In step 3 a quantitively online survey was conducted. The questions were elaborated between July 2023 and September 2023. The content of the survey questionnaire is based both on the findings of the literature analysis and the results of the workshops. It serves to capture a further picture of the mood of the stakeholders in the AECO sector. The literature analysis and the workshops have produced initial findings that shed light on potential challenges such as interoperability and data protection. At the same time, initial use cases were identified, including the possibility of using the metaverse as a new communication tool that bridges the gap between the real and virtual worlds. In particular, the literature shows potential in the planning phase by using XR technology and individual avatars to make the planning design more vivid and to use simulations of real events to minimize planning errors. It is of interest to find out whether the industry players also recognize these potentials and whether they perceive the identified challenges in a similar way as described in the literature and the workshops. (see Sect. 2 ) The results of this survey will help to shape further steps towards metaverse integration and identify the need for additional areas of research.
At the beginning of September 2023, the online survey was checked by 16 pre-testers from various areas of expertise of the AECO industry, such as project developer, constructors, facility managers or building informaticians. Based on this, the online survey was revised and optimized. In particular, the formulations were specified in order to achieve an exact result. The online survey was activated on 16 October 2023. In order to receive as many answers as possible, the link was shared on LinkedIn, via mail, via Newsletter (e.g., Fraunhofer or Mittelstand Digital Zentrum Bau) and in various companies and courses. The questionnaire was written in German and English. All in all, 291 people participated in the survey, all of them were respondents from Germany. The total number of possible stakeholders in the German AECO industry is 3,500,000 stakeholders in the AECO industry [ 97 ]. With a margin of error of 5% and a confidence level of 90%, this results in a sample size of 273, which means that the number of participants (291) exceeds the required number of respondents and is representative (see Sect. 4.2 ).
The 4 workshops were conducted between November 2022 and January 2023. The workshops were moderated by one moderator, who designed, executed, and evaluated the workshops. In the workshop itself, various brainstorming methods were used to evaluate potential use cases and the associated challenges and opportunities. The results were developed and documented in individual brainstorming phases, sharing phases and in joint group discussions. All participants of the workshops were early adopters, that are using metaverse technologies in their daily business or are planning to do so. This aimed to evaluate the challenges and opportunities, that may arise or arose by implementing the metaverse in the AECO industry.
The workshops were based on the aforementioned literature analysis as well as reports of proof-of-concepts of other industries, such as mechanical engineering, medicine, or teaching. Furthermore, the experiences of the authors were integrated in the preparation of the workshops. The workshops were semi-structured and lasted approx. four hours. Regularly 2–4 persons (without the moderator) participated in the workshops.
Firstly, the workshops aimed to evaluate possible applications of the metaverse for the AECO industry and validate possible applications, that were mentioned in the literature (see Sect. 2.3 ). Due to the participants of the workshops, the use cases are divided in use cases for Real estate development and marketing, Design, Construction Management and Facility Management. As shown in Table 2 , various possible use cases for the application of the metaverse in the AECO industry were evaluated in the workshops.
In Table 2 it can be seen, that the four stakeholder groups associate different use cases with the implementation of the metaverse in the AECO industry. While Real Estate Developers see use cases especially in the fields of marketing and new business models, Designers focus information use and organizational aspects. For the Construction Management especially better communication by using immersive technologies was mentioned. The Facility Managements expects a better data management and storage by implementing the metaverse in FM.
Beside the definition of possible use cases for the stakeholders (for the summary of the use cases see Sect. 4.1.1 ), especially technical, social and economic barriers and opportunities were discussed. Especially the following aspects were mentioned in the workshops:
The metaverse offers new possibilities and business models. All participants stated, that the metaverse could improve their actual business model. Especially the generation of new business areas (e.g., renting and developing spaces in the metaverse), supporting current processes (e.g., immersive construction or planning meetings) or developing new, digital processes (e.g., integrating ne spaces of communication), were mentioned.
The metaverse is more than the use of VR or AR. The workshop participants stated that most of their partners and customers believe, that the metaverse is the same as the use of VR or AR glasses. Therefore, they emphasize the development of one uniformed and accepted definition of the metaverse for AECO industry.
The metaverse is a new approach of designing, constructing and operating buildings. The social aspect must not be neglected, when integrating the metaverse in the AECO industry. Especially due to the digital change of the industry (e.g., Building Information Modeling or Artificial Intelligence) a new digital tool can lead to a defensive attitude on the part of those involved. Therefore, it is necessary to educate and train the stakeholders of the AECO industry about the aims and contents of the metaverse.
The metaverse contributes to the need to integrate even more other disciplines into the industry. This is especially due to new needed programming skills, new skills for the provision and operation of hardware and a necessary change management to implement the metaverse in the AECO industry.
The metaverse is actually not a trending topic in the AECO industry. Despite the early adopters, that took part in the workshop, the participants stated, that the metaverse is not well known in the AECO industry and no relevant standard.
These aspects show that various use cases (see Sect. 2 .3 ) could be generated. On the other hand, the AECO industry is conservative, so that the implementation of new technologies or tools need a lot of time. Therefore, the participants stated, that only few use cases should be implemented and researched at the beginning. From that point, the metaverse could gain more attraction to become a relevant state of the art in the AECO industry.
The results of the workshops (use cases, challenges, opportunities) and the literature analysis were incorporated into the quantitative survey. The following sections show the results of this survey. The questionnaire can be found in the “ Appendix ”.
In total, 291 participants answered the questionnaire. It has to be said that all the questions were optional, for that reason not all responses are complete for every question. Regarding the age of our participants (cf. Fig. 2 ), more than half of them are between 16 and 29 years (68.49%; n = 150). Followed by 30–40 years and 41–50 years (each 12.79%; n = 28). Nine participants were in the age group of 51–60 years (4.11%). Three participants answered to belong to the age group of 61–70 years (1.37%). No respondent belongs to the age group of 71–80 years (0%), while one participant did not answer the question (0.46%).
Age structure of the online survey
We then asked the participants whether they are student or professional, followed by the specific question on the degree program they are enrolled in respective their role in the real estate industry. We can observe a balanced picture regarding students and professionals (cf. Fig. 3 ): There were 140 students (48.11%) and 150 professionals (51.55%) answering the questionnaire, one not responding to this question (0.34%). The students were mostly from civil engineering (68.57%, n = 96), followed by Green Building Engineering (16.43%, n = 23), industrial engineering (8.57%, n = 12), digitization management and management (0.71%, n = 1 each). 6 participants did not provide an answer to that question (4.29%).
Students and professionals answering the questionnaire
For the professionals, the role in the industry is more widespread, as shown in Fig. 4 . With 5.84%, most of the respondents self-assessed as civil engineer (n = 17), followed by architects and consulting (n = 11, 3.78% each), planners of technical building equipment and facility management (n = 10, 3.44% each). All other roles were mentioned. Additionally, eight participants chose “other” and complemented “BIM Manager”, “IT” (two times), “education”, “professor”, “measurement”, and “public client”.
Self-assessment of roles of the professionals responding to the questionnaire in the real estate industry
When asked how confident the participants are regarding the usage of the term “metaverse” on a Likert scale with 5 being very confident and 1 not confident at all, a majority (55.56%, n = 120) is unconfident or rather unconfident (1: n = 53, 24.54%; 2: n = 67, 31.02%, cf. Fig. 5 ). 26.85% (n = 58) seem to be not sure and selected a value of three. Only 17.59% (n = 38) participants felt confident or very confident (4: n = 33, 15.28%; 5: n = 5, 2.31%).
Self-assessment for the usage of the term metaverse
Based on the definition of Buchholz et al. (2022), we asked our participants to rate the seven characteristics described in the paper [ 55 ]. Figure 6 visualizes the average values captured in our questionnaire. In average, the most mentioned characteristic was the multimodality (average 4.03, SD = 0.99). Second, the characterization as an integrated system integrating XR and other technologies is mentioned (avg. 3.84, SD = 1.04). Then, participants mentioned the combination of virtual and augmented real worlds (avg. 3.75, SD = 1.0), directly followed by the social medium aspects with interaction, communication, collaboration, and property ownership (avg. 3.72, SD = 1.05). Next, the participants agreed with an average of 3.3 that “capturing the state of the user and the real environment is a key action for metaverse applications.” (SD = 1.15), followed by a persistent and long-lasting state (avg. 3.04, SD = 1.25). The least mentioned characteristic is the close coupling with reality with an average of 2.9 (SD = 1.17).
Rating of the characteristics of the metaverse on a Likert scale by the participants (average values)
Finally, we also asked whether the participants see the metaverse as a new communication basis in the construction and real estate industry. As shown in Fig. 7 , a majority of 64.38% (n = 141) agreed, 23.29% (n = 51) disagreed, 6.85% (n = 15) chose “other” and expressed mostly, that it is only partially, 5.48% (n = 12) gave no answer.
The metaverse is seen as a new communication basis in the construction and real estate industry by a majority of the participants
One main goal of our survey was to identify, which phase in a buildings’ lifecycle could benefit most from metaverse technology usage (cf. Fig. 8 ). Hence, we asked the participants, which phase they think will be the most changed by the metaverse. Here, the participants mentioned the marketing phase on the first place (avg. 4.12, SD = 1.1), followed by the planning phase (avg. 3.93, SD = 1.03). During initiation or project planning, an average value of 3.61 (SD = 1.13) was recorded. The redevelopment phase was mentioned with an average value of 3.05 (SD = 1.13). The two least rated phases were the demolition phase (avg. 2.83, SD = 1.12) and surprisingly the construction phase (avg. 2.68, SD = 1.2).
Building lifecycle phases that may benefit from the metaverse (average values)
With the following questions, we dig deeper into the specific phases, starting with the planning phase depicted in Fig. 9 . In the planning phase, the highest rated application according to our survey is the virtual property inspection using XR technologies (avg. 4.15, SD = 1.09). The collaborative cooperation of all stakeholders (avg. 3.8, SD = 1.1) is directly followed by the digital real estate planning to support decision making (avg. 3.75, SD = 1.07) and the simulation for training (avg. 3.71, SD = 1.09). Integrating cubatures into the landscape (avg. 3.4, SD = 1.12) was averagely rated higher than the digital purchase and sale of real estate in the metaverse (avg. 3.37, SD = 1.25) and the support with digital building applications and coordination with approval authorities (avg. 2.95, SD = 1.31).
Relevant application areas especially for the planning phase (average values)
When looking at the average values in the construction phase (cf. Fig. 10 ), the variance is not high: All values are between 3.36 and 3.7, except for one application area. The tracking of construction defects received the lowest rating in our study (avg. 3.0, SD = 1.26). In contrast, virtual and collaborative construction project planning and site meetings received overall the highest score (avg. 3.7, SD = 1.15). In descending order the participants rated the usage of metaverse tools for building structure creation and checking and real time designs (avg. 3.65, SD = 1.04), the simulation of construction processes, hazard and interface analysis (avg. 3.6, SD = 1.16), the coordination of resource requirements by simulation and digital construction project planning (avg. 3.58, SD = 1.07), the coordination of logistics (avg. 3.44, SD = 1.08), safety training on the construction site (avg. 3.42, SD = 1.31), and the construction monitoring and actual state recordings using drones with live transmission to the metaverse (avg. 3.36, SD = 1.21).
Relevant application areas especially for the construction phase (average values)
Another phase that might be relevant is the operation phase of a building. Hence, we asked the participants to rate several application areas here as well (cf. Fig. 11 ). With a value of 3.69 (SD = 1.06), building automation control was rated highest in average, followed by the explanation of safety measures or building instructions for users/occupants (avg. 3.61, SD = 1.06). The metaverse as an interaction community for residents (avg. 3.41, SD = 1.19) was slightly above indoor navigation (avg. 3.35, SD = 1.21), and virtual facility management (avg. 3.31, SD = 1.17). Least rated was the simulation of media flows (avg. 3.11, SD = 1.11).
Relevant application areas especially for the operating phase (average values)
As seen above, the participants saw great potential for metaverse usage regarding marketing. Asked about specific application areas, the results show that virtual property viewings to market the property are rated highest (avg. 4.12, SD = 1.04), followed by consultation and sales talks in the metaverse (avg. 3.55, SD = 1.26), and due diligence (avg. 3.09, SD = 1.09).
For the recovery of buildings in the demolition phase, we asked specifically if the digital twin could be relevant to support the recycling and recovery process of used substances and materials (avg. 3.26, SD = 1.09), or if the coordination of the demolition concept may be supported by metaverse technologies (avg. 3.29, SD = 1.13). Both values appear to be rather in midfield, reflecting the rather low value for benefits in the demolition phase expressed in Fig. 8 .
The results of both the marketing and the demolition phase application area ratings are summarized in Table 3 .
With our questionnaire, we covered also challenges in relation to the metaverse (cf. Fig. 12 ). As this was a multiple-choice question, participants were able to give multiple answers. 171 times the answer data protection and privacy was selected, hence landing on the first place. Then, the participants mentioned the dependence on the digital world (n = 143) and insufficient hardware equipment (n = 125). High implementation costs only are on the fourth place with 123 mentions. On the other end of the spectrum, the risk of a monopoly position of a provider (n = 68), too much fusion of digital and real properties (n = 67), and digital currencies (n = 64) are not seen as main challenges. For the “other” option, we provided again the possibility to enter free text, which nine participants did, mentioning amongst others “entry barriers”, “immature technology”, “communication problems and interpersonal understanding”, or the creation of a “potential digital parallel world, which should not be the main focus due to real tasks” (0.34%, n = 1 each).
Challenges in relation to the metaverse (n = 291)
Regarding the opportunities of metaverse usage in the real estate industry (cf. Figure 13 ), the improved understanding through enhanced visualization (avg. 4.0, SD = 1.04) received the highest rate, followed by the simplification of decision making with 3D visualizations in the metaverse (avg. 3.95, SD = 0.98). Communication independent of time and place (avg. 3.73, SD = 1.15), and the expanded communication basis of all actors concerned (avg. 3.65, SD = 1.05) join next. Other opportunities are the increased efficiency of process flows within the lifecycle phases (avg. 3.64, SD = 0.97), the flexibilization during the lifecycle (avg. 3.4, SD = 1.08), open communication structures (avg. 3.34, SD = 1.16), and lastly an increased sense of reality (avg. 3.22, SD = 1.34).
Opportunities of a real estate metaverse
Taking a closer look to the different functions of the professional participants, one can see the distribution shown in Fig. 14 regarding the opportunities rating of a real estate metaverse. It must be said that for investment and property management, only one participant responded the survey, and for project development, only two participants were involved (cf. average values and standard deviations in Table 4 ). Hence, the high values for project management participants, especially for open communication structures and flexibilization in the course of the life cycle might be misleading. The same applies for the “other” category, as there are multiple functions with low participation numbers included (cf. Sect. 4 .2.1 and Fig. 4 ).
Opportunities of a real estate metaverse rated by the professional participants
If we in turn consider the age of all participants (students and professionals) and examine the strength rating for different age group, we get the distribution shown in Fig. 15 . One might get the impression that especially older participants rate lower than the younger, but again we only had three participants that identified with the age group of 61–70 years (cf. average values and standard deviations in Table 5 ). And the age groups of 41–50 years get higher results as the age group of 30–40 years. Note that the age group of 16–29 years had lower average values than the 30–40- and 41–50-year-old.
Opportunities of a real estate metaverse rated by student and professional participants, divided into age groups
To implement a metaverse in the AECO industry, some prerequisites on different levels (e.g., technical, or personal) may be required. This forms the last two major questions in our questionnaire. First, we investigate the technical requirements: Here, the average values were above 4.0 for all categories (cf. Fig. 16 ). First, a reliable IT infrastructure is agreed on by most of the participants (avg. 4.44, SD = 0.95). Then, adequate security solutions (avg. 4.26, SD = 0.99), and data format interoperability and interfaces (avg. 4.26, SD = 0.86) share the second place, directly followed by software interoperability and interface (avg. 4.24, SD = 0.86). Next, hardware interoperability and interfaces (avg. 4.21, SD = 0.9) is mentioned. Lastly, the scalability of the technology for growing demand (avg. 4.01, SD = 1.0) is rated on the last place.
Technological prerequisites for implementing the metaverse in the lifecycle (average values)
Personal knowledge might also be required when implementing a metaverse within the AECO industry (cf. Table 6 ). Here, participants rated the adaptability for technology changes highest (avg. 4.31, SD = 0.91), followed by the understanding of security risks (avg. 4.01, SD = 0.98), analytical skills for data analysis (avg. 3.88, SD = 0.9), and technical know-how, like programming languages, technology overall, etc. (avg. 3.85, SD = 1.11).
At the end, we gave our participants the opportunity to add suggestions or comments on the topic of metaverse in the real estate industry. While 208 participants did not provide an answer, and 72 did not see the question or finished the questionnaire before that question, 11 chose to share their thoughts in the free text field. Although these answers are not representative and can only be seen as anecdotal, we want to share a summary of them. The responses were mostly negative. The metaverse was seen as a “technology without a promising future, although there might be interesting tools, but a too high barrier of entry, so that too few people are going to access it”. Another respondent mentions “data manipulation as new botched-up construction”. Another participant doesn’t see the advantage of the metaverse and asks “why setting up additional (and ecological expensive) infrastructure for a virtual environment, if we already have Teams, cloud storage, and open data formats? And why should I do a meeting in a virtual room, when I can do a Teams call instead?”. Another statement emphasizes on the digital transformation in general, stating “the digitization in the construction industry is and remains (initially) a mammoth task”. Similarly, another participant states: “We all have enough to do with the transition to digital building modelling, an additional level of action in the metaverse can only arise—if at all—as an additional, costly marketing channel for property sales. Currently a high-risk application.”. Also, the fact that the questionnaire did not contain an introduction of the term metaverse was criticized: “You should briefly explain, what metaverse means, especially if you want to get a complete overview with the survey, including small and medium enterprises. I did not know the term yet, although the topic is really present for us.”. Another voice mentions the metaverse definition as well: “The definition of the metaverse should be substantiated. I think that Microsoft with Teams and Facebook with virtual ‘phantasy worlds’ are working on fundamentally different goals.”. Regarding the visual aspects one participant states: “In my view, the metaverse is reduced far too much to the visual level. The focus should be much more on the integration of building data and built space. The aim is to create an accessible meta-level for buildings. Based on this, VR access can be created—not the other way round.”.
Our study contains multiple observations, that we are going to discuss in the following section. Overall, we can identify several limitations and challenges.
The anticipated metaverse hype [ 77 ] seems to have subsided, or it has not fully reached the construction and real estate industry, yet. On the one hand, this could be due to the practical nature of the industry, where tangible results and direct applications take precedence over futuristic projections. The lack of visible, immediate benefits may contribute to the metaverse being perceived as a distant future rather than an imminent reality. And there is something to that argument, given that many other issues in digitizing the industry will have to be solved first. This includes issues like data-access, roles, and rights, or simply enough rolled-out and sufficiently powerful mobile devices with fast mobile data communication. On the other hand, this is Amara’s law which states that we tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run. Just like technical drawings in different domains went from 2D ink on paper, over 2D computer-aided design (CAD) to 3D modelling, the AECO industry is following the same trend. Soon, 3D data will be common-place and it will be readily available to users on location at the right time, and in the right quality. Being on location with mobile devices literally allows putting data in the right perspective based on the user’s position and orientation in the environment. Computer applications of the last 6 decades have been mostly presented on 2D screens of different sizes. We have witnessed the advent of mobile computing largely fulfilling the idea of Weiser’s ubiquitous computing, but still they remained on 2D screens, mostly (with pervasive games like Pokémon Go and a few other examples breaking the general rule). Now we are slowly progressing towards spatial computing with mobile devices, be it tablets or head-mounted displays. This will benefit all applications whose data is related to the world and three-dimensional. This future 3D-Internet, a.k.a. “the Metaverse”, will not replace 2D applications, but provide additional possibilities. The three-dimensional data of the AECO industry is an ideal candidate to benefit from this evolution in the long run and provide for interactive 3D data-exploration and modification using XR technology.
It is notable that predominantly younger individuals have participated in the survey, which could skew the data towards a demographic more inclined to be optimistic about technological innovations. However, our data already show a strong skepticism from the participants. And regarding the opportunities of a potential real estate metaverse, the age group of 16–29 year even had lower average values for all application areas than e.g., 30–40- or 41–50-year-old. Although our study only includes answers from three people identifying as 61–70 years, it can be said that there is no clear trend from our data that older people are more skeptic or rate the strength more critical than younger participants. There is no clear demographic difference regarding the potentials of a real estate metaverse. While younger participants (16–29 years) may in general be considered more open to the metaverse, their rating of potentials appears to be lower than other (older) age groups, potentially leading to an even slower adoption curve (cf. also “Underreported Skepticism” below). It is to expect that the entry barriers should be lower for younger generations, as they are more familiar with new technological devices. But XR technology appears to be not yet widespread enough—also regarding leisure activities and entertainment at home—that younger generations take these technologies for granted and want to employ them in their professional daily routine. One can note that this apparently reflects only the perspective of the real estate industry in Germany. How is it possible to fascinate more young people for these upcoming technologies and prepare them for later professional usage? For sure, education, especially in universities, but also in handicraft training, play a crucial role in this context. The earlier young people get in touch with these technologies, the easier is a potential use in their professional life afterwards. At least, they should know about the technological possibilities and limits in order to evaluate further developments and technological advancements on their own.
The perception of the metaverse as a rather abstract topic presents significant barriers to its acceptance. For an industry grounded in physical space and tangible assets, the challenge lies in translating the virtual, often nebulous, concepts of the metaverse into concrete, actionable business strategies. This requires a multifaceted approach that is driven by the users’ needs rather than technological prowess to turn the abstract into something comprehensible. Based on existing experiences from human–computer interaction studies over the last decades, this mandates for several strands that need to get handled and intertwined.
First, pilot programs need to be initiated to build relevant prototypes and proof of concepts in a user-centric fashion. Only by doing so will it be possible to truly reflect on ideas, design decisions, and the usefulness of the chosen approach to identify flaws. This has to be done in an iterative fashion to address the flaws and integrate new ideas, and the process has to include all relevant stakeholders, e.g. from research and development, over sales to customers and business partners. Data and insights from these initiatives can inform larger-scale implementations.
Second, collaborate with other organisations and form strategic partnerships. It is unlikely that in a competitive labour market the required and scarce technological expertise will exist in the own organisation. Therefore, organisation have to form strategic partnerships to leverage external expertise.
Third, once you have results, make sure to raise the awareness about them for an increased understanding and education. This can help stakeholders comprehend the potential benefits and implications for the business. Which should help to allocate sufficient resources, both in terms of budget and talent, to support metaverse initiatives. Allow for evolutionary growth rather than one-off initiatives and identify areas where your initiatives can enhance existing operations rather than disrupting them.
As metaverse-like initiatives are unlikely to replace existing work-practices and interaction metaphors it is important to bear in mind that not everything needs to be 3D—especially if the underlying data is less than 3D, or the current way or working in 2D on planar surfaces is effective and efficient.
As the metaverse can be seen as a “3D Internet”, it makes sense to look at analogies in their development. Early stages are concerned with infrastructure, compute, and connectivity to pass the data around. Then standards appear. Preferably they should be open like HTTP to help building and thriving on top of them, rather than closed and leading to platform capitalism. Maybe the AECO industry can still draw upon Gropius’ Bauhaus manifesto which over 100 years ago postulated a unity of art and craft that conceives the structures of the future, which should be built by a million hands. This can be regarded as an analogy to the evolution of the Internet.
Diverse applications that catered for specific needs followed the Internet standards. More recent developments in social media focussed on user engagement, user profiling, and microtargeting. People get services allegedly for “free” for which they pay with their attention and private data in return. This get marketed to modify our behaviour in exchange for money. Such a business model is unsustainable in the metaverse, although big tech might see that otherwise [ 98 ]. Therefore, it seems paramount to tackle the difficult transfer-problem from academia to industry and also get used to paying for software applications and their development, again [ 99 ].
There is a pronounced skepticism among survey participants, yet they simultaneously recognize the metaverse as a potential new foundation for communication within the industry. This contradiction indicates a complex attitude: while there is caution, there is also an understanding that the metaverse could revolutionize interactions with clients and within the industry, suggesting a readiness to explore its capabilities further. Hence, other factors might be more obstructive for the metaverse implementation within the industry. Besides that, more information on the potentials of the metaverse is needed. This gets reflected also in our data: While the construction phase was rated with an average value of 2.68 only, the application areas within that phase received average values greater 3. Hence, the participants saw a certain potential for the application areas but were skeptic whether the overall work in the construction phase is going to change with metaverse usage. Regarding the characterization of the metaverse as a social medium, where people can interact communicate, collaborate, and own property, an average value of 3.72 shows a slight consent among the participants. And 64.38% see the metaverse as a new communication basis in the construction and real estate industry. Is the metaverse thus only a new communication platform for the construction and real estate industry? For sure, it will offer new interaction ways with clients, with other stakeholders and within companies, although there is still a way to go. Communication will not be the only aspect, but one of the key aspects when introducing metaverse technologies to the construction and real estate industry. Here again, low participation hurdles for that communication as well as a multimodal approach supporting different devices with different immersion levels seems to be important for a huge distribution and overall acceptance. Instead of a closed system, open standards and exchange formats need to be considered, especially with regard to the construction and real estate industry, which developed such standards, namely Industry Foundation Classes (IFC) amongst others, for file-based BIM model exchange over the last decades.
The research indicates that the actual level of skepticism may be higher than what the survey data reveals. This 'dark figure' of skepticism can signify a larger group of industry professionals who are reticent about the metaverse, possibly due to a lack of clear understanding or fear of the unknown. Significant potential for new business models within the life cycle was recognized during the workshop, but at the same time a considerable need for action was also identified. This relates to the necessary programming knowledge, data protection measures, interoperability, and the need for training for correct and targeted application. These aspects were also considered in the subsequent survey. On the one hand, the survey results make it clear that the metaverse is seen by respondents as a desirable basis for communication, particularly in the initiation, planning and marketing phases. On the other hand, the construction phase, the renovation phase, and the administration phase are perceived by the respondents as having less metaverse potential. The perceived potential is limited to linking the metaverse with XR technologies, which are seen as highly coherent by respondents, with 3D visualization seen as optimizing the decision-making process. However, the assessment of potential challenges, particularly of a technical nature, is rated as extremely high. Almost 60% of respondents see data protection as a significant hurdle, while 50% see the possibility of dependence on the digital world as a potential problem in the real world. In addition, the mean score of 4.24 on a scale of 1 to 5 indicates that a certain degree of interoperability in the metaverse is an important technical requirement to ensure successful application in the AECO industry. This interoperability must also be able to cope with regulatory changes and the diversity of construction projects. Furthermore, the interviewees identified challenges such as insufficient user acceptance and a lack of hardware. The practical example of BIM integration illustrates current challenges and makes it clear that the desired interoperability is not available to the extent that the market requires. These difficulties could therefore be transferred to the topic of the metaverse. The results indicate that in the context of the AECO industry, a concise user-friendliness of the metaverse is essential. The implementation of the metaverse requires intuitive and secure handling to arouse the interest of potential users and to recognize and effectively use the comprehensive potential of the metaverse in AECO activities. Only by ensuring user-friendliness and a manual on the correct use of metaverse applications, the metaverse can create added value for the entire AECO industry. Additional workshops with experts from the industry can be of significant relevance for the initial step. These workshops serve to gain concrete insights into the actual potential of the metaverse and at the same time identify the fears and concerns of the target group. By defining and developing appropriate solutions, these workshops can help to create a sound framework for the introduction of the metaverse in the AECO sector. This can include, for example, a transparent and standardized manual and guidelines for handling the metaverse. The aim should be to define a common standard for the metaverse. The choice of contributors to such works is important, as the stakeholder group may also have legal implications in addition to the AECO sector and therefore government members, for example, may need to be involved.
Even among those enthusiastic about the metaverse, there is a visible caution. This can be attributed to the respondents being well-informed about the industry's challenges and perhaps having witnessed the gap between initial technological hype and practical implementation. It can be assumed that only those who are interested in the topic participated in our survey, reflecting a rather conservative attitude of the overall industry. The ongoing digitization in the AECO industry, characterized by the introduction of Building Information Modeling, artificial intelligence, the Internet of Things, and robotics, can also explain the cautious attitude of the respondents. It is possible that the metaverse, with its characteristic features, appears premature for the target group, especially as the need for BIM and other digitization processes in the industry has yet to be definitively defined and established. This dynamic can indicate the need to first focus on consolidating and integrating existing digital technologies before the target group can consider seamlessly integrating the metaverse. It can therefore be seen as a revolutionary innovation within the AECO industry, although it is not yet within reach for the target group due to other ongoing digitization processes. The study by PWC [ 1 ] has shown that there is a discrepancy in the AECO sector between progress in terms of sustainability and digital transformation. While sustainability efforts are progressing, digitization is lagging behind. This discrepancy could explain why skepticism and resistance to digital transformation is evident in the survey conducted. In fact, digital initiatives in the AECO sector are met with resistance, as the example of BIM illustrates. Problems such as a lack of interoperability and high investment costs continue to hamper successful implementation in the sector. In the workshops held, it was recognized that the participants see potential for new business models in the metaverse, but they also emphasized the need for training to promote a common understanding. Interoperability, data protection, the introduction of new hardware and the creation of uniform standards were also cited as barriers to successful implementation. By conducting further studies, holding workshops and integrating the topic into teaching, the fears, uncertainties and potential of industry players can be better identified. This forms a solid basis for creating a uniform understanding, ensuring transparency and better integrating the topic of metaverse into the AECO sector.
The integration of Building Information Modeling (BIM) was and still is a considerable investment for the construction industry [ 38 ]. With the metaverse poised as the next big technological venture, there is an evident hesitance to commit further funds. The industry is likely still assessing the ROI from BIM and is cautious about investing in a technology that, while promising, has not yet proven its value for construction and real estate. This might be the largest driver for the above-mentioned skepticism and caution regarding a metaverse for the construction and real estate industry. Especially after the implementation of BIM in most of the companies of the AECO industry, many companies tend to take a wait-and-see attitude towards the metaverse and the resulting costs and interoperability.
On the one hand, this may be because the introduction of other digital technologies and methods, such as the BIM method, has not yet been accompanied by clear regulations on payment for services. This can be illustrated using the example of the BIM method. The BIM methodology ensures that some services that were traditionally carried out in later life cycle phases (e.g., the construction phase) are brought forward to earlier phases (e.g., the design phase). In particular, if the respective companies change after the award and planning is not carried out across the life cycle, this results in disadvantages for the planners in the early phases. For this reason, there should be an adjustment in the remuneration of the various phases, but this has not yet been fully implemented in the AECO industry.
On the other hand, interoperability and the exchange between different software programs is an essential basis for the successful use of digital technologies and methods in the AECO industry. This is also a decisive success criterion for the implementation of the metaverse, as the results on interoperability show. The respondents indicated with an avg. 4.26 that they consider interoperability and interfaces to other data formats to be a technological prerequisite for implementation in the metaverse. This aspect in particular plays a central role in the current discussion about the BIM methodology, as difficulties arise in lifecycle-oriented data exchange as part of the BIM method due to the lack of interfaces or interfaces that have not been implemented neutrally by the software manufacturers.
In conclusion, this discussion underscores the complex, cautious approach the construction and real estate industry has towards the metaverse. It highlights a generational divide, perceptual challenges, and financial considerations. We thus suggest that the metaverse's successful integration requires a more grounded approach that addresses these concerns.
The results of the survey show, that the main applications are seen in the fields of marketing and visualization as well as collaboration. Especially in marketing the arithmetic mean is constantly over 4.0 (e.g., marketing phase avg. 4.12 or virtual visits of the real estate avg. 4.12). Furthermore, the participants see high potentials in the optimization of communication and to develop new ways to communicate and interact, especially by integrating visualizations. This result can not only be seen in the area of the AECO industry, but also in other industry. Deloitte for example stated in 2016, that the metaverse could support the marketing by providing virtual showrooms and product presentations [ 100 ]. [ 101 ] also stated, that the metaverse will support the processes especially in communications, marketing and teaching [ 101 ].
On the other hand, the results show that the processes in the design and construction phase—that are characterized by craftsmanship—are actually not seen as use cases or application for the integration with the metaverse. The highest average can be found at virtual construction meetings, that might be supported by the metaverse (avg. 3.7), the supervising of the construction site (avg. 3.37) or the tracking of defects (avg. 3.0) are not seen as applications for the metaverse.
This result is also shown in Fig. 17 . The figure shows the average of the answers, where the metaverse could be integrated in the various phases of the buildings’ lifecycle. On the other hand, the figure shows, which characterize the respective phases. While project planning and the planning phase are characterized by designing plans on computers, the construction, redevelopment and demolition phase are characterized by handcraft work. It can be seen that all phases, that are characterized by handcraft work, are below 3.0 (except the redevelopment phase with 3.05), while the communication and computer-work-based phases are all higher than 3.60.
Comparison of the different lifecycle phases
That means, that the metaverse is not seen as a tool to support the production or craft on the construction site, but the communication, visualization, and marketing. This may result of the fact, that the AECO industry is seen as a traditional industry, in which changes of processes and tools take a long time. On the other hand, it shows, that the metaverse applications have not arrived yet in the metaverse.
The AECO industry sees potential in the integration of the metaverse into the life cycle. This is seen in particular regarding the life cycle phases and use cases that focus on marketing, communication and visualization. The results show a clearer reluctance in the case of life cycle phases characterized by craftsmanship, which are subject to a certain tradition in the AECO industry.
However, the results also show that young people in particular feel addressed by the metaverse. As a result, the young generation can create a dynamic in the AECO industry that triggers a digital shift. But—and this is also, what the results of the survey show—the implementation of the metaverse in the AECO industry must be carefully prepared and requires change management. Based on experience with other digital technologies that have been introduced in recent years, the results show that costs, interoperability, and the involvement of the various stakeholders from the outset are decisive success criteria. Furthermore, it is necessary to have a clear definition of the term metaverse, as proposed by [ 55 ].
This means, that further research is needed to implement the metaverse in the AECO industry. First, the results should again be discussed with the early adopters, that were interviewed in the workshops. Second, a definition for the metaverse in the AECO industry needs to be set. Hereby, the results of the survey could be a basis. Third, it is necessary to integrate the metaverse more in teaching to educate metaverse natives, that could support the digital shift of the AECO industry. Fourth, the companies of the AECO industry need to get familiar with the metaverse and the possibilities. For this, we envision applied research pilot projects for virtual decentral immersive construction meetings in the metaverse with particular focus on the connection between remote and on-site users. From our point of view, the on-site component of such systems is a core component for a real construction metaverse.
By doing so, the metaverse could support the AECO industry by the transformation to a sustainable and digital industry.
Data is provided within the manuscript.
Not applicable.
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TH Köln - University of Applied Sciences, Betzdorfer Str., 50679, Cologne, Germany
Hannah Claßen & Niels Bartels
Fraunhofer FIT, Schloss Birlinghoven 1, 53757, Sankt Augustin, Germany
Urs Riedlinger & Leif Oppermann
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Conceptualization: NB, UR, HC; methodology: NB; formal analysis and investigation: HC, NB, UR; writing—original draft preparation: HC, UR, NB, LO; writing—review and editing: HC, UR, NB, LO; supervision: NB, LO.
Correspondence to Niels Bartels or Urs Riedlinger .
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FT = Free Text, LS = Likert Scale, LSM = Likert Scale Matrix, MC = Multiple Choice, SC = Single Choice.
To which age group do you belong? [SC]
16–29 years
30–40 years
41–50 years
51–60 years
61–70 years
71–80 years
Are you a student or a professional? [SC]
Professional
(only if Q2 student) In which degree programme are you enrolled? [FT]
(only if Q2 professional) What function do you perform in the real estate industry? [SC]
Civil engineer
Planning of technical building equipment
Structural engineering
Project development
Project management
Facility Management
Property Management
Investmentmanagement
Other: [FT]
How confident do you feel in using the term metaverse? [LS: 5 = very safe, 1 = very unsafe]
What characteristics define the term metaverse for you? [LSM: 5 = fully agree, 1 = fully disagree]
A metaverse is a social medium where people can interact, communicate, collaborate and own property.
A metaverse is a combination of virtual worlds and augmented real worlds.
A metaverse is persistent and long-lasting.
A metaverse is an integrated system that incorporates and uses XR and other technologies.
Capturing the state of the user and the real environment is a key action for metaverse applications.
Metaverse participation is multimodal and can take place with different intensities and representations, such as embodiment through avatars.
A metaverse is closely coupled with reality.
How much do you think the metaverse will change the work in the following life cycle phases? [LSM: 5 = fully agree, 1 = fully disagree]
Project planning/initiation phase
Planning phase
Construction phase
Marketing phase
Redevelopment phase
Demolition phase
Do you see the Metaverse as a new communication basis in the construction and real estate industry? [SC]
Other [Free Text]
Which areas of application in the real estate industry, especially for the planning phase, could be relevant? [LSM: 5 = fully agree, 1 = fully disagree]
Digital purchase and sale of real estate in the metaverse
Collaborative cooperation of all stakeholders concerned on a building model
Simulation of the user profile of the planned building model, of hazardous situations during the use phase in the form of training (e.g. fire protection), sustainability balances
Virtual property inspections using XR technologies
Digital real estate planning as a digital twin enables real-time data that supports decision-making
Support with the digital building application and coordination with approval authorities
Integrating cubatures into the landscape
Which areas of application in the real estate industry, especially in the construction phase, could be relevant? [LSM: 5 = fully agree, 1 = fully disagree]
Virtual/collaborative construction project planning/site meetings
Use tools in the metaverse to create and check building structures and designs in real time.
Construction monitoring and actual state recordings by means of drones for live transmission to the Metaverse
Simulation of construction processes, hazard analysis, interface analysis (e.g. with other subcontractors
Safety training for employees on the construction site
Coordination of resource requirements by means of simulation and digital construction project planning
Coordination of logistics by means of simulation and digital construction project planning
Tracking of construction defects in the metaverse
Which areas of application in the real estate industry, especially in the operating phase, could be relevant? [LSM: 5 = fully agree, 1 = fully disagree]
Virtual facility management: management of buildings in the metaverse, including maintenance, servicing, repairs, space optimisation, energy management
Building automation control
Explanation of safety measures, building introduction for users/occupants
The metaverse serves as an interaction community for the users/residents
Use as indoor navigation
Simulation of media flows
Which areas of application in the real estate industry, especially in the marketing phase, could be relevant? [LSM: 5 = fully agree, 1 = fully disagree]
Virtual property viewings to market the property
Consultation and sales talks in the metaverse
Due Diligence in the Metaverse
Which areas of application in the real estate industry, especially in the demolition phase, could be relevant? [LSM: 5 = fully agree, 1 = fully disagree]
Digital twin in the Metaverse supports the recycling and recovery process of used substances and materials
Coordination of the demolition concept
What challenges do you see in relation to the metaverse? [MC]
Data protection and privacy
Dependence on the digital world
Lack of user acceptance
Social isolation
Lack of social interaction
Fears of cyber attacks
Fraud, e.g. through data theft
Monopoly position of a provider
Insufficient hardware equipment (e.g. VR / AR glasses
Slow internet connection
Insufficient software equipment
Too much fusion of digital and real properties (keyword: who is the owner?)
Health problems (e.g. fatigue from using XR, motion sickness).
High implementation costs
Digital currencies (Bitcoin, etc.)
What can be the strengths of using Metaverse in the real estate industry? [LSM: 5 = fully agree, 1 = fully disagree]
Increasing the efficiency of process flows within the life cycle phases
Expanded communication basis of all actors concerned, using the example of collaborative cooperation
3D visualisations in the metaverse simplify decision making
Open communication structures
Communication independent of time and place
Flexibilisation in the course of the life cycle
Improving understanding through enhanced visualization
Increased sense of reality
Which technological prerequisites are essential for implementing the metaverse in the life cycle? [LSM: 5 = fully agree, 1 = fully disagree]
A reliable IT infrastructure
Adequate security solutions
Scalability of the technology for growing demand
Interoperability and interfaces to other data formats
Interoperability and interfaces to other hardware products
Interoperability and interfaces to other software products
What personal knowledge is essential for implementing the metaverse in the life cycle? [LSM: 5 = fully agree, 1 = fully disagree]
Technical know-how (programming languages, technology, etc.
Understanding security risks
Adaptability for changes in technology
Analytical skills to analyse data and gain insights from it
Do you have any other suggestions or comments on the topic of metaverse in the real estate industry that you would like to share? [FT]
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Claßen, H., Bartels, N., Riedlinger, U. et al. Transformation of the AECO industry through the metaverse: potentials and challenges. Discov Appl Sci 6 , 461 (2024). https://doi.org/10.1007/s42452-024-06162-z
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Published : 27 August 2024
DOI : https://doi.org/10.1007/s42452-024-06162-z
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