Connected Health Care Research Articles

Cryptanalysis and improvement of a user authentication scheme preserving uniqueness and anonymity for connected health care.

Nowadays, connected health care applications are used more and more in the world. Service through the applications can save the patients' time and expense, such as telecare medical information system (TMIS) and integrated electronic patient record (EPR) information system. In the applications, preserving patients' privacy, transmitting messages securely and keeping mutual authentication should all be paid attention. Many authentication schemes have been proposed to make a secure communicating environment. Recently Xie et al. showed that Wen's scheme was insecure because it was under the off-line password guessing attack and without user anonymity and forward security. They gave a new three-factor authentication scheme and claimed that it was secure. However, we find that Xie et al's scheme is vulnerable to the De-synchronization attack and the server has too much storage burden in the scheme. Then we present an improved scheme which overcomes the usual weaknesses and keeps ordinary security characters. Compared with recent schemes of the same kind, our scheme is secure and practical.

Improvement of a Uniqueness-and-Anonymity-Preserving User Authentication Scheme for Connected Health Care

Patient's privacy-preserving, security and mutual authentication between patient and the medical server are the important mechanism in connected health care applications, such as telecare medical information systems and personally controlled health records systems. In 2013, Wen showed that Das et al.'s scheme is vulnerable to the replay attack, user impersonation attacks and off-line guessing attacks, and then proposed an improved scheme using biometrics, password and smart card to overcome these weaknesses. However, we show that Wen's scheme is still vulnerable to off-line password guessing attacks, does not provide user's anonymity and perfect forward secrecy. Further, we propose an improved scheme to fix these weaknesses, and use the applied pi calculus based formal verification tool ProVerif to prove the security and authentication.

On the security of two remote user authentication schemes for telecare medical information systems.

The telecare medical information systems (TMISs) support convenient and rapid health-care services. A secure and efficient authentication scheme for TMIS provides safeguarding patients' electronic patient records (EPRs) and helps health care workers and medical personnel to rapidly making correct clinical decisions. Recently, Kumari et al. proposed a password based user authentication scheme using smart cards for TMIS, and claimed that the proposed scheme could resist various malicious attacks. However, we point out that their scheme is still vulnerable to lost smart card and cannot provide forward secrecy. Subsequently, Das and Goswami proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. They simulated their scheme for the formal security verification using the widely-accepted automated validation of Internet security protocols and applications (AVISPA) tool to ensure that their scheme is secure against passive and active attacks. However, we show that their scheme is still vulnerable to smart card loss attacks and cannot provide forward secrecy property. The proposed cryptanalysis discourages any use of the two schemes under investigation in practice and reveals some subtleties and challenges in designing this type of schemes.

A Robust Uniqueness-and-Anonymity-Preserving Remote User Authentication Scheme for Connected Health Care

User authentication plays an important role to protect resources or services from being accessed by unauthorized users. In a recent paper, Das et al. proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. This scheme uses three factors, e.g. biometrics, password, and smart card, to protect the security. It protects user privacy and is believed to have many abilities to resist a range of network attacks, even if the secret information stored in the smart card is compromised. In this paper, we analyze the security of Das et al.'s scheme, and show that the scheme is in fact insecure against the replay attack, user impersonation attacks and off-line guessing attacks. Then, we also propose a robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. Compared with the existing schemes, our protocol uses a different user authentication mechanism to resist replay attack. We show that our proposed scheme can provide stronger security than previous protocols. Furthermore, we demonstrate the validity of the proposed scheme through the BAN (Burrows, Abadi, and Needham) logic.

A Secure and Efficient Uniqueness-and-Anonymity-Preserving Remote User Authentication Scheme for Connected Health Care

Connected health care has several applications including telecare medicine information system, personally controlled health records system, and patient monitoring. In such applications, user authentication can ensure the legality of patients. In user authentication for such applications, only the legal user/patient himself/herself is allowed to access the remote server, and no one can trace him/her according to transmitted data. Chang et al. proposed a uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care (Chang et al., J Med Syst 37:9902, 2013). Their scheme uses the user's personal biometrics along with his/her password with the help of the smart card. The user's biometrics is verified using BioHashing. Their scheme is efficient due to usage of one-way hash function and exclusive-or (XOR) operations. In this paper, we show that though their scheme is very efficient, their scheme has several security weaknesses such as (1) it has design flaws in login and authentication phases, (2) it has design flaws in password change phase, (3) it fails to protect privileged insider attack, (4) it fails to protect the man-in-the middle attack, and (5) it fails to provide proper authentication. In order to remedy these security weaknesses in Chang et al.'s scheme, we propose an improvement of their scheme while retaining the original merit of their scheme. We show that our scheme is efficient as compared to Chang et al.'s scheme. Through the security analysis, we show that our scheme is secure against possible attacks. Further, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to ensure that our scheme is secure against passive and active attacks. In addition, after successful authentication between the user and the server, they establish a secret session key shared between them for future secure communication.

A Uniqueness-and-Anonymity-Preserving Remote User Authentication Scheme for Connected Health Care

Connected health care provides new opportunities for improving financial and clinical performance. Many connected health care applications such as telecare medicine information system, personally controlled health records system, and patient monitoring have been proposed. Correct and quality care is the goal of connected heath care, and user authentication can ensure the legality of patients. After reviewing authentication schemes for connected health care applications, we find that many of them cannot protect patient privacy such that others can trace users/patients by the transmitted data. And the verification tokens used by these authentication schemes to authenticate users or servers are only password, smart card and RFID tag. Actually, these verification tokens are not unique and easy to copy. On the other hand, biometric characteristics, such as iris, face, voiceprint, fingerprint and so on, are unique, easy to be verified, and hard to be copied. In this paper, a biometrics-based user authentication scheme will be proposed to ensure uniqueness and anonymity at the same time. With the proposed scheme, only the legal user/patient himself/herself can access the remote server, and no one can trace him/her according to transmitted data.

Connected health care: the future of health care and the role of the pharmacist

The population of the world is ageing. As a result, the incidence of chronic disease is projected to increase, there are predicted shortages in health care workforce and budget restraints; implications for future health care provision are serious. The current model of health care is not equipped to deal with these changes. Connected health care, via the use of health informatics, disease management and home telehealth technologies, has been suggested as an approach to ease the projected strain on future health care. Evidence to date suggests a positive impact of the use of connected health care model; however, the majority of studies have overlooked the involvement of the community pharmacist. As the most common point of contact with primary health services for most of the population, the community pharmacist may be well placed to provide connected health care. The research to date is promising with improvements in outcomes for cardiovascular patients noted; however, further work is required to investigate the potential role the community pharmacist can play in the future of connected health care.

Overview and Summary: The Value of RNs: How Can We Communicate our Economic Worth?

Any discussion of economics and economic valuing in what now is a globally connected health care delivery system is daunting talk, particularly to those among us who might prefer a focus on the art and science of care giving. Yet the nursing discipline is embedded in, and central to any discussion on the economic valuing and delivery of health care on many fronts. If this were not the case, one would have to seriously wonder, Why not? It is hard to imagine any serious health care venue consuming nursing resources in the United States or abroad - acute care, primary care, long-term care, home or public/community-based care, the military, informatics firms, pharmaceutical companies, and others - without seriously considering the value that nurses and nursing bring to bear on care or services outcomes. Chang, Price, and Pfoutz (2001) describe economics as the science that studies how consumers, business firms, government entities, and other organizations make choices to overcome the problem of scarcity. Scarcity exists because there are not enough resources to satisfy all existing human wants and desires (p. 6). As they reflect on health care, they state that most patients and families do not have the necessary means to obtain all health services. This situation is complicated through the use of third parties (insurance companies and the government, for instance) who are involved as players in what would be, in parallel business entities, a relationship restricted to that between a buyer (patient) and seller (provider). Those who embrace this edition of the OJIN: The Online Journal of Issues in Nursing will benefit in thinking about nursing's value contribution, present and future, to the health care system. The articles exemplify concepts espoused by Chang, Price, and Pfoutz (2001): (a) cost/quality valuation (what is the value of nursing interventions to patients or other aspects of the industry in the context of the outcomes produced?), (b) supply and demand (which influence salary, but also must link to career satisfaction and security), (c) awareness of markets (which asks who needs or will benefit from nursing's knowledge, skills, and abilities in the context of the discipline's social contract and emerging interests?), (d) service and product development and advancement (that link the full scope of nursing roles from basic to the highest levels of preparation with existing and new programs), and (e) pricing (where reimbursement for services and valuing of nursing contributions are in dynamic relationship). As you peruse these articles, recall that economic value is dynamic, not a static process. Value is not the purview of the supplier of services (in this case, nurses), but rather is created in tandem with users of services (the patient or health system, dependent upon the unit of analysis). Economic value is but one way, albeit a very significant one, of valuing nurses and nursing. In traditional economic models the notion of the law of demand drives prices and value beyond the reach of users, giving access to those who can demand services preferentially. Among the challenges for the nursing discipline is the creation of fair value and economic reward for a discipline that extends itself to all aspects of society to be non-scarce in light of influencing the health and well-being of society, through which healthy workers emerge to constitute the backbone that feeds all other industries. In the first article, Welton presents a robust discussion on the topic of mandatory hospital nurse staffing ratios, noting the various tensions that center on nursing's value as a commodity versus as a professional service provider. This article exemplifies the pricing concept noted above. Two articles follow that explain the relevance and use of the National Database of Nursing Quality IndicatorsTM (NDNQI)®, presented by authors Montalvo and also Dunton, Gajewski, and Klaus respectively. Using the NDNQI, both writers elucidate the importance of gathering and interpreting nurse-sensitive data when the unit of analysis is not at the institutional level, but rather at the unit level. …

About the evaluation of computerised health care services: Some critical points

This article analyses the concept of productivity underpinning the implementation of an information-technology-driven virage ambulatoire, or shift to outpatient care, as a solution to the productivity ‘crisis’ in Quebec’s health care system. This ‘crisis’ was diagnosed in the 1970s and based on expenditure trends. These trends were regarded by the State as an ‘obstacle’ to balanced budgets and more generally, economic growth. Into this situation stepped the IT-driven virage ambulatoire with a structural reorganisation following a productivist logic. Unrolled in the 1980s, this connected health care to the economistic discourses of the 1960s which were developed to boost productivity in a service- or information-based economy. The State thus came to draw on analytic categories, developed for a very particular mode of economic analysis, to produce a hospital restructuring program oriented around IT-based ambulatory care. The result was the reduction of health care’s principles of clinical and therapeutic efficiency to the administrative imperatives of time, quantum, cost, and optimisation, all of which became variables to be controlled, and the placement of economic logics ahead of clinical imperatives. Quebec has thus moved to a neoliberal productivist system in which clinical and therapeutic effectiveness are subordinate to economic need.