Distributed Healthcare Environment Research Articles

An Extended Attribute-Based Access Control (ABAC) Model for Distributed Collaborative Healthcare System

The healthcare system is a real example of a distributed collaborative system, which aims to improve the patient's healthcare. The most important requirements of the healthcare system are the sensitivity of the medical data processed, large numbers of medical and para-medical interveners, as well as the medical treatment activity is a non-static process. Protecting data from unauthorized access and data sharing security in the healthcare environment is a critical process that influences system credibility. To achieve this goal and to meet the requirements of the healthcare system, the authors propose an extended Attribute-Based Access Control (ABAC) model by introducing the medical activity concept. This article defines the medical activity concept as an abstraction of collaboration in a care unit, defined by a medical activity purpose, in which the collaborators (or actors) realize their tasks in order to achieve the treatment purpose. The current access control model ABAC and these variants do not take into account the (business process) activity concept in the decision mechanism. In this paper, the authors propose a new access control model, called Medical-Activity-Attribute-Based Access Control (MA-ABAC), which can effectively enhance the security for healthcare system and produce more perfect and flexible mechanism of access control; order to strongly respond to the requirements of the distributed healthcare environment.

How (not) to protect genomic data privacy in a distributed network: using trail re-identification to evaluate and design anonymity protection systems

The increasing integration of patient-specific genomic data into clinical practice and research raises serious privacy concerns. Various systems have been proposed that protect privacy by removing or encrypting explicitly identifying information, such as name or social security number, into pseudonyms. Though these systems claim to protect identity from being disclosed, they lack formal proofs. In this paper, we study the erosion of privacy when genomic data, either pseudonymous or data believed to be anonymous, are released into a distributed healthcare environment. Several algorithms are introduced, collectively called RE-Identification of Data In Trails (REIDIT), which link genomic data to named individuals in publicly available records by leveraging unique features in patient-location visit patterns. Algorithmic proofs of re-identification are developed and we demonstrate, with experiments on real-world data, that susceptibility to re-identification is neither trivial nor the result of bizarre isolated occurrences. We propose that such techniques can be applied as system tests of privacy protection capabilities.

Extensions to the HISA Standard – the SynEx Computing Environment

This paper reports on the integration work required to support the delivery of healthcare. Specifically, four elements are included being: the DHE (a standards based distributed healthcare environment), Synapses which is a patient record server, XML as a technology to deliver records, and finally two client applications that facilitate structured data entry (SDE) and the remote booking of specialist services. A general motivation for the work is presented and augmented on hand of a clinical scenario. Additionally, the adoption of a middleware approach is reviewed. The role of computerised patient records is described followed by an account of a federated record server. The approach favoured by standards bodies in utilising XML is covered and the tailoring to suit the needs of the integration is explained. The main practical challenges in achieving integration are presented, one of these being the mapping between the DHE data model and the Synapses server record architecture. The described environment has been demonstrated to provide the functionality that is required and in addition it has been shown that the engineering challenges can be met in a controlled and orderly manner. The role of the DHE middleware component acting as an 'anchor' has been shown to be a valid one onto which other specialised components can be added to provide a richer service environment. Additionally, it has been demonstrated that XML is a good candidate technology that facilitates connectivity to client applications over an extranet. The demands inherent in both the clinical scenario and the computerised patient record can be met by the computing environment described in the paper.

A telemedicine model for integrating point-of-care testing into a distributed health-care environment.

Centralized testing demands costly laboratories, which are inefficient and may provide poor services. Recent advances make it feasible to move clinical testing nearer to patients and the requesting physicians, thus reducing the time to treatment. Internet technologies can be used to create a virtual laboratory information system in a distributed health-care environment. This allows clinical testing to be transferred to a cooperative scheme of several point-of-care testing (POCT) nodes. Two pilot virtual laboratories were established, one in Italy (AUSL Modena) and one in Greece (Athens Medical Centre). They were constructed on a three-layer model to allow both technical and clinical verification. Different POCT devices were connected. The pilot sites produced good preliminary results in relation to user acceptance, efficiency, convenience and costs. Decentralized laboratories can be expected to become cost-effective.

The CEN healthcare information systems architecture standard and the DHE middleware.: A practical support to the integration and evolution of healthcare systems

The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services, not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and informational basis common to the whole organisation. New applications can be also be rapidly developed and natively integrated with the rest of the system. Such architecture has already been formalised through the proposed European Prestandard, defined by the CEN/TC251/PT1013 Standard Architecture for Health care Information Systems [1]. Thanks to the availability of industrial products conforming to the standard, the effectiveness and validity of this approach has already been demonstrated in practice. For example, through the Hansa collaboration, hospitals and industries from 15 European countries use the same industrial middleware (i.e. the DHE—Distributed Healthcare Environment) for integrating existing systems as well as for developing new applications.