Electronic Health Record Privacy Research Articles

Privacy Preservation of Electronic Health Records in the Modern Era: A Systematic Survey

Building a secure and privacy-preserving health data sharing framework is a topic of great interest in the healthcare sector, but its success is subject to ensuring the privacy of user data. We clarified the definitions of privacy, confidentiality and security (PCS) because these three terms have been used interchangeably in the literature. We found that researchers and developers must address the differences of these three terms when developing electronic health record (EHR) solutions. We surveyed 130 studies on EHRs, privacy-preserving techniques, and tools that were published between 2012 and 2022, aiming to preserve the privacy of EHRs. The observations and findings were summarized with the help of the identified studies framed along the survey questions addressed in the literature review. Our findings suggested that the usage of access control, blockchain, cloud-based, and cryptography techniques is common for EHR data sharing. We summarized the commonly used strategies for preserving privacy that are implemented by various EHR tools. Additionally, we collated a comprehensive list of differences and similarities between PCS. Finally, we summarized the findings in a tabular form for all EHR tools and techniques and proposed a fusion of techniques to better preserve the PCS of EHRs.

Survey of Secure Data Access Control Models in Cloud computing for EHR

Today cloud computing is the first choice of many individuals and different organizations. Computing services offered by different CSP’s are available as per need and the requirement. Most of the healthcare organizations are using cloud services for transmitting, storing and processing electronic health records (EHR) of patients. Patient’s health record is sensitive and there is possibility of violation of privacy by CSP’s. Data access control is one of the best mechanisms to address security issues in cloud computing and ensure the safety, reliability of the system and privacy of the user data. Existing surveys on access control mechanisms in cloud computing focus on all traditional centralized models. However, decentralized access models like block chain with traditional access control model is also used now days for ensuring privacy of EHR. This paper takes the detailed of reviews such existing access control mechanisms in cloud computing, based both types of access control models. Also provides comparisons on each model’s advantages and limitations, and discusses the challenges of, and future research direction for access control.

Healthcare System Using Blockchain

The global Electronic Health Record (EHR) market is growing dramatically and is expected to reach $39.7 billion by 2022. To safeguard the security and privacy of EHR, access control is an essential mechanism for managing EHR data. This paper proposes a hybrid architecture to facilitate access control of EHR data by using both blockchain and edge nodes. Within the architecture, a blockchain-based controller manages identity and access control policies and serves as a tamper-proof log of access events. In addition, off-chain edge nodes store the EHR data and apply policies specified in Abbreviated Language For Authorization (ALFA) to enforce attribute-based access control on EHR data in collaboration with the blockchain-based access control logs. We evaluate the proposed hybrid architecture by utilizing the Hyperledger Composer Fabric blockchain to measure the performance of executing smart contracts and ACL policies in terms of transaction processing time and response time against unauthorized data retrieval. Keywords:Attribute-based Access Control, Access Control List, Blockchain, Edge Computing, Hyperledger, Smart Contract

Security & Privacy of Electronic Health Records

Healthcare facilities like hospitals and clinics are adopting new technology at a dizzying pace. However, confidentiality concerns are frequently neglected, placing healthcare institutions at risk of cyber security problems, fines, reputational harm, and even catastrophic patient implications. Clinical documentation, patient profiles, lab findings, imaging findings, and diagnostic procedures make up Electronic Health Record (EHR) systems. EHRs are getting more and more complex with time, necessitating more and more data storage. In order to secure healthcare-based technologies and networks, new protection and security techniques are being explored with the growth of the IoT, Software as a service, and City Development platforms.

EHR privacy preservation using federated learning with DQRE-Scnet for healthcare application domains

A distributed learning technique named Federated Learning (FL) is utilized by mobile devices, clinical research labs, and hospitals for secure healthcare data sharing. FL has been utilized by several researchers for preserving the privacy of Electronic Health Record (EHR) information while updating the global server. Still, the privacy and higher number of communication rounds limit the performance of the model. Hence, this research introduces the privacy-preserving EHR information sharing technique, FL, based on deep Q reinforcement learning with spectral clustering (FL+DQRE-SCnet). In this, the local healthcare information is trained using the DCNN in the respective hospitals based on FL criteria. After learning the local model, the information is shared with the global model for updating the EHR to enhance the accuracy of disease diagnosis. The global model aggregates the information from the local models over several communication rounds by randomly selecting the local models, increasing the need for more communication rounds. Therefore, DQRE-SCnet is introduced before data aggregation to minimize the communication rounds. In addition, including a homomorphic encryption technique ensures privacy protection for FL data sharing. The analysis of FL+DQRE-SCnet based on the assessment measures of accuracy, precision, recall, and F-measure acquired maximal values of 95%, 94.9%, 94.94%, and 93.94%, respectively. Also, the error rate of 0.46 and the execution time of 1400 sec are accomplished by the FL+DQRE-SCnet method. Here, for comparing the performance of the model, the baseline methods like FedAvg, LoAdaBoost, BOFRF, PP-FedAvg and AdaFed are considered, wherein the proposed method acquired superior performance.

A Granular Approach to Secure the Privacy of Electronic Health Records Through Blockchain Technology

The method of storing data in traditional Electronic Health Records (EHRs) becomes even more obsolete when it has to undertake data from more than one institution. This problem is bigger than it seems as, most of the times the patients' medical data is scattered among various Healthcare Centers. Also, these multiple and inconsistent health records are almost never reviewed which further makes them unreliable. All this can be achieved by implementing the Blockchain Technology into the traditional Electronic Health Records. We propose a blockchain technology based Electronic Health Record portal for patients, doctors, and other users to provide temper proof, secure, and efficient access to health records while maintaining the privacy of patient’s health records. The aim of this paper is to deal with the various needs of patients, doctors, and third parties, as well as to see how the system could resolve privacy and security issues in the healthcare industry.

On the Design of Secured and Reliable Dynamic Access Control Scheme of Patient E-Healthcare Records in Cloud Environment.

Traditional healthcare services have changed into modern ones in which doctors can diagnose patients from a distance. All stakeholders, including patients, ward boy, life insurance agents, physicians, and others, have easy access to patients' medical records due to cloud computing. The cloud's services are very cost-effective and scalable, and provide various mobile access options for a patient's electronic health records (EHRs). EHR privacy and security are critical concerns despite the many benefits of the cloud. Patient health information is extremely sensitive and important, and sending it over an unencrypted wireless media raises a number of security hazards. This study suggests an innovative and secure access system for cloud-based electronic healthcare services storing patient health records in a third-party cloud service provider. The research considers the remote healthcare requirements for maintaining patient information integrity, confidentiality, and security. There will be fewer attacks on e-healthcare records now that stakeholders will have a safe interface and data on the cloud will not be accessible to them. End-to-end encryption is ensured by using multiple keys generated by the key conclusion function (KCF), and access to cloud services is granted based on a person's identity and the relationship between the parties involved, which protects their personal information that is the methodology used in the proposed scheme. The proposed scheme is best suited for cloud-based e-healthcare services because of its simplicity and robustness. Using different Amazon EC2 hosting options, we examine how well our cloud-based web application service works when the number of requests linearly increases. The performance of our web application service that runs in the cloud is based on how many requests it can handle per second while keeping its response time constant. The proposed secure access scheme for cloud-based web applications was compared to the Ethereum blockchain platform, which uses internet of things (IoT) devices in terms of execution time, throughput, and latency.

E-Healthcare Privacy Data Sharing with Fine-Grained Access Control

The E-Healthcare Cloud system has shown that it can improve healthcare quality as well as individual quality of life. Unfortunately, concerns about security and privacy prevent it from being widely adopted and used. Several studies have been carried out in order to protect the privacy of electronic health record (EHR) data. We start with a two-layer encryption scheme. We create first-layer encryption to ensure efficient and fine-grained access control over EHR data, in which we create a highly specialised access policy for each data attribute in the EHR and encrypt them individually with high efficiency. To protect the privacy of role attributes and access policies used in the first-layer encryption, we construct the second-layer encryption systematically. We made a recommendation. User revocation is commonly supported in such schemes, as users' group memberships may change for a variety of reasons. Prior to now, the computational overhead for Auto user revocation. Binary key generation is included for file storage. We proposed enabling file encryption alongside proxy re encryption.

Patient-Controlled Mechanism Using Pseudonymization Technique for Ensuring the Security and Privacy of Electronic Health Records

An Internet-based Electronic Health Record (EHR) system allows patients to access their medical history whenever they need it. Access to patient records and transactions related to diagnosis is helpful to patients and the health care department and executives. But this practice may lead to major privacy concerns of patients' private data. For EHR adaptation, the major elements are laws and regulations, monetary inducement and hurdles, technology state, and corporation effect. In this paper, I have proposed a Patient Controlled mechanism using the pseudonymization technique for ensuring the security and privacy of Electronic Health records. It is found that most of the potential approaches have used pseudonymization techniques to deal with the issues involved in a healthcare information system. This proposed solution is simple and efficiently ensures the privacy of patient data. Comparative analysis with other existing approaches has been undertaken.

Multiple access control scheme for EHRs combining edge computing with smart contracts

To make up the insufficient computing power of remote medical devices and solve the transmission delay problem, edge computing has been widely studied in academic community. The application of edge computing in E-health makes it more convenient for medical providers to view the patient’ electronic health records (EHRs), which not only improves the work efficiency of medical providers, but also provides patients with more personalized treatments. However,there are some security problems in the E-health system, such as EHRs leakage or tampering. Therefore, attribute-based encryption (CP-ABE) is widely used in the access control of EHRS. In order to reduce the computing cost of resource-constrained devices and achieve more flexible fine-grained access control, this paper proposes an effective ABE scheme that outsources part of the computing load to the fog nodes, which safely shares data with lower overheads. It also supports users revocation and attribute revocation. In addition, we combine smart contract and blockchain to share more fine-grained EHRs. The security proof and experimental results show that our scheme has higher efficiency to protect the patients’ EHRs privacy.

Secure decentralized electronic health records sharing system based on blockchains

Blockchain technology has a great potential for improving efficiency, security and privacy of Electronic Health Records (EHR) sharing systems. However, existing solutions relying on a centralized database are susceptible to traditional security problems such as Denial of Service (DoS) attacks and a single point of failure similar to traditional database systems. In addition, past solutions exposed users to privacy linking attacks and did not tackle performance and scalability challenges. In this paper, we propose a permissioned Blockchain based healthcare data sharing system that integrates Blockchain technology, decentralized file system and threshold signature to address the aforementioned problems. The proposed system is based on Istanbul Byzantine Fault Tolerant (IBFT) consensus algorithm and Interplanetary File System (IPFS). We implemented the proposed system on an enterprise Ethereum Blockchain known as Hyperledger Besu. We evaluated and compared the performance of the proposed system based on various performance metrics such as transaction latency, throughput and failure rate. Experiments were conducted on a variable network size and number of transactions. The experimental results indicate that the proposed system performs better than existing Blockchain based systems. Moreover, the decentralized file system provides better security than existing traditional centralized database systems while providing the same level of performance.

BSF-EHR: Blockchain Security Framework for Electronic Health Records of Patients.

In the current epoch of smart homes and cities, personal data such as patients’ names, diseases and addresses are often violated. This is frequently associated with the safety of the electronic health records (EHRs) of patients. EHRs have numerous benefits worldwide, but at present, EHR information is subject to considerable security and privacy issues. This paper proposes a way to provide a secure solution to these issues. Previous sophisticated techniques dealing with the protection of EHRs usually make data inaccessible to patients. These techniques struggle to balance data confidentiality, patient demand and constant interaction with provider data. Blockchain technology solves the above problems since it distributes information in a transactional and decentralized manner. The usage of blockchain technology could help the health sector to balance the accessibility and privacy of EHRs. This paper proposes a blockchain security framework (BSF) to effectively and securely store and keep EHRs. It presents a safe and proficient means of acquiring medical information for doctors, patients and insurance agents while protecting the patient’s data. This work aims to examine how our proposed framework meets the security needs of doctors, patients and third parties and how the structure addresses safety and confidentiality concerns in the healthcare sector. Simulation outcomes show that this framework efficiently protects EHR data.

Healthchain: A novel framework on privacy preservation of electronic health records using blockchain technology.

The privacy of Electronic Health Records (EHRs) is facing a major hurdle with outsourcing private health data in the cloud as there exists danger of leaking health information to unauthorized parties. In fact, EHRs are stored on centralized databases that increases the security risk footprint and requires trust in a single authority which cannot effectively protect data from internal attacks. This research focuses on ensuring the patient privacy and data security while sharing the sensitive data across same or different organisations as well as healthcare providers in a distributed environment. This research develops a privacy-preserving framework viz Healthchain based on Blockchain technology that maintains security, privacy, scalability and integrity of the e-health data. The Blockchain is built on Hyperledger fabric, a permissioned distributed ledger solutions by using Hyperledger composer and stores EHRs by utilizing InterPlanetary File System (IPFS) to build this healthchain framework. Moreover, the data stored in the IPFS is encrypted by using a unique cryptographic public key encryption algorithm to create a robust blockchain solution for electronic health data. The objective of the research is to provide a foundation for developing security solutions against cyber-attacks by exploiting the inherent features of the blockchain, and thus contribute to the robustness of healthcare information sharing environments. Through the results, the proposed model shows that the healthcare records are not traceable to unauthorized access as the model stores only the encrypted hash of the records that proves effectiveness in terms of data security, enhanced data privacy, improved data scalability, interoperability and data integrity while sharing and accessing medical records among stakeholders across the healthchain network.

A privacy-preserving public integrity check scheme for outsourced EHRs

Cloud storage as an emerging technology has already drawn people’s attention and hospitals and medical institutions increasingly begin to outsource their huge electronic health records (EHRs) to cloud. Since EHRs always involve lots of sensitive privacy, it is necessary to protect the confidentiality and privacy of EHRs. Meanwhile, existing works do not consider that combining classified storage with special data structures to improve the efficiency of integrity check for outsourced EHRs. In this paper, we propose an efficient integrity check scheme for classified EHRs. First, our scheme not only protects the privacy of category information for EHRs, but also ensures the EHRs themselves. Second, we improve the performance of lookup and data updating dramatically by deploying adjustable-capacity cuckoo filter with a linked list, which is a container storing the EHRs’ ciphertexts and verification metadata. Third, we implement our scheme in a more practical way by extending batch auditing of EHRs from single category to multi-category. The provable update for the cloud service provider and the third-party auditor after updating EHRs is also guaranteed. Finally, the security of our scheme is proven, and numerical analyses and simulation experiments show that our scheme is efficient.

Privacy preservation in e-health cloud: taxonomy, privacy requirements, feasibility analysis, and opportunities

Electronic health records (EHRs) are increasingly employed to maintain, store and share varied types of patient data. The data can also be utilized for various research purposes, such as clinical trials or epidemic control strategies. With the increasing cost and scarcity of healthcare services, healthcare organizations feel at ease in outsourcing these services to cloud-based EHRs. That serves as pay-as-you-go (PAYG) “e-health cloud” models to aid the healthcare organizations handling with existing and imminent demands yet restricting their costs. Technologies can host some risks; hence the privacy of information in these systems is of utmost importance. Regardless of its increased effectiveness and growing eagerness in its adoption, not much care is being employed to the privacy issues that might arise. Privacy preservation need to be reviewed about the changing privacy rules and legislations regarding sensitive personal data. Our work aims at answering three major questions: firstly, how privacy models and privacy techniques correlate with each other, secondly, how we can fix the privacy-utility-trade off by using different combinations of privacy models and privacy techniques and lastly, what are the most relevant privacy techniques that can be adapted to achieve privacy of EHR on cloud.

Preserving the Privacy of Electronic Health Records using Blockchain

Abstract Electronic health records (EHRs) are health information of patients that are saved digitally in a network. Various opportunities to enhance patient care, performance measures in clinical practice and contribute to clinical research in the future are provided by EHRs. The schemes used to store EHRs have been very insecure in the present era of smart cities and homes. The data can be easily breached by hackers and unauthorized external parties. Also, the data is not accessible to patients and care providers. These schemes are unable to create a balance between data security and data accessibility. But blockchain can resolve these issues. Blockchain creates a ledger system that is immutable and allows the transactions to take place in a decentralized manner. The three main features of blockchain technology - Security, Decentralization, and Transparency make any application built using it secure and not accessible by unauthorized parties. The manipulation of data is almost impossible to do in a blockchain network. In this project, we propose a system to implement EHRs using blockchain technology and make EHRs more secure and private. The blockchain technology will keep control over access to information using its cryptographic techniques and decentralization. It will also maintain the balance between data privacy and data accessibility. Our main objective of this project is the framing of data privacy and security issues in electronic healthcare

Privacy-Preserving Data Sharing using Multi-layer Access Control Model in Electronic Health Environment

Electronic Health Data (EHD) is an emerging health information exchange model that facilitates healthcare providers and patients to efficiently store and share their private healthcare information from any place and at any time as per demand. Generally, Cloud services provide the infrastructure by reducing the cost of storing, processing and updating information with improved efficiency and quality. However, the privacy of Electronic Health Records (EHR) is a significant hurdle while outsourcing private health data in the cloud because there is a higher peril of leaking health information to unauthorized parties. Several existing techniques are able to analyse the security and privacy issues associated with e-healthcare services. These methods are designed for single database, or databases, with an authentication centre and thus cannot adequately protect the data from insider attacks. Therefore, this research study mainly focusses on how to ensure the patient privacy while sharing the sensitive data between same or different organisations as well as healthcare providers in a cloud environment. This paper proposes a multi-layer access control mechanism named MLAC Model to construct a secure and privacy-preserving EHR system that enables patients to share their data with stakeholders. In this paper, we use a Dual layer access control model named Pseudo-Role Attribute based access control (PR-ABAC) mechanism that integrates attributes with roles for the secure sharing of EHR between multiple collaborators. The proposed framework also uses the concept of Provenance to ensure the Integrity of patient data. This work is expected to provide a foundation for developing security solutions against cyber-attacks, and thus contribute to the robustness of healthcare information sharing environments.

Intelligent Security and Privacy of Electronic Health Records Using Biometric Images.

In the presence of Cloud Environment and the migration of Electronic Health Systems and records to the Cloud, patient privacy has become an emergent problem for healthcare institutions. Government bylaws, electronic health documentation, and innovative internet health services generate numerous security issues for healthcare conformity and information security groups. To deal with these issues, healthcare institutes must protect essential IT infrastructure from unauthorized use by insiders and hackers. The Cloud Computing archetype allows for EHealth methods that improve the features and functionality of systems on the cloud. On the other hand, sending patients' medical information and records to the Cloud entails a number of risks in the protection and privacy of the health records during the communication process. In this paper, a solution is proposed for the security of Electronic Health Records (EHRs) in cloud environment during the process of sending the data to the cloud. In addition, the proposed method uses biometric images that allow for unified patient identification across cloud-based EHRs and across medical institutions. To protect the privacy of patients' information and streamline the migration process, a watermarking-based method is proposed for health care providers to ensure that patients' data are only accessible to authorized personnel. Patients' information, such as name, id, symptoms, diseases, and previous history, is secured in biometric images of patients as an encrypted watermark. Quality and impeccability analysis and robustness were performed to test the proposed method. The PSNR values show that the proposed method produced excellent results. The robustness and impressibility of the proposed method were tested by subjecting the watermarked images to different simulated attacks. The watermarks were largely impermeable to varied and repeated attacks.

Security and Privacy-Preserving Challenges of e-Health Solutions in Cloud Computing

A systematic and comprehensive review of security and privacy-preserving challenges in e-health solutions indicates various privacy preserving approaches to ensure privacy and security of electronic health records (EHRs) in the cloud. This paper highlights the research challenges and directions concerning cyber security to build a comprehensive security model for EHR. We carry an intensive study in the IEEE, Science Direct, Google Scholar, PubMed, and ACM for papers on EHR approach published between 2000 and 2018 and summarized them in terms of the architecture types as well as evaluation strategies. We surveyed, investigated, and reviewed various aspects of several articles and identified the following tasks: 1) EHR security and privacy; 2) security and privacy requirements of e-health data in the cloud; 3) EHR cloud architecture, and; 4) diverse EHR cryptographic and non-cryptographic approaches. We also discuss some crucial issues and the ample opportunities for advanced research related to security and privacy of EHRs. Since big data provide a great mine of information and knowledge in e-Health applications, serious privacy and security challenges that require immediate attention exist. Studies must focus on efficient comprehensive security mechanisms for EHR and also explore techniques to maintain the integrity and confidentiality of patients’ information.

Health Care Personnel Perception of the Privacy of Electronic Health Records.

A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.