Safeguarding health data with enhanced accountability and patient awareness

Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits. In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.PhDCommittee Chair: Mustaque Ahamad; Committee Member: Douglas M. Blough; Committee Member: Ling Liu; Committee Member: Mark Braunstein; Committee Member: Wenke Le

Ensuring patients privacy in a cryptographic-based-electronic health records using bio-cryptography

Several recent works have proposed and implemented cryptography as a means to preserve privacy and security of patients health data. Nevertheless, the weakest point of electronic health record (EHR) systems that relied on these cryptographic schemes is key management. Thus, this paper presents the development of privacy and security system for cryptography-based-EHR by taking advantage of the uniqueness of fingerprint and iris characteristic features to secure cryptographic keys in a bio-cryptography framework. The results of the system evaluation showed significant improvements in terms of time efficiency of this approach to cryptographic-based-EHR. Both the fuzzy vault and fuzzy commitment demonstrated false acceptance rate (FAR) of 0%, which reduces the likelihood of imposters gaining successful access to the keys protecting patients protected health information. This result also justifies the feasibility of implementing fuzzy key binding scheme in real applications, especially fuzzy vault which demonstrated a better performance during key reconstruction

Information Accountability Framework for a Trusted Health Care System

Trusted health care outcomes are patient centric. Requirements to ensure both the quality and sharing of patients’ health records are a key for better clinical decision making. In the context of maintaining quality health, the sharing of data and information between professionals and patients is paramount. This information sharing is a challenge and costly if patients’ trust and institutional accountability are not established. Establishment of an Information Accountability Framework (IAF) is one of the approaches in this paper. The concept behind the IAF requirements are: transparent responsibilities, relevance of the information being used, and the establishment and evidence of accountability that all lead to the desired outcome of a Trusted Health Care System. Upon completion of this IAF framework the trust component between the public and professionals will be constructed. Preservation of the confidentiality and integrity of patients’ information will lead to trusted health care outcomes

An electronic healthcare record server implemented in PostgreSQL

This paper describes the implementation of an Electronic Healthcare Record server inside a PostgreSQL relational database without dependency on any further middleware infrastructure. The five-part international standard for communicating healthcare records (ISO EN 13606) is used as the information basis for the design of the server. We describe some of the features that this standard demands that are provided by the server, and other areas where assumptions about the durability of communications or the presence of middleware lead to a poor fit. Finally, we discuss the use of the server in two real-world scenarios including a commercial application

A systematic literature review of cloud computing in eHealth

Cloud computing in eHealth is an emerging area for only few years. There needs to identify the state of the art and pinpoint challenges and possible directions for researchers and applications developers. Based on this need, we have conducted a systematic review of cloud computing in eHealth. We searched ACM Digital Library, IEEE Xplore, Inspec, ISI Web of Science and Springer as well as relevant open-access journals for relevant articles. A total of 237 studies were first searched, of which 44 papers met the Include Criteria. The studies identified three types of studied areas about cloud computing in eHealth, namely (1) cloud-based eHealth framework design (n=13); (2) applications of cloud computing (n=17); and (3) security or privacy control mechanisms of healthcare data in the cloud (n=14). Most of the studies in the review were about designs and concept-proof. Only very few studies have evaluated their research in the real world, which may indicate that the application of cloud computing in eHealth is still very immature. However, our presented review could pinpoint that a hybrid cloud platform with mixed access control and security protection mechanisms will be a main research area for developing citizen centred home-based healthcare applications

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

The Serums Tool-Chain:Ensuring Security and Privacy of Medical Data in Smart Patient-Centric Healthcare Systems

Digital technology is permeating all aspects of human society and life. This leads to humans becoming highly dependent on digital devices, including upon digital: assistance, intelligence, and decisions. A major concern of this digital dependence is the lack of human oversight or intervention in many of the ways humans use this technology. This dependence and reliance on digital technology raises concerns in how humans trust such systems, and how to ensure digital technology behaves appropriately. This works considers recent developments and projects that combine digital technology and artificial intelligence with human society. The focus is on critical scenarios where failure of digital technology can lead to significant harm or even death. We explore how to build trust for users of digital technology in such scenarios and considering many different challenges for digital technology. The approaches applied and proposed here address user trust along many dimensions and aim to build collaborative and empowering use of digital technologies in critical aspects of human society