An open platform for personal health record apps with platform-level privacy protection

One of the main barriers to the adoption of Personal Health Records (PHR) systems is their closed nature. It has been argued in the literature that this barrier can be overcome by introducing an open market of substitutable PHR apps. The requirements introduced by such an open market on the underlying platform have also been derived. In this paper, we argue that MyPHRMachines, a cloud-based PHR platform recently developed by the authors, satisfies these requirements better than its alternatives. The MyPHRMachines platform leverages Virtual Machines as flexible and secure execution sandboxes for health apps. MyPHRMachines does not prevent pushing hospital- or patient-generated data to one of its instances, nor does it prevent patients from sharing data with their trusted caregivers. External software developers have minimal barriers to contribute innovative apps to the platform, since apps are only required to avoid pushing patient data outside a MyPHRMachines cloud. We demonstrate the potential of MyPHRMachines by presenting two externally contributed apps. Both apps provide functionality going beyond the state-of-the-art in their application domain, while they did not require any specific MyPHRMachines platform extension

Exploring the Emergence of Open Platforms in Healthcare: Design Considerations and Experiences from an Initial Case in Norwegian Primary Care

Despite significant efforts on improving interoperability of health information and lowering socio-technical cost of replacing clinical applications, healthcare organizations and professionals struggle with fragmented and non-interoperable Health Information Technologies. This paper describes the emergence of open platforms, which may alleviate challenges related to interoperability issues, weak integrations, siloed data repositories, and numerous legacy systems within healthcare. Using a proposed platform initiative in Norway, we explore the open platform phenomenon with a socio-technical lens, and highlights four key topics that have produced tension and merits consideration from the involved stakeholders: i) Procurement strategy and vendor neutrality, ii) Ability to facilitate flexible use, iii) The use of standards and separation of data and application, and iv) Strategies for development and governance of standards. We further discuss the related implications and design considerations necessary to support complex patient pathways and provide clinicians more flexible and effective systems

Integrated, reliable and cloud-based personal health record: a scoping review.

Personal Health Records (PHR) emerge as an alternative to integrate patient’s health information to give a global view of patients' status. However, integration is not a trivial feature when dealing with a variety electronic health systems from healthcare centers. Access to PHR sensitive information must comply with privacy policies defined by the patient. Architecture PHR design should be in accordance to these, and take advantage of nowadays technology. Cloud computing is a current technology that provides scalability, ubiquity, and elasticity features. This paper presents a scoping review related to PHR systems that achieve three characteristics: integrated, reliable and cloud-based. We found 101 articles that addressed thosecharacteristics. We identified four main research topics: proposal/developed systems, PHR recommendations for development, system integration and standards, and security and privacy. Integration is tackled with HL7 CDA standard. Information reliability is based in ABE security-privacy mechanism. Cloud-based technology access is achieved via SOA.CONACYT - Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Securing clouds using cryptography and traffic classification

Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources that can be rapidly provisioned and released with minimal management effort or service provider interaction. Over the last decade, cloud computing has gained popularity and wide acceptance, especially within the health sector where it offers several advantages such as low costs, flexible processes, and access from anywhere. Although cloud computing is widely used in the health sector, numerous issues remain unresolved. Several studies have attempted to review the state of the art in eHealth cloud privacy and security however, some of these studies are outdated or do not cover certain vital features of cloud security and privacy such as access control, revocation and data recovery plans. This study targets some of these problems and proposes protocols, algorithms and approaches to enhance the security and privacy of cloud computing with particular reference to eHealth clouds. Chapter 2 presents an overview and evaluation of the state of the art in eHealth security and privacy. Chapter 3 introduces different research methods and describes the research design methodology and processes used to carry out the research objectives. Of particular importance are authenticated key exchange and block cipher modes. In Chapter 4, a three-party password-based authenticated key exchange (TPAKE) protocol is presented and its security analysed. The proposed TPAKE protocol shares no plaintext data; all data shared between the parties are either hashed or encrypted. Using the random oracle model (ROM), the security of the proposed TPAKE protocol is formally proven based on the computational Diffie-Hellman (CDH) assumption. Furthermore, the analysis included in this chapter shows that the proposed protocol can ensure perfect forward secrecy and resist many kinds of common attacks such as man-in-the-middle attacks, online and offline dictionary attacks, replay attacks and known key attacks. Chapter 5 proposes a parallel block cipher (PBC) mode in which blocks of cipher are processed in parallel. The results of speed performance tests for this PBC mode in various settings are presented and compared with the standard CBC mode. Compared to the CBC mode, the PBC mode is shown to give execution time savings of 60%. Furthermore, in addition to encryption based on AES 128, the hash value of the data file can be utilised to provide an integrity check. As a result, the PBC mode has a better speed performance while retaining the confidentiality and security provided by the CBC mode. Chapter 6 applies TPAKE and PBC to eHealth clouds. Related work on security, privacy preservation and disaster recovery are reviewed. Next, two approaches focusing on security preservation and privacy preservation, and a disaster recovery plan are proposed. The security preservation approach is a robust means of ensuring the security and integrity of electronic health records and is based on the PBC mode, while the privacy preservation approach is an efficient authentication method which protects the privacy of personal health records and is based on the TPAKE protocol. A discussion about how these integrated approaches and the disaster recovery plan can ensure the reliability and security of cloud projects follows. Distributed denial of service (DDoS) attacks are the second most common cybercrime attacks after information theft. The timely detection and prevention of such attacks in cloud projects are therefore vital, especially for eHealth clouds. Chapter 7 presents a new classification system for detecting and preventing DDoS TCP flood attacks (CS_DDoS) for public clouds, particularly in an eHealth cloud environment. The proposed CS_DDoS system offers a solution for securing stored records by classifying incoming packets and making a decision based on these classification results. During the detection phase, CS_DDOS identifies and determines whether a packet is normal or from an attacker. During the prevention phase, packets classified as malicious are denied access to the cloud service, and the source IP is blacklisted. The performance of the CS_DDoS system is compared using four different classifiers: a least-squares support vector machine (LS-SVM), naïve Bayes, K-nearest-neighbour, and multilayer perceptron. The results show that CS_DDoS yields the best performance when the LS-SVM classifier is used. This combination can detect DDoS TCP flood attacks with an accuracy of approximately 97% and a Kappa coefficient of 0.89 when under attack from a single source, and 94% accuracy and a Kappa coefficient of 0.9 when under attack from multiple attackers. These results are then discussed in terms of the accuracy and time complexity, and are validated using a k-fold cross-validation model. Finally, a method to mitigate DoS attacks in the cloud and reduce excessive energy consumption through managing and limiting certain flows of packets is proposed. Instead of a system shutdown, the proposed method ensures the availability of service. The proposed method manages the incoming packets more effectively by dropping packets from the most frequent requesting sources. This method can process 98.4% of the accepted packets during an attack. Practicality and effectiveness are essential requirements of methods for preserving the privacy and security of data in clouds. The proposed methods successfully secure cloud projects and ensure the availability of services in an efficient way