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

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

Since the 1990s, the Veterans Health Administration (VHA) has used information and communications technologies to provide high-quality, coordinated, and comprehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans' homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA's success -- like the organization's leadership, culture, and existing information technology infrastructure -- as well as opportunities and challenges

Exploiting Multimodal Biometrics in E-Privacy Scheme for Electronic Health Records

Existing approaches to protect the privacy of Electronic Health Records (EHR) are either insufficient for existing medical laws or they are too restrictive in their usage. For example, smartcard-based encryption systems require the patient to be always present to authorize access to medical records. A major issue in EHR is how patient’s privacy and confidentiality can be maintained because there are known scenarios where patients’ health data have been abused and misused by those seeking to gain selfish interest from it. Another issue in EHR is how to provide adequate treatment and have access to the necessary information especially in pre-hospital care settings. Questionnaires were administered by 50 medical practitioners to identify and categorize different EHR attributes. The system was implemented using multimodal biometrics (fingerprint and iris) of patients to access patient record in pre-hospital care. The software development tools employed were JAVA and MySQL database. The system provides applicable security when patients’ records are shared either with other practitioners, employers, organizations or research institutes. The result of the system evaluation shows that the average response time of 6seconds and 11.1 seconds for fingerprint and iris respectively after ten different simulations. The system protects privacy and confidentiality by limiting the amount of data exposed to users. The system also enables emergency medical technicians to gain easy and reliable access to necessary attributes of patients’ EHR while still maintaining the privacy and confidentiality of the data using the patient’s fingerprint and iris. Keywords: Electronic Health Record, Privacy, Biometric

Pervasive Technologies and Support for Independent Living

A broad range of pervasive technologies are used in many domains, including healthcare: however, there appears to be little work examining the role of such technologies in the home, or the different wants and needs of elderly users. Additionally, there exist ethical issues surrounding the use of highly personal healthcare-related data, and interface issues centred on the novelty of the technologies and the disabilities experienced by the users. This report examines these areas, before considering the ways in which they might come together to help support independent-living users with disabilities which may be age-related

Watching You: Systematic Federal Surveillance of Ordinary Americans

To combat terrorism, Attorney General John Ashcroft has asked Congress to "enhance" the government's ability to conduct domestic surveillance of citizens. The Justice Department's legislative proposals would give federal law enforcement agents new access to personal information contained in business and school records. Before acting on those legislative proposals, lawmakers should pause to consider the extent to which the lives of ordinary Americans already are monitored by the federal government. Over the years, the federal government has instituted a variety of data collection programs that compel the production, retention, and dissemination of personal information about every American citizen. Linked through an individual's Social Security number, these labor, medical, education and financial databases now empower the federal government to obtain a detailed portrait of any person: the checks he writes, the types of causes he supports, and what he says "privately" to his doctor. Despite widespread public concern about preserving privacy, these data collection systems have been enacted in the name of "reducing fraud" and "promoting efficiency" in various government programs. Having exposed most areas of American life to ongoing government scrutiny and recording, Congress is now poised to expand and universalize federal tracking of citizen life. The inevitable consequence of such constant surveillance, however, is metastasizing government control over society. If that happens, our government will have perverted its most fundamental mission and destroyed the privacy and liberty that it was supposed to protect

Applications of Automated Identification Technology in EHR/EMR

Although both the electronic health record (EHR) and the electronic medical record (EMR) store an individuals computerized health information and the terminologies are often used interchangeably, there are some differences between them. Three primary approaches in Automated Identification Technology (AIT) are barcoding, radio frequency identification (RFID), and biometrics. In this paper, technology intelligence, progress, limitations, and challenges of EHR/EMR are introduced. The applications and challenges of barcoding, RFID, and biometrics in EHR/EMR are presented respectively

Electronic Signatures in E-Healthcare: The Need for a Federal Standard

Healthcare, like many industries, is fast embracing the benefits of modern information technology ( IT ). The wide range of available publications on the use of IT in healthcare indicates that IT provides the promise of faster and more comprehensive information about all aspects of the healthcare delivery process, to all classes of its consumers - patients, doctors, nurses, insurance adjudicators, health inspectors, epidemiologists, and biostatisticians. But the drive towards electronic information in health care is not rooted merely in efficiency; more recently, significant emphasis has been placed on patient safety issues raised by the Institute of Medicine\u27s ( IOM ) year 2001 quality report on the subject. It is believed that the deficiencies indicated in that report can be substantially overcome by the use of IT in health care. However, to make this transition successful and complete, all aspects of health care delivery, information management, and business transactions, have to be logically migrated into the electronic world. This includes the function and use of the signature. The use of signatures in business contexts has traditionally provided two functions of legal significance: 1) evidence that can attribute documents to a particular party, and 2) indication of assent and intent that the documents have legal effect. In the recent decades, state and federal statutes have substantiated these functional attributes to digital or electronic signatures. Many of these statutes derive from model codes, such as the Uniform Electronic Transactions Act ( UETA ), that attempt to standardize use and technology surrounding electronic signatures. Subsequent sections will attempt to identify gaps in the standards which prevent true transaction portability. Lack of portability defeats one of the fundamental goals of health care IT solutions - improved efficiency. The discussion will end with a proposal for a uniform federal statutory scheme for standardized electronic signatures for health care

Implementation of a Biometric Screening Program and Wellness Coaching Program in a Hospital Employee Wellness Center

Background: Wellness programs are an emerging priority among organizations concerned about employee wellness and productivity. Data from Long Island Jewish Medical Center (LIJMC) revealed that in 2019 there were 1,690 employee visits to the ER due to chronic diseases; 30% were classified as ER sick visit and 40% of employees who visited the ER had no primary care provider. Many companies use biometric screening and health risk assessment to measure the health of their employees. The purpose of this improvement project was to implement a biometric screening program (BSP) that included wellness coaching to improve the health outcomes of LIJMC employees. Methods: Employees with known adverse biomarkers were invited to participate in the 12-week BSP program. Participants engaged in a baseline and exit assessment and six scheduled visits for wellness coaching. Evaluation: Biometric values (A1c, total cholesterol, systolic BP, BMI) and VPRA were compared pre (baseline) and post (12 weeks) to assess change and percent improvement. SES and CSQ scores were assessed pre and post program to assess participant and staff satisfaction with BSP program. Results: Pre-and post- mean biometric values demonstrated reductions in A1c (↓ 3.74%; goal ↓ 2%), systolic BP (↓ 11 mmHg; goal ↓ 10 mm Hg reduction), and BMI (↓1.59%; goal ↓ 5%). Pre/post measure of TC did not improve (↑ 0.62%; goal ↓5%). VPRA scores improved 10.22% at the end of 12 weeks. The VPRA pre heart score of 55 years old showed a reduced post heart score of 51 years old. The SES score shifted from an average pre-SES (92%) to average post-SES (98%). Overall, CSQ satisfaction scale scores indicated that 69% of participants rated the program as “excellent” and 31% reported it was “good”. Conclusion: Implementation of a biometric screening and wellness coaching program in an employee wellness program demonstrated improvements in most biomarkers as well as increased self-awareness and satisfaction. Results highlight the importance of biometric screening and wellness coaching to mitigate the epidemic of chronic diseases