ICT in telemedicine: conquering privacy and security issues in health care services

Advancement in telecommunication combined with improved information technology infrastructures has opened up new dimensions in e-health environment. Such technologies make readily available to access, store, manipulate and replicate medical information and images. These technologies help reduced the time and effort in diagnoses and treatment at lower cost. However, protection and authentication of such medical information and images are now becoming increasingly important in telemedicine environment, where images are readily distributed over electronic networks. Intruders/hackers may gain access to confidential information and possible alter or even delete such vital records. The ultimate success of telemedicine demands an effective technology as well as privacy and security of records should be main concern. This paper explores recent identified privacy and security issues that affect telemedicine. Featuring threats on security and authentication of medical records, and proposing digital watermarking as a technology to curb authentication issues in telemedicine is highlighted

A Systematic Review on Image Data Protection Methods

Securing data is the main goal of any data security system (DSS). Valuable data must be protected all the time and stored in a very highly secure data storage device. This need has become more critical due to the continuous growth of data size.  Furthermore, non-text data in the form of images, audio, and videos can now be transferred and processed easily and thus become part of sensitive data that needs to be protected. Since there is a need to secure and protect data in any form in order to keep them private and valid, it is expected that there would be many attempts already that have been proposed in the literature for this purpose. This paper reviews a group of these proposed strategies and methods that have been applied to different kinds of DSSs. Challenges and future trends of DSSs are also discussed. A number of main findings are grouped and organized as follows: (1) there are many different kinds of security techniques, each of which offers varying degrees of performance in terms of the amount of data and information that can be managed securely, (2) depending on the architecture of the proposed method, the tactics or strategies of the security system, the kinds of DSSs, as well as a few other factors, some methods are more appropriate for the storage of certain categories of data than others

Design of a secure architecture for the exchange of biomedical information in m-Health scenarios

El paradigma de m-Salud (salud móvil) aboga por la integración masiva de las más avanzadas tecnologías de comunicación, red móvil y sensores en aplicaciones y sistemas de salud, para fomentar el despliegue de un nuevo modelo de atención clínica centrada en el usuario/paciente. Este modelo tiene por objetivos el empoderamiento de los usuarios en la gestión de su propia salud (p.ej. aumentando sus conocimientos, promocionando estilos de vida saludable y previniendo enfermedades), la prestación de una mejor tele-asistencia sanitaria en el hogar para ancianos y pacientes crónicos y una notable disminución del gasto de los Sistemas de Salud gracias a la reducción del número y la duración de las hospitalizaciones. No obstante, estas ventajas, atribuidas a las aplicaciones de m-Salud, suelen venir acompañadas del requisito de un alto grado de disponibilidad de la información biomédica de sus usuarios para garantizar una alta calidad de servicio, p.ej. fusionar varias señales de un usuario para obtener un diagnóstico más preciso. La consecuencia negativa de cumplir esta demanda es el aumento directo de las superficies potencialmente vulnerables a ataques, lo que sitúa a la seguridad (y a la privacidad) del modelo de m-Salud como factor crítico para su éxito. Como requisito no funcional de las aplicaciones de m-Salud, la seguridad ha recibido menos atención que otros requisitos técnicos que eran más urgentes en etapas de desarrollo previas, tales como la robustez, la eficiencia, la interoperabilidad o la usabilidad. Otro factor importante que ha contribuido a retrasar la implementación de políticas de seguridad sólidas es que garantizar un determinado nivel de seguridad implica unos costes que pueden ser muy relevantes en varias dimensiones, en especial en la económica (p.ej. sobrecostes por la inclusión de hardware extra para la autenticación de usuarios), en el rendimiento (p.ej. reducción de la eficiencia y de la interoperabilidad debido a la integración de elementos de seguridad) y en la usabilidad (p.ej. configuración más complicada de dispositivos y aplicaciones de salud debido a las nuevas opciones de seguridad). Por tanto, las soluciones de seguridad que persigan satisfacer a todos los actores del contexto de m-Salud (usuarios, pacientes, personal médico, personal técnico, legisladores, fabricantes de dispositivos y equipos, etc.) deben ser robustas y al mismo tiempo minimizar sus costes asociados. Esta Tesis detalla una propuesta de seguridad, compuesta por cuatro grandes bloques interconectados, para dotar de seguridad a las arquitecturas de m-Salud con unos costes reducidos. El primer bloque define un esquema global que proporciona unos niveles de seguridad e interoperabilidad acordes con las características de las distintas aplicaciones de m-Salud. Este esquema está compuesto por tres capas diferenciadas, diseñadas a la medidas de los dominios de m-Salud y de sus restricciones, incluyendo medidas de seguridad adecuadas para la defensa contra las amenazas asociadas a sus aplicaciones de m-Salud. El segundo bloque establece la extensión de seguridad de aquellos protocolos estándar que permiten la adquisición, el intercambio y/o la administración de información biomédica -- por tanto, usados por muchas aplicaciones de m-Salud -- pero no reúnen los niveles de seguridad detallados en el esquema previo. Estas extensiones se concretan para los estándares biomédicos ISO/IEEE 11073 PHD y SCP-ECG. El tercer bloque propone nuevas formas de fortalecer la seguridad de los tests biomédicos, que constituyen el elemento esencial de muchas aplicaciones de m-Salud de carácter clínico, mediante codificaciones novedosas. Finalmente el cuarto bloque, que se sitúa en paralelo a los anteriores, selecciona herramientas genéricas de seguridad (elementos de autenticación y criptográficos) cuya integración en los otros bloques resulta idónea, y desarrolla nuevas herramientas de seguridad, basadas en señal -- embedding y keytagging --, para reforzar la protección de los test biomédicos.The paradigm of m-Health (mobile health) advocates for the massive integration of advanced mobile communications, network and sensor technologies in healthcare applications and systems to foster the deployment of a new, user/patient-centered healthcare model enabling the empowerment of users in the management of their health (e.g. by increasing their health literacy, promoting healthy lifestyles and the prevention of diseases), a better home-based healthcare delivery for elderly and chronic patients and important savings for healthcare systems due to the reduction of hospitalizations in number and duration. It is a fact that many m-Health applications demand high availability of biomedical information from their users (for further accurate analysis, e.g. by fusion of various signals) to guarantee high quality of service, which on the other hand entails increasing the potential surfaces for attacks. Therefore, it is not surprising that security (and privacy) is commonly included among the most important barriers for the success of m-Health. As a non-functional requirement for m-Health applications, security has received less attention than other technical issues that were more pressing at earlier development stages, such as reliability, eficiency, interoperability or usability. Another fact that has contributed to delaying the enforcement of robust security policies is that guaranteeing a certain security level implies costs that can be very relevant and that span along diferent dimensions. These include budgeting (e.g. the demand of extra hardware for user authentication), performance (e.g. lower eficiency and interoperability due to the addition of security elements) and usability (e.g. cumbersome configuration of devices and applications due to security options). Therefore, security solutions that aim to satisfy all the stakeholders in the m-Health context (users/patients, medical staff, technical staff, systems and devices manufacturers, regulators, etc.) shall be robust and, at the same time, minimize their associated costs. This Thesis details a proposal, composed of four interrelated blocks, to integrate appropriate levels of security in m-Health architectures in a cost-efcient manner. The first block designes a global scheme that provides different security and interoperability levels accordingto how critical are the m-Health applications to be implemented. This consists ofthree layers tailored to the m-Health domains and their constraints, whose security countermeasures defend against the threats of their associated m-Health applications. Next, the second block addresses the security extension of those standard protocols that enable the acquisition, exchange and/or management of biomedical information | thus, used by many m-Health applications | but do not meet the security levels described in the former scheme. These extensions are materialized for the biomedical standards ISO/IEEE 11073 PHD and SCP-ECG. Then, the third block proposes new ways of enhancing the security of biomedical standards, which are the centerpiece of many clinical m-Health applications, by means of novel codings. Finally the fourth block, with is parallel to the others, selects generic security methods (for user authentication and cryptographic protection) whose integration in the other blocks results optimal, and also develops novel signal-based methods (embedding and keytagging) for strengthening the security of biomedical tests. The layer-based extensions of the standards ISO/IEEE 11073 PHD and SCP-ECG can be considered as robust, cost-eficient and respectful with their original features and contents. The former adds no attributes to its data information model, four new frames to the service model |and extends four with new sub-frames|, and only one new sub-state to the communication model. Furthermore, a lightweight architecture consisting of a personal health device mounting a 9 MHz processor and an aggregator mounting a 1 GHz processor is enough to transmit a 3-lead electrocardiogram in real-time implementing the top security layer. The extra requirements associated to this extension are an initial configuration of the health device and the aggregator, tokens for identification/authentication of users if these devices are to be shared and the implementation of certain IHE profiles in the aggregator to enable the integration of measurements in healthcare systems. As regards to the extension of SCP-ECG, it only adds a new section with selected security elements and syntax in order to protect the rest of file contents and provide proper role-based access control. The overhead introduced in the protected SCP-ECG is typically 2{13 % of the regular file size, and the extra delays to protect a newly generated SCP-ECG file and to access it for interpretation are respectively a 2{10 % and a 5 % of the regular delays. As regards to the signal-based security techniques developed, the embedding method is the basis for the proposal of a generic coding for tests composed of biomedical signals, periodic measurements and contextual information. This has been adjusted and evaluated with electrocardiogram and electroencephalogram-based tests, proving the objective clinical quality of the coded tests, the capacity of the coding-access system to operate in real-time (overall delays of 2 s for electrocardiograms and 3.3 s for electroencephalograms) and its high usability. Despite of the embedding of security and metadata to enable m-Health services, the compression ratios obtained by this coding range from ' 3 in real-time transmission to ' 5 in offline operation. Complementarily, keytagging permits associating information to images (and other signals) by means of keys in a secure and non-distorting fashion, which has been availed to implement security measures such as image authentication, integrity control and location of tampered areas, private captioning with role-based access control, traceability and copyright protection. The tests conducted indicate a remarkable robustness-capacity tradeoff that permits implementing all this measures simultaneously, and the compatibility of keytagging with JPEG2000 compression, maintaining this tradeoff while setting the overall keytagging delay in only ' 120 ms for any image size | evidencing the scalability of this technique. As a general conclusion, it has been demonstrated and illustrated with examples that there are various, complementary and structured manners to contribute in the implementation of suitable security levels for m-Health architectures with a moderate cost in budget, performance, interoperability and usability. The m-Health landscape is evolving permanently along all their dimensions, and this Thesis aims to do so with its security. Furthermore, the lessons learned herein may offer further guidance for the elaboration of more comprehensive and updated security schemes, for the extension of other biomedical standards featuring low emphasis on security or privacy, and for the improvement of the state of the art regarding signal-based protection methods and applications

Mobile-based Telemedicine Application using SVD and F-XoR Watermarking for Medical Images

منصة الخدمات الطبية عبارة عن تطبيق متنقل يتم من خلاله تزويد المرضى بتشخيصات الأطباء بناءً على المعلومات المستقاة من الصور الطبية. يجب ألا يتم تبديل محتوى هذه النتائج التشخيصية بشكل غير قانوني أثناء النقل ويجب إعادته إلى المريض الصحيح. في هذه المقالة، نقدم حلاً لهذه المشكلات باستخدام علامة مائية عمياء وقابلة للانعكاس وهشة استنادًا إلى مصادقة صورة المضيف. في الخوارزمية المقترحة، يتم استخدام الإصدار الثنائي من ترميز بوس_شوهوري _هوكوينجهام (BCH) للتقرير الطبي للمريض (PMR) والصورة الطبية الثنائية للمريض (PMI) بعد استخدام الغامض الحصري أو (F-XoR) لإنتاج العلامة الفريدة للمريض باستخدام مخطط المشاركة السرية (SSS). يتم استخدامه لاحقًا كعلامة مائية ليتم تضمينها في مضيف (PMI) باستخدام خوارزمية تحليل القيمة المفرد (SVD) العمياء القائمة على العلامة المائية. وهو حل جديد اقترحناه أيضًا بتطبيق SVD على صورة العلامة المائية العمياء. تحافظ الخوارزمية الخاصة بنا على مصادقة محتوى (PMI) أثناء النقل وملكية (PMR) للمريض لنقل التشخيص المصاحب فيما بعد إلى المريض الصحيح عبر تطبيق التطبيب عن بعد المحمول. يستخدم تقييم الخوارزمية لدينا علامات مائية مسترجعة توضح النتائج الواعدة لمقاييس الأداء العالية مقارنتا مع نتائج الاعمال السابقة في مقاييس الكشف عن التزوير وإمكانية الاسترداد الذاتي، مع قيمة 30NB PSNR، قيمة NC هي 0.99.A medical- service platform is a mobile application through which patients are provided with doctor’s diagnoses based on information gleaned from medical images. The content of these diagnostic results must not be illegitimately altered during transmission and must be returned to the correct patient. In this paper, we present a solution to these problems using blind, reversible, and fragile watermarking based on authentication of the host image. In our proposed algorithm, the binary version of the Bose_Chaudhuri_Hocquengham (BCH) code for patient medical report (PMR) and binary patient medical image (PMI) after fuzzy exclusive or (F-XoR) are used to produce the patient's unique mark using secret sharing schema (SSS). The patient’s unique mark is used later as a watermark to be embedded into host PMI using blind watermarking-based singular value decomposition (SVD) algorithm. This is a new solution that we also proposed to applying SVD into a blind watermarking image. Our algorithm preserves PMI content authentication during the transmission and PMR ownership to the patient for subsequently transmitting associated diagnosis to the correct patient via a mobile telemedicine application. The performance of experimental results is high compare to previous results, uses recovered watermarks demonstrating promising results in the tamper detection metrics and self-recovery capability, with 30db PSNR, NC value is 0.99

Copyright Protection of Color Imaging Using Robust-Encoded Watermarking

In this paper we present a robust-encoded watermarking method applied to color images for copyright protection, which presents robustness against several geometric and signal processing distortions. Trade-off between payload, robustness and imperceptibility is a very important aspect which has to be considered when a watermark algorithm is designed. In our proposed scheme, previously to be embedded into the image, the watermark signal is encoded using a convolutional encoder, which can perform forward error correction achieving better robustness performance. Then, the embedding process is carried out through the discrete cosine transform domain (DCT) of an image using the image normalization technique to accomplish robustness against geometric and signal processing distortions. The embedded watermark coded bits are extracted and decoded using the Viterbi algorithm. In order to determine the presence or absence of the watermark into the image we compute the bit error rate (BER) between the recovered and the original watermark data sequence. The quality of the watermarked image is measured using the well-known indices: Peak Signal to Noise Ratio (PSNR), Visual Information Fidelity (VIF) and Structural Similarity Index (SSIM). The color difference between the watermarked and original images is obtained by using the Normalized Color Difference (NCD) measure. The experimental results show that the proposed method provides good performance in terms of imperceptibility and robustness. The comparison among the proposed and previously reported methods based on different techniques is also provided

Ensuring the security and privacy of information in mobile health-care communication systems

The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information

Biometric Security Through Visual Encryption for Fog Edge Computing

Fog and mobile edge computing have gained considerable attention from the research and development community. The problems related to security and privacy of biometric content are simpler to solve through edge computing resulting in improved security and privacy of biometric and other critically private information. Zero-watermarking has been proposed as a solution to help protect the ownership of multimedia content that is easy to copy and distribute. Visual cryptography is another approach to secure data that is to be shared through generating multiple shares. This paper is concerned with developing a biometric security solution for face images, using visual cryptography and zero-watermarking, that does not adversely impact the visual quality of the image. The original face image is not modified through the zero-watermarking and visual encryption procedures and this in turn does not adversely impact the recognition rate