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

Authentication and authorisation in entrusted unions

This paper reports on the status of a project whose aim is to implement and demonstrate in a real-life environment an integrated eAuthentication and eAuthorisation framework to enable trusted collaborations and delivery of services across different organisational/governmental jurisdictions. This aim will be achieved by designing a framework with assurance of claims, trust indicators, policy enforcement mechanisms and processing under encryption to address the security and confidentiality requirements of large distributed infrastructures. The framework supports collaborative secure distributed storage, secure data processing and management in both the cloud and offline scenarios and is intended to be deployed and tested in two pilot studies in two different domains, viz, Bio-security incident management and Ambient Assisted Living (eHealth). Interim results in terms of security requirements, privacy preserving authentication, and authorisation are reported

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Blockchain leveraged decentralized IoT eHealth framework

Blockchain technologies recently emerging for eHealth, can facilitate a secure, decentral- ized and patient-driven, record management system. However, Blockchain technologies cannot accommodate the storage of data generated from IoT devices in remote patient management (RPM) settings as this application requires a fast consensus mechanism, care- ful management of keys and enhanced protocols for privacy. In this paper, we propose a Blockchain leveraged decentralized eHealth architecture which comprises three layers: (1) The Sensing layer –Body Area Sensor Networks include medical sensors typically on or in a patient body transmitting data to a smartphone. (2) The NEAR processing layer –Edge Networks consist of devices at one hop from data sensing IoT devices. (3) The FAR pro- cessing layer –Core Networks comprise Cloud or other high computing servers). A Patient Agent (PA) software replicated on the three layers processes medical data to ensure reli- able, secure and private communication. The PA executes a lightweight Blockchain consen- sus mechanism and utilizes a Blockchain leveraged task-offloading algorithm to ensure pa- tient’s privacy while outsourcing tasks. Performance analysis of the decentralized eHealth architecture has been conducted to demonstrate the feasibility of the system in the pro- cessing and storage of RPM data

Pursuing perspectives on ambient intelligence.

This paper takes a broad perspective on ambient, intelligent technologies in the context of contemporary European society at the turn of the 21st century. The underlying ideas and expectations of ambient intelligence in a period when Europe focuses progressively on the various social, economic, and ethical challenges facing the Information Society are discussed. The use of information and communication technologies in different organizational and economic settings are explored, with an illustrative focus on eHealth. It is particularly argued that more space, effort and facilities need to be created for a public social and ethical debate among European‟s citizens with regard to information and communication technologies development

Secure data sharing and processing in heterogeneous clouds

The extensive cloud adoption among the European Public Sector Players empowered them to own and operate a range of cloud infrastructures. These deployments vary both in the size and capabilities, as well as in the range of employed technologies and processes. The public sector, however, lacks the necessary technology to enable effective, interoperable and secure integration of a multitude of its computing clouds and services. In this work we focus on the federation of private clouds and the approaches that enable secure data sharing and processing among the collaborating infrastructures and services of public entities. We investigate the aspects of access control, data and security policy languages, as well as cryptographic approaches that enable fine-grained security and data processing in semi-trusted environments. We identify the main challenges and frame the future work that serve as an enabler of interoperability among heterogeneous infrastructures and services. Our goal is to enable both security and legal conformance as well as to facilitate transparency, privacy and effectivity of private cloud federations for the public sector needs. © 2015 The Authors

eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects

Background: The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth.Objective: This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders.Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018–2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation.Results: The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration.Conclusions: This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies

Towards fog-driven IoT eHealth:Promises and challenges of IoT in medicine and healthcare

Internet of Things (IoT) offers a seamless platform to connect people and objects to one another for enriching and making our lives easier. This vision carries us from compute-based centralized schemes to a more distributed environment offering a vast amount of applications such as smart wearables, smart home, smart mobility, and smart cities. In this paper we discuss applicability of IoT in healthcare and medicine by presenting a holistic architecture of IoT eHealth ecosystem. Healthcare is becoming increasingly difficult to manage due to insufficient and less effective healthcare services to meet the increasing demands of rising aging population with chronic diseases. We propose that this requires a transition from the clinic-centric treatment to patient-centric healthcare where each agent such as hospital, patient, and services are seamlessly connected to each other. This patient-centric IoT eHealth ecosystem needs a multi-layer architecture: (1) device, (2) fog computing and (3) cloud to empower handling of complex data in terms of its variety, speed, and latency. This fog-driven IoT architecture is followed by various case examples of services and applications that are implemented on those layers. Those examples range from mobile health, assisted living, e-medicine, implants, early warning systems, to population monitoring in smart cities. We then finally address the challenges of IoT eHealth such as data management, scalability, regulations, interoperability, device–network–human interfaces, security, and privacy

Design science research towards resilient cyber-physical eHealth systems

Most eHealth systems are cyber-physical systems (CPSs) making safety-critical decisions based on information from other systems not known during development. In this design science research, a conceptual resilience governance framework for eHealth CPSs is built utilizing 1) cybersecurity initiatives, standards and frameworks, 2) science of design for software-intensive systems and 3) empowering cyber trust and resilience. According to our study, a resilient CPS consists of two sub-systems: the proper resilient system and the situational awareness system. In a system of CPSs, three networks are composed: platform, software and social network. The resilient platform network is the basis on which information sharing between stakeholders could be created via software layers. However, the trust inside social networks quantifies the pieces of information that will be shared - and with whom. From citizens’ point of view, eHealth is wholeness in which requirements of information security hold true. Present procedures emphasize confidentiality at the expense of integrity and availability, and regulations/instructions are used as an excuse not to change even vital information. The mental-picture of cybersecurity should turn from “threat, crime, attack” to “trust” and “resilience”. Creating confidence in safe digital future is truly needed in the integration of the digital and physical world’s leading to a new digital revolution. The precondition for the exchange of information “trust” must be systematically built at every CPS’ level. In health sector, increasingly interconnected social, technical and economic networks create large complex CPSs, and risk assessment of many individual components becomes cost and time prohibitive. When no-one can control all aspects of CPSs, protection-based risk management is not enough to help prepare for and prevent consequences of foreseeable events, but resilience must be built into systems to help them quickly recover and adapt when adverse events do occur.Most eHealth systems are cyber-physical systems (CPSs) making safety-critical decisions based on information from other systems not known during development. In this design science research, a conceptual resilience governance framework for eHealth CPSs is built utilizing 1) cybersecurity initiatives, standards and frameworks, 2) science of design for software-intensive systems and 3) empowering cyber trust and resilience. According to our study, a resilient CPS consists of two sub-systems: the proper resilient system and the situational awareness system. In a system of CPSs, three networks are composed: platform, software and social network. The resilient platform network is the basis on which information sharing between stakeholders could be created via software layers. However, the trust inside social networks quantifies the pieces of information that will be shared - and with whom. From citizens’ point of view, eHealth is wholeness in which requirements of information security hold true. Present procedures emphasize confidentiality at the expense of integrity and availability, and regulations/instructions are used as an excuse not to change even vital information. The mental-picture of cybersecurity should turn from “threat, crime, attack” to “trust” and “resilience”. Creating confidence in safe digital future is truly needed in the integration of the digital and physical world’s leading to a new digital revolution. The precondition for the exchange of information “trust” must be systematically built at every CPS’ level. In health sector, increasingly interconnected social, technical and economic networks create large complex CPSs, and risk assessment of many individual components becomes cost and time prohibitive. When no-one can control all aspects of CPSs, protection-based risk management is not enough to help prepare for and prevent consequences of foreseeable events, but resilience must be built into systems to help them quickly recover and adapt when adverse events do occur