Towards Secure Interoperability of EHR among Healthcare Organizations in Palestine

Technological development in the e-health field helps to facilitate and enhance healthcare, and improve treatment quality. Different public and private healthcare facilities in Palestine employ different health information systems; consequently, sharing health information has become more challenging and complex. In this paper, the researchers firstly investigate the current status of Electronic Health Records (EHR) in Palestine and the readiness of the various healthcare centers to foster the interoperability of EHRs. Secondly, the researchers propose a secure framework that might be used to deploy interoperability among healthcare centers. The mixed method approach was used to achieve the objectives of the research. Interviews were conducted with IT managers, and questionnaires were distributed to 331 out of 2350 personnel employed in five Palestinian hospitals. The findings of quantitative and qualitative studies show that there is no electronic exchange of EHRs between private and public healthcare facilities, and they highlight the necessity of putting interoperability into practice to enhance the quality of healthcare in Palestine and keep up with global advancements in health technology. Based on these findings, the researchers propose a technical framework for interoperability in Palestine using UXP/ X-Road, to securely and effectively share EHRs among healthcare centers

Privacy aware collaborative traffic monitoring via anonymous access and autonomous location update mechanism

Collaborative Traffic Monitoring, CTM, systems collect information from users in the aim of generating a global picture of traffic status. Users send their location information including speed and directions, and in return they get reports about traffic in certain regions. There are two major approaches for the deployment of CTM systems. The first approach relies on dedicated communication infrastructure (DI). This approach is still being investigated by researchers and there is no important deployments done yet. The other approach utilizes existing communication infrastructures (EI) such as Wi-Fi, GSM, and GPRS for communication between users and traffic server. Due to the sensitivity of location information, different privacy preserving techniques have been proposed for both DI and EI approaches. In DI approach the concentration was on anonymous access using pseudonyms. In EI approach privacy techniques concentrate on hiding the identity of a particular user within other k-1 users at the same region or time stamp by using cloaking. Cloaking means generalization of location or time stamp so that other k-1 users will have the same generalized value. Unfortunately, cloaking decreases the quality of the data and requires a Trusted Third Party (TTP) to determine the cloaked region or cloaked time stamp. In this thesis, we propose a Privacy Aware Collaborative Traffic Monitoring System (PA-CTM) that considers the privacy and security properties of VANETs and existing infrastructures. PA-CTM provides a client server architecture that relies on existing infrastructures and enhances privacy by (1) Using a robust Collusion Resistant Pseudonym Providing System, CoRPPS, for anonymous access. Users are able to change their pseudonyms and hence hide their complete trajectory information form traffic server; (2) Utilizing a novel Autonomous Location Update Mechanism, ALUM, that does not rely on a Trusted Third Party and uses only local parameters (speed and direction) for triggering a location update or pseudonym change. Our performance results showed that CoRPPS provides a high level of anonymity with strong resistant against collusion attacks. Performance results also showed that ALUM is effective for traffic monitoring in terms of both privacy and utility

Flexible fair and collusion resistant pseudonym providing system

In service providing systems, user authentication is required for different purposes such as billing, restricting unauthorized access, etc., to protect the privacy of users, their real identities should not be linked to the services that they use during authentication. A good solution is to use pseudonyms as temporary identities. On the other hand, it may also be required to have a backdoor in pseudonym systems for identity revealing that can be used by law enforcement agencies for legal reasons. Existing systems that retain a backdoor are either punitive (full user anonymity is revealed), or they are restrictive by revealing only current pseudonym identity of. In addition to that, existing systems are designed for a particular service and may not fit into others. In this paper, we address this gap and we propose a novel pseudonym providing and management system. Our system is flexible and can be tuned to fit into services for different service providers. The system is privacy-preserving and guarantees a level of anonymity for a particular number of users. Trust in our system is distributed among all system entities instead of centralizing it into a single trusted third party. More importantly, our system is highly resistant to collusions among the trusted entities. Our system also has the ability to reveal user identity fairly in case of a request by law enforcement. Analytical and simulation based performance evaluation showed that Collusion Resistant Pseudonym Providing System (CoRPPS) provides high level of anonymity with strong resistance against collusion attacks

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

P2-CTM: privacy preserving collaborative traffic monitoring

Collaborative Traffic Monitoring (CTM) systems exploit the location information continuously collected from cars. Users collaborate by providing their location information to have a global picture of the current traffic in real-time. However, location is very sensitive information. Therefore, privacy is a major obstacle for the widespread usage of CTM systems. In this paper, we present our position for a novel system addressing the security and especially privacy problems of CTM systems. Existing CTM solutions generally use two different methodologies. The first one is the dedicated infrastructure approach, also called VANETs (Vehicular Ad Hoc Networks), where a dedicated infrastructure for communication is deployed. The second methodology utilizes existing wireless networks, such as GSM, GPRS, EDGE, UMTS and Wi-Fi. Our P2-CTM (Privacy Preserving CTM) approach combines the best parts of these two existing approaches. In order to address the privacy challenge in CTM systems, we propose a privacy preserving location update mechanism that meets the requirements of both traffic monitoring and map generation. A privacy metric is adopted to evaluate the location update mechanism. We also discuss the performance issues regarding the location update mechanism. We aim to have a sound indication for our system from the points of view of privacy, security and performance