Requirements for Integrating End-to-End Security into Large-Scale EHR Systems

Electronic Health Records (EHR) are becoming a growing trend in the healthcare industry. Especially when applied across healthcare organizations, EHRs provide benefits such as financial incentives and a more complete view of a patient’s history. However, they also face security issues regarding the confidentiality and privacy of the patients’ data, especially when the EHRs are stored at third-party providers or in the cloud. In general,confidentiality can be ensured by using cryptographic mechanisms or access control. Unfortunately, both techniques diminish the usability of the EHR if they are applied straightforwardly. Privacy and confidentiality have to be ensured in a way that does not restrict usability as it reduces the benefits of the EHR. This paper presents experiences from a requirements analysis we made during ongoing projects. We summarize the requirements for integrating end-to-end confidentiality into large-scale EHR systems in a usable fashion. In particular, show(i)which data granularity is useful to been crypted without interfering with access control, (ii) requirements for an authorization mechanism to access encrypted data, (iii) a privacy classification of typical metadata in EHRs, and (iv) interoperability issues that must be solved to allow for secure and usable EHR implementations.

[1]  Waegemann Cp.  The five levels of electronic health records. , 1996 .

[2]  Ruth Breu,et al.  A Security Infrastructure for Shared Electronic Health Records - Role Based Access Control as IHE XDS Extension towards End-to-end Security , 2007 .

[3]  Wouter Joosen,et al.  Hardening XDS-Based Architectures , 2008, 2008 Third International Conference on Availability, Reliability and Security.

[4]  R. Cross.  The Illinois Department of Public Health. , 1955 .

[5]  A. Boonstra,et al.  Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions , 2010, BMC health services research.

[6]  Sebastian Garde,et al.  Towards Semantic Interoperability for Electronic Health Records , 2007, Methods of Information in Medicine.

[7]  Noboru Sonehara,et al.  Aspects of privacy for electronic health records , 2011, Int. J. Medical Informatics.

[8]  Adam Bosworth,et al.  What it takes: characteristics of the ideal personal health record. , 2009, Health affairs.

[9]  Neal Leavitt,et al.  Internet Security under Attack: The Undermining of Digital Certificates , 2011, Computer.

[10]  David W. Bates,et al.  The use of health information technology in seven nations , 2008, Int. J. Medical Informatics.

[11]  D. Brailer.  Interoperability: the key to the future health care system. , 2005, Health affairs.

[12]  Dawn Xiaodong Song,et al.  On the Feasibility of Internet-Scale Author Identification , 2012, 2012 IEEE Symposium on Security and Privacy.

[13]  Robert Steele,et al.  Role-Based Access To Portable Personal Health Records , 2009, 2009 International Conference on Management and Service Science.

[14]  Björn Bergh,et al.  EHR access rights and the role of the patient , 2009 .

[15]  Paul Greenfield,et al.  A Decentralised Approach to Electronic Consent and Health Information Access Control , 2005, J. Res. Pract. Inf. Technol..

[16]  Daniel Slamanig,et al.  Privacy-enhancing methods for e-health applications: how to prevent statistical analyses and attacks , 2008, Int. J. Bus. Intell. Data Min..

[17]  Ahmad-Reza Sadeghi,et al.  Securing the e-health cloud , 2010, IHI.

[18]  Jan Marco Leimeister,et al.  Integration of Patient Health Portals into the German Healthcare Telematics Infrastructure , 2009, AMCIS.

[19]  Eric C. Pan,et al.  The value of health care information exchange and interoperability. , 2005, Health affairs.

[20]  Reihaneh Safavi-Naini,et al.  Privacy preserving EHR system using attribute-based infrastructure , 2010, CCSW '10.

[21]  Kaija Saranto,et al.  Definition, structure, content, use and impacts of electronic health records: A review of the research literature , 2008, Int. J. Medical Informatics.

[22]  Matthew Green,et al.  Securing electronic medical records using attribute-based encryption on mobile devices , 2011, SPSM '11.

[23]  Marcel Winandy.  A Note on the Security in the Card Management System of the German E-Health Card , 2010, eHealth.

[24]  C. A. Klein,et al.  Cloudy confidentiality: clinical and legal implications of cloud computing in health care. , 2011, The journal of the American Academy of Psychiatry and the Law.

[25]  Thomas Neubauer,et al.  Pseudonymization with Metadata Encryption for Privacy-Preserving Searchable Documents , 2012, 2012 45th Hawaii International Conference on System Sciences.

[26]  Craig Gentry,et al.  Fully homomorphic encryption using ideal lattices , 2009, STOC '09.