Securing Patient-Centric Personal Health Records Sharing System in Cloud Computing

Personal health record （PHR） enables patients to manage their own electronic medical records （EMR） in a centralized way, and it is oRen outsourced to be stored in a third-party server. In this paper we propose a novel secure and scalable system for sharing PHRs. We focus on the multiple data owner scenario, and divide the users in the system into multiple security domains that greatly reduce the key management complexity for owners and users. A high degree of patient privacy is guaranteed by exploiting hierarchical and multi- authority attribute-sets based encryption （HM- ASBE）. Our system not only supports compound attributes due to flexible attribute sets combinations, but also achieves fine-grained access control. Our scheme supports efficient on-demand user/attribute revocation and break-glass access under emergency scenarios.

Fog-Based Secure Framework for Personal Health Records Systems

The rapid development of personal health records(PHR)systems enables an individual to collect,create,store and share his PHR to authorized entities.Health care systems within the smart city environment require a patient to share his PRH data with a multitude of institutions’repositories located in the cloud.The cloud computing paradigm cannot meet such a massive transformative healthcare systems due to drawbacks including network latency,scalability and bandwidth.Fog computing relieves the load of conventional cloud computing by availing intermediate fog nodes between the end users and the remote servers.Assuming a massive demand of PHR data within a ubiquitous smart city,we propose a secure and fog assisted framework for PHR systems to address security,access control and privacy concerns.Built under a fog-based architecture,the proposed framework makes use of efficient key exchange protocol coupled with ciphertext attribute based encryption(CP-ABE)to guarantee confidentiality and fine-grained access control within the system respectively.We also make use of digital signature combined with CP-ABE to ensure the system authentication and users privacy.We provide the analysis of the proposed framework in terms of security and performance.

BC-PC-Share:Blockchain-Based Patient-Centric Data Sharing Scheme for PHRs in Cloud Computing

Sharing of personal health records(PHR)in cloud computing is an essential functionality in the healthcare system.However,how to securely,efficiently and flexibly share PHRs data of the patient in a multi-receiver setting has not been well addressed.For instance,since the trust domain of the cloud server is not identical to the data owner or data user,the semi-trust cloud service provider may intentionally destroy or tamper shared PHRs data of user or only transform partial ciphertext of the shared PHRs or even return wrong computation results to save its storage and computation resource,to pursue maximum economic interest or other malicious purposes.Thus,the PHRs data storing or sharing via the cloud server should be performed with consistency and integrity verification.Fortunately,the emergence of blockchain technology provides new ideas and prospects for ensuring the consistency and integrity of shared PHRs data.To this end,in this work,we leverage the consortiumblockchain technology to enhance the trustworthiness of each participant and propose a blockchain-based patient-centric data sharing scheme for PHRs in cloud computing(BC-PC-Share).Different from the state-of-art schemes,our proposal can achieve the following desired properties:(1)Realizing patient-centric PHRs sharing with a public verification function,i.e.,which can ensure that the returned shared data is consistent with the requested shared data and the integrity of the shared data is not compromised.(2)Supporting scalable and fine-grained access control and sharing of PHRs data with multiple domain users,such as hospitals,medical research institutes,and medical insurance companies.(3)Achieving efficient user decryption by leveraging the transformation key technique and efficient user revocation by introducing time-controlled access.The security analysis and simulation experiment demonstrate that the proposed BC-PC-Share scheme is a feasible and promising solution for PHRs data sharing via consortium blockchain.

基于个人健康记录的全程管理模式干预对老年糖尿病患者的效果评价

目的 分析基于个人健康记录(PHR)的全程管理模式干预对老年糖尿病患者认知水平、心理痛苦、自我管理行为、生活质量及血糖、血脂的影响。方法 将100例老年糖尿病患者按照随机数字表法分成常规组和干预组,各50例。常规组患者采用常规管理措施进行干预,干预组患者采用基于PHR的糖尿病全程管理模式进行干预。两组患者均干预6个月,各失访1例,最后分别纳入49例患者。干预前后采用自制糖尿病认知问卷、糖尿病痛苦量表(DDS)、糖尿病患者自我管理行为量表(SDSCA)、生存质量特异性量表(DSQL)评定两组患者认知水平、心理痛苦、自我管理行为、生存质量,比较干预前后两组患者血糖、血脂水平。结果 干预后,两组患者糖尿病认知水平均优于干预前,且干预组优于常规组(P<0.01)。干预后,两组患者DDS、DSQL各维度评分均低于干预前,且干预组低于常规组(P<0.05或0.01);两组患者SDSCA各维度评分均高于干预前,且干预组高于常规组(P<0.05或0.01)。干预后,两组患者空腹血糖、糖化血红蛋白、餐后2 h血糖、总胆固醇、低密度脂蛋白、三酰甘油水平均低于干预前,且干预组低于常规组(P<0.01);高密度脂蛋白水平高于干预前,且干预组高于常规组(P<0.01)。结论 基于PHR的糖尿病全程管理模式不仅有助于提升老年糖尿病患者的认知水平,缓解其心理痛苦,增强患者自我管理行为,提升患者生存质量,还能够改善老年糖尿病患者的糖脂控制情况。

改进的HABE算法在基于雾计算的PHR系统中的研究

私人健康记录(PHR)系统基于云计算提供个性化的私人健康服务。利用雾计算技术可使PHR系统获得更好的移动化支持,但海量的雾设备对病人隐私也造成了巨大的威胁,因此急需一套严格的数据保护与访问权限控制方案。结合密文定长机制和外包解密机制,提出了一种支持外包解密的等级化属性加密(OHABE-CC)算法。首先采用等级化的属性权威提高方案可扩展性,使之适用于雾计算的动态环境,其次任何PHR明文经过加密都会转换成固定长度的密文。通过外包解密机制,用户仅需通过极少的计算就可以解密PHR密文。基于q-DBDH困难假设,证明了该算法满足IND-RCCA2安全性。功能与解密效率分析表明,该算法相比其他现有算法更加适用于基于雾计算的PHR系统。

基于区块链的可代理健康档案访问方案

将区块链作为数据存储平台的个人健康档案安全访问方案是当下研究的热点。区块链上数据不可篡改的特点,有效保证了数据的安全。因此基于区块链的特性,提出一种基于区块链的个人健康档案安全访问方案,在该方案中,患者提前将其个人健康档案的访问权限授予代理签名者,授权信息存储在代理签名者所属的授权机构私有链中,确保在患者不可控的情况下,医生仍可以对其个人健康档案进行正常访问。该方案满足不可抵赖性和不可伪造性,且具有较高的安全性和较低的运算量。

医疗云平台中个人健康档案转诊时的安全共享方案

为解决医疗云平台共享个人健康档案(personal health record,PHR)存在的隐私泄露和加解密效率不理想的问题,以医疗云平台中帕金森病患者的转诊场景为例,提出了一种基于线性秘密共享的改进密文属性代理重加密方案(improved linear secret sharing based ciphertext attribute proxy re-encryption scheme,LCPS)。该方案利用线性秘密共享技术来隐藏访问策略中的隐私属性,降低因访问策略暴露引发的隐私泄露风险;该方案还对代理重加密算法进行改进,通过减少复杂的双线性运算,提高了加解密效率。结果表明,LCPS在加解密方面的表现要优于其他方案。在判定性q-BDHE(q-decisional bilinear Diffie-Hellman exponent)困难假设下具有选择明文攻击时的不可区分性(indistinguishability under chosen-plaintext attack,IND-CPA)。该方案具有可移植性,同样适用于医疗云中其他病症转诊时的个人健康档案安全共享。

基于超级帐本和手指静脉的PHR共享方案

当前个人健康记录(PHR:Personal Health Records)存在着存储不安全和难以共享的问题。为提高PHR的安全性和共享性,提出一种基于超级帐本(Hyperledger)和手指静脉(FV:Finger Vein)特征身份验证的安全共享模型。PHR提供方在录入医疗记录时将FV特征与临床医生的私钥签名结合,生成PHR索引。然后将PHR的索引存储在Hyperledger Fabric中,将真正的隐私数据存储在Filecoin中,减少了存储成本和链上存储压力。同时,设计了PHR访问控制合约防止恶意节点攻击。实验结果表明,该模型在性能和存储上有显著的优势。

适用于PHR系统的混合属性加密签名方案

PHR系统可以用于个人身体健康信息的交互,但信息的存储往往需要一个第三方服务器,这给用户的隐私信息安全带来了隐患。同时,现有PHR系统仅考虑到服务器的存储优势,并没有考虑到其计算优势。为了有效保护用户个人隐私,提高用户计算效率,文章提出了一个密文策略的外包混合属性加密签名方案,方案结合属性签名隐私保护以及属性加密访问控制的功能,为消息提供机密性、不可伪造性和匿名性,其密钥生成代价小于属性签名与属性加密的简单组合。该方案将接收方大部分的存储和验证以及解密算法中所有的双线性对运算交由云服务器执行,用户只需执行指数运算,有效地节约了用户本地资源。

支持细粒度权限控制且可搜索的PHR云服务系统

随着云存储技术的不断发展,将个人健康记录(personal health records,PHR)信息外包给云服务器获得了人们极大的关注.PHR外包不仅给病人带来了极大的便利,而且实现了各医疗机构之间数据的高效共享.然而,随着将个人敏感信息上传至云服务器,数据拥有者以及使用者个人身份信息的泄露等一些安全担忧也随之出现.基于匿名的属性加密方案不仅可以保证云端数据的安全,而且能够有效保护数据使用者的个人身份信息.已有工作都着眼于保证数据内容安全和基本的访问控制,却很少关注文件的细粒度权限控制.提出的方案不仅实现了基于关键字容错的云端密文搜索,而且通过赋予云端数据不同的特权,实现了对文件的细粒度权限控制,只有那些被赋予了相应特权的数据用户才能对云端数据作相应的权限操作.最后,安全性分析表明该方案是安全的.

E-Health and Telemedicine: Current State and Future Steps

The article reviews the questions related to building the e-health systems. The key element of the system is electronic healthcare record to be formed according to the modular approach in the form of primary and satellite electronic medical records. Person-centred healthcare is proposed as a foundation for e-health. Such an approach provides a potential opportunity for all the medical doctors to obtain necessary information about their patients at any time via the teleconsultations in particular. Transition to e-health is associated with the creation of new opportunities for making diagnostic and therapeutic decisions based on the use of build-in decision support modules. The computer-assisted software design or hybrid systems are considered as the fourth generation medical information systems. It is reasonable to implement the entire information space of e-health, including the information systems of medical institutions and regional data repositories, based on cloud-optimized storage and computing solutions. This approach is expected to be implemented in Russia as a part of the unified state health information system. The authorized access to integrated databases for medical doctors of various specialties is required. In the framework of e-health, telemedicine is considered as an important component. Main elements comprise the real-time access of medical consultants to personified medical databases and remote follow-up of patients by the means of personal or home-based telemedicine. The use of personal portable devices for the control of vital signs of the organism is especially promising. Electronic stethoscopes and specialized video cameras for acquiring objective information should be increasingly used by remote consultants. Unfortunately, this trend is still underdeveloped in Russia. In perspective, e-health as unified medical space will provide a transition to the integrated analysis of population health by medical doctors of various specialties from different countries and will open new prospects for studying health based on the intelligent analysis of integrated data of patients.

Reported National Level Stock-Outs of Home-Based Records—A Quiet Problem for Immunization Programmes That Needs Attention

Home-based records (HBRs) are an important tool for recording and communicating within primary healthcare service delivery. Unfortunately, HBRs are currently unable to fulfil their intended purpose in many communities either because the HBR is not functionally well-designed to serve its objectives, not made available, not fully adopted and/or not appropriately utilized by caregivers and/or health workers. This brief report describes the occurrence of nationally reported HBR stock-outs and HBR financing patterns during 2014 and 2015 across 195 countries reporting immunization system performance data to the World Health Organization and United Nations Children’s Fund. National level HBR stock-outs were reported by 19 and 22 countries during 2014 and 2015, respectively, with eleven countries reporting stock-outs during both 2014 and 2015. During 2015, 12 of the 22 countries reporting HBR stock-outs were from the African Region and two-thirds of the countries were Gavi-eligible. Information on HBR stock-outs was either not available or not reported by 66 countries (19 were Gavi-eligible) for 2014 and 53 (11 were Gavi-eligible) countries for 2015. Among the 22 countries reporting HBR stock-outs in 2015, 12 (54%) countries reported a single HBR financing source, and nine (41%) countries reported more than one source for HBR financing. The occurrence of HBR stock-outs remains a concern, particularly in Gavi-eligible countries introducing new vaccines where dedicated funding is received for revising and printing new recording tools, including HBRs. Additional attention is needed to understand the root causes for stock-outs and identify solutions to ensure a well-designed, durable HBR is readily available in the right quantity, in the right place at the right time in all countries.

An Efficient Blockchain-Based Healthcare System Using Artificial Intelligence

Personal health records and electronic health records are considered as the most sensitive information in the healthcare domain.Several solutions have been provided for implementing the digital health system using blockchain,but there are several challenges,such as secure access control and privacy is one of the prominent issues.Hence,we propose a novel framework and implemented an attribute-based access control system using blockchain.Moreover,we have also integrated artificial intelligence(AI)based approach to identify the behavior and activity for security reasons.The current methods only focus on the related clinical records received from a medical diagnosis.Moreover,existing methods are too inflexible to resourcefully sustenance metadata changes.A secure patient data access framework is proposed in this research,integrating blockchain,trust chain,and blockchain methods to overcome these problems in the literature for sharing and accessing digital healthcare data.We have used a neural network and classifier to categorize the user access to our proposed system.Our proposed scheme provides an intelligent and secure blockchain-based access control system in the digital healthcare system.Experimental results surpass the existing solutions by collecting attributes such as the number of transactions,number of nodes,transaction delay,block creation,and signature verification time.

基于患者门户系统建立的个人电子健康记录和慢性病管理平台对高血压患者自我管理能力、生活质量的影响

目的 探讨基于患者门户系统(PPS)的个人电子健康记录(PHR)和慢性病管理平台对高血压患者自我管理能力、生活质量的影响。方法 选取2022年1月至2022年6月我院出院的高血压患者313例,采用随机数字表法分为研究组155例与对照组158例。对照组进行常规出院办理和随访,研究组基于PPS的PHR和慢性病管理平台进行出院办理和随访。管理3个月和6个月后比较两组的自我管理能力、生活质量、管理效果和满意度。结果 管理3、6个月后,研究组的合伙人健康量表(PIH)评分低于对照组,健康状况调查简表(SF-36)评分高于对照组(P<0.05);患者急诊和再入院次数、患者折返医院办理线下业务的次数均低于对照组(P<0.05);服药依从率81.29%高于对照组69.62%(P<0.05);并发症发生率6.45%低于对照组13.29%(P<0.05);满意度评分也高于对照组(P<0.05)。结论 基于PPS的PHR和慢性病管理平台增加高血压患者的就医便利性,提高自我管理能力,改善生活质量,慢病管理效果良好。

外部支持如何影响个人健康记录管理——以血友病群体为例

个人健康记录对提高罕见病群体治疗效果和患者生活质量具有重要价值。但是,目前有关外部支持如何影响罕见病群体个人健康记录管理的研究较为缺失。文章选择血友病群体作为研究对象,采用问卷调查法,以滚雪球抽样的方式调查168位患者形成、保存和整理个人健康记录的行为,并且通过线性回归和逻辑回归模型分析制度性和社会性支持因素对血友病群体个人健康记录管理行为的影响。研究表明,血友病患者群体的个人健康记录管理水平总体较低,来自医疗机构、公益组织的制度性支持有助于提高患者群体保存个人健康记录的可能性,来自家人、病友的社会性支持则有助于提高信息组织的程度。

个人健康信息管理研究初探

本文对美国、加拿大、澳大利亚和英国的个人健康信息管理的现状和实践进行了研究,在对国内外个人健康信息管理研究的基础上,分析了我国个人健康信息管理实践中存在的问题,并根据我国的国情,提出了完善个人健康信息管理的若干对策。

个人健康记录云管理系统中支持用户撤销的细粒度访问控制

随着云计算的发展,越来越多的用户在使用个人健康记录(PHR)云管理系统,由于PHR包含了患者的隐私信息,因此一般在将PHR上传到云平台之前会先对其进行加密。基于比较的加密(CBE)在基于属性的访问策略中实现了时间比较,然而CBE加密时间与访问策略中的属性数目线性增长,从而导致其开销过大;同时,方案难以实时撤销用户的访问权限。该文提出支持用户撤销的细粒度访问控制(FGUR)方案,通过将属性层次引入到CBE中,同时结合广播密文策略的基于属性加密(BCP-ABE),高效地实现PHR云管理系统中的细粒度访问控制及用户实时撤销。实验结果表明,与CBE相比,FGUR方案在加密开销和动态访问权限方面具有更好的性能。

个人健康档案共享的主观障碍与对策分析

目的探讨推动我国PHR共享的途径和方法。方法借鉴国外经验,分析影响PHR共享的主观因素,讨论现阶段可行的推动其共享的方法。结果影响我国PHR共享的主观因素包括对共享数据安全性的担忧,质疑共享的PHR可能被用于牟取不正当利益,信息贡献者担心自己不是PHR共享的最大有效受益者等。结论解决这些困难需要从政策法规、社会效益和经济效益3个方面共同进行。

云计算在电子健康中的新应用

在医疗健康信息爆炸式增长的电子健康时代,如何获取存储分析与管理医疗健康数据,并以更低的IT成本实现更加智能、更为个性化的医疗健康服务成为未来电子健康发展的重要课题。云计算作为新兴的信息技术为应对上述挑战提供了新的技术途径。对电子健康领域中基于云计算的新型电子健康应用服务进行了介绍,讨论了云计算对电子健康未来发展的趋势性影响。

基于XML技术的个人健康档案

随着信息技术的不断发展,医疗卫生行业已逐步实现了信息化,HIS、LIS、PACS等系统也已进入较为成熟的发展阶段。然而随着人们对健康问题进一步的重视,传统的健康信息管理模式已经不能满足人们的需求,个人健康档案PHR(Personal Health Record)这一概念也由此被提出。个人健康档案是一种以拥有人为中心,综合管理个人健康信息的方案,它记录了个人日常生活中的各种健康状态,包括各种病史,用药情况,每次体检情况以及自检情况等。通过这种方式,医疗资源可以被有效地集中起来,这对预防医学的发展无疑也是有益的。在设计个人健康档案的存储标准时,XML是一种较为合适的选择,它的可读性、扩展性、平台无关性恰好解决了健康信息多来源、非结构化等问题。HL7 CDA标准同样选择了XML,这也使得我们在设计符合中国国情的健康档案时有了很好的参考标准。