Current systems used by medical institutions for the management and transfer of Electronic Medical Records (EMR) can be vulnerable to security and privacy threats. In addition, these centralized systems often lack interoperability and give patients limited or no access to their own EMRs. In this paper, we propose a novel distributed data sharing scheme that applies the security benefits of blockchain to handle these concerns. With blockchain, we incorporate smart contracts and a distributed storage system to alleviate the dependence on the record-generating institutions to manage and share patient records. To preserve privacy of patient records, we implement our smart contracts as a method to allow patients to verify attributes prior to granting access rights. Our proposed scheme also facilitates selective sharing of medical records among staff members that belong to different levels of a hierarchical institution. We provide extensive security, privacy, and evaluation analyses to show that our proposed scheme is both efficient and practical.
In 2017, another functioning electronic medical record-sharing scheme was presented to provide a secure solution using the blockchain @cite_1 . The system uses a cloud-based storage system to store the medical records. With centralized storage, the system becomes liable to a single point of failure. Similar to MedRec, this work builds over a private blockchain, which is a monitored blockchain where each node involved in maintaining consensus is known. Studies such as @cite_26 and @cite_22 present possible methods to evaluate private blockchains and potential concerns and vulnerabilities. They show that there is a trade-off between performance and security.
@cite_26 @cite_1 @cite_22
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Years of heavy regulation and bureaucratic inefficiency have slowed innovation for electronic medical records (EMRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. In this paper, we propose MedRec: a novel, decentralized record management system to handle EMRs, using blockchain technology. Our system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing -- crucial considerations when handling sensitive information. A modular design integrates with providers' existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. We incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain &#x0022;miners&#x0022;. This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. The purpose of this short paper is to expose, prior to field tests, a working prototype through which we analyze and discuss our approach. Electronic patient records (EPRs) contain a wealth of patient-related data and capture clinical problem-solving experiences and decisions. Excelicare is such a system which is also a platform for the national generic clinical system in the UK. Objective: This paper presents, ExcelicareCBR, a case-based reasoning (CBR) system which has been developed to complement Excelicare. Objective of this work is to integrate CBR to support clinical decision making by harnessing electronic patient records for clinical experience reuse. Methods: CBR is a proven problem solving methodology in which past solutions are reused to solve new problems. A key challenge that we address in this paper is how to extract and represent a case from an EPR. Using an example from the lung cancer domain we demonstrate our generic case representation approach where Excelicare fields are mapped to case features. Once the case base is populated with cases containing data from the EPRs database a standard weighted k-nearest neighbour algorithm combined with a genetic algorithm based feature weighting mechanism is used for case retrieval and reuse. Conclusions: We conclude that incorporating case authoring functionality and a generic retrieval mechanism were key to successful integration of ExcelicareCBR. This paper also demonstrates how the application of CBR can enable sharing of lessons learned through the retrieval and reuse of EPRs captured as cases in a case base. Distributed m-healthcare cloud computing system significantly facilitates efficient patient treatment for medical consultation by sharing personal health information among healthcare providers. However, it brings about the challenge of keeping both the data confidentiality and patients’ identity privacy simultaneously. Many existing access control and anonymous authentication schemes cannot be straightforwardly exploited. To solve the problem, in this paper, a novel authorized accessible privacy model (AAPM) is established. Patients can authorize physicians by setting an access tree supporting flexible threshold predicates. Then, based on it, by devising a new technique of attribute-based designated verifier signature, a patient self-controllable multi-level privacy-preserving cooperative authentication scheme (PSMPA) realizing three levels of security and privacy requirement in distributed m-healthcare cloud computing system is proposed. The directly authorized physicians, the indirectly authorized physicians and the unauthorized persons in medical consultation can respectively decipher the personal health information and or verify patients’ identities by satisfying the access tree with their own attribute sets. Finally, the formal security proof and simulation results illustrate our scheme can resist various kinds of attacks and far outperforms the previous ones in terms of computational, communication and storage overhead. This paper addresses privacy issues in managing electronic health records by a third party cloud based service. Compared to traditional authentication-authorization mechanisms, the proposed approach minimizes the leakage of identity information of involved participants through unlinkability. Furthermore, it gives the ability to health record owners for making access control decisions. This solution employs an identity management scheme that enhances consumer privacy by preventing consumer profiling based on the credentials used to satisfy the service provider policies. The paper proposes a set of mechanisms to allow authenticated unlinkable access to electronic health records, while giving the record owners ability to make access control decisions. The security evaluation for accessing data in the cloud is detailed, and the implementation of the system is evaluated in this paper.