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In this paper, digital watermarking and EEG compression are introduced firstly, and then a number of digital watermarking methods are explored to resolve the problem of integrality and authenticity in EEG compression. At last, the current state of this technique inside and outside country is summarized and future endeavors are discussed.
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The functionality of a personal Electronic Healthcare Record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. It is one means to support patient empowerment. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions need specific security and access management requirements to be considered and implemented.
OBJECTIVE: To determine whether differences in the provision of pharmacy services exist among different types of Internet pharmacies. DESIGN: Survey of selected pharmacies with a presence on the Internet. Data were abstracted onto a data collection form for further analysis. Data collection was limited to 3 weeks. SETTING: U.S.-based Internet pharmacies that allow patients to purchase prescription medications online. Pharmacies were identified using a metasearch engine with the search terms "Internet pharmacy" and "Internet pharmacist." INTERVENTION: Survey. MAIN OUTCOME MEASURES: Comparisons of availability of 10 commonly used products representing a variety of product categories, prescription verification methods, and privacy issues; and determinations of site navigability, drug information and provider access, and payment methods. Sites were categorized as "chain pharmacy extensions," "mail order pharmacies," "independent pharmacy extensions," and "online pharmacies." RESULTS: Thirty-three sites were reviewed. There was significant variation among the four types of pharmacies selling prescriptions over the Internet. Most pharmacies provided all of the drugs in the survey. Patients were required to provide their own prescription at 88% of the sites, and 75% of sites used mail or fax to verify prescription integrity. More than 50% of sites had privacy policies posted, and 64% used cookies. Chain pharmacy extensions required completion of an average of 10.2 pages to order drugs versus 2.4 to 4 pages for all other site types. Drug information was written at an eighth-grade reading level at 36% of the sites. More than two-thirds of the sites provided a toll-free telephone for a health care professional. Nearly 80% of the sites accepted health insurance, and 95% accepted credit cards; however, only 40% used a secure transmission mechanism for patient or payment information. CONCLUSION: Internet pharmacies provide varying levels of service. Policies regarding the use of the Internet for obtaining medications should focus on improving the privacy of consumer information and ensuring the secure transmission of financial information.
In this paper, a secure medical digital library is presented. It is based on the CORBA specifications for distributed systems. The described approach relies on a three-tier architecture. Interaction between the medical digital library and its users is achieved through a Web server. The choice of employing Web technology for the dissemination of medical data has many advantages compared to older approaches, but also poses extra requirements that need to be fulfilled. Thus, special attention is paid to the distinguished nature of such medical data, whose integrity and confidentiality should be preserved at all costs. This is achieved through the employment of Trusted Third Parties (TTP) technology for the support of the required security services. Additionally, the proposed digital library employs smartcards for the management of the various security tokens that are used from the above services.
A chip card based medical information system was developed as a good possibility to create a portable electronic patient record. The produced software module provides an on-line, portable diabetes medical record information system. In particular the patient data card makes the up-to-date patient's record available whenever needed. The developed Core System includes a patient record management system that has the ability to handle topics such as medical anamnesis, administrative, medical and physical examination data. Issues tackled were simplicity, data security and reporting. Customization and internationalization were also covered by presenting a novel approach using native initialization files. Proper care has been addressed during the development of the software modules for matters of security, data integrity and confidentiality.
This paper deals with the main security services of data protection: integrity, authentication, nonrepudiation and confidentiality. It describes the different tools which may be used to achieve these security objectives: encryption, digital signature, access controls, integrity control, audit and certification. The French legislation concerning encryption has been recently updated in order to simplify the use of encryption techniques for personal data security. This legislation describes different authorization or reporting procedures according to the type of the request (application, equipment, import or export of encryption techniques) and the security level required.
One of the results of the 49th Bavarian Physician's Conference was that in 1996 the Bavarian Statutory Health Care Administration (Kassenärztliche Vereinigung Bayerns, KVB) and the Bavarian Medical Association (Bayerische Landesärztekammer, BLAK) jointly suggested a project for the development and verification of a security infrastructure for the online transmission of medical patient data. This Project, the so-called "Health Care Professionals Protocol" (HCP-Protokoll), was designed to establish the first consensus standard for a secure and probably open system to be used in the health care system operating under the constraints of the diverse and heterogeneous IT-infrastructure in Bavaria, with a view towards utilization in all of Germany. In January 1997, the HCP-Protocol was accepted as the strategic mainline project for telematics applications in medicine by the State of Bavaria and endowed with more than 1.3 million DM in the framework of "Bavaria Online II". In the meantime, various national organizations of the German medical community as well as important industrial partners have expressed support for this initiative. Mention in the Roland-Berger study "Telematics in Health Care, Perspectives of Telemedicine in Germany", designation as an "exemplary scenario" in the final report of the Working Group 7 of the Forum Info 2000 "Telematics Applications in Health Care", as well as integration of the new German health professional card, make the HCP-Protocol the most promising candidate for a de facto standard in the security infrastructure for all participants in health care telecommunication in Germany. Since the middle of 1998, an expert group under the guidance of the joint "Projektbüro Telemedizin" of the KVB and BLAK has been working on the definition of this protocol, taking into consideration the current legal framework of the German medical profession (Berufsordnung), the German signature law (SigG), and the national data security laws (BDSG), as well as today's technical possibilities and existing components. The results of this definition will be published at the first opportunity (sometime during the first half of 1999) and then placed into public domain, so that any solution provider can reference this source to create secure and mutually interoperable application programs for health care professionals in Germany.
The upcoming HIPAA security regulations are forcing a change in business and operating procedures that many, if not most, healthcare organizations are ill-prepared to tackle. Of all healthcare organizational structures, membership organizations will most likely face the greatest number of obstacles in preparing for and implementing the HIPAA security regulations. This is because the membership organization as a whole must find a way to accommodate the disparate technologies, business and operating methodologies and processes, and available, limited resources of its individual member organizations, and integrate these into a uniform implementation plan. Compounding these obvious difficulties is the unique challenge of enforcement authority. The individual member organizations are autonomous business entities, whereas the membership organization as a whole merely acts as an advisor or consultant, and has only limited enforcement authority over any individual member organization. This article explores this unique situation in depth. We focus on PROMINA Health System, a nonprofit healthcare membership organization that consists of five disparate member healthcare organizations. We examine the challenges PROMINA has encountered in its quest to institute an organization-wide HIPAA security program and its methodology for accomplishing program implementation.
The paper presents the enrichment of an existing e-referral / e-prescription application within a Regional Healthcare Information Network with security functionality, solving current authentication, integrity, non-repudiation and confidentiality issues and thus significantly enhancing the overall system security, operability, applicability and user acceptance. The application makes use of an underlying PKI framework, in order to provide strong authentication, digital signature, encryption and time-stamping services. XML is used for the representation of the healthcare data itself, the encrypted form of this data, as well as the relevant data security information, following W3C standards.
Electronic Health Records (EHR) are moving towards the core application of health information systems. Enabling informational interoperability of shared care environment including EHR, structure and function of components used have to follow open standards and publicly available specifications. This comprises also methods and tools applied. Security services needed have to be an integral part of architecture and operation of the specified and implemented components. Starting with basic architectural paradigms the Magdeburg Medical Informatics Department was involved in at the early nineties, the secure behaviour of components has been derived. For establishing the required trustworthiness, security models have been introduced and presented in the paper. Beside communication security services based on standardised Public Key Infrastructure (PKI) and security token such as Health Professional Cards (HPC), policy-defined application security services such as authorisation, access control, accountability, etc., of information recorded, stored and processed must be guaranteed. In that context, appropriate resource access decision services have to be established. As the HARP project result, a component-based EHR architecture has been specified and demonstrated for enforcing fine-grained security services by binding certificates to application components, by the way enforcing policies.
The healthcare environment is currently changing and the health sector is being transformed to meet new challenges and to benefit from new opportunities. Priorities for the 21st century ought to be set based on emerging dominant trends in healthcare, including the shift towards shared or integrated care, in which an individual's healthcare is the responsibility of a team of professionals across all levels of the healthcare system hierarchy. In addition to the requirement for efficient and secure access to the Integrated Electronic Health Record (I-EHR) of a citizen, this necessitates the development and deployment of Regional Health Information Networks (RHINs), synchronous and asynchronous collaboration services, and novel eHealth and mHealth services, facilitated by intelligent sensors, monitoring devices, hand-held or wearable technologies, the Internet and wireless broadband communications. These further require the adoption of an open Reference Architecture and the creation of a scalable Health Information Infrastructure (HII).This paper discusses the challenges encountered in developing and deploying HYGEIAnet, the Regional Health Information Network of Crete, as well as relevant benefits for citizens and health professionals. Furthermore, HYGEIAnet systems and services are presented, with emphasis on the development of the HII and the implementation of the I-EHR service for providing secure, role-based access to validated content by authorized and authenticated users.
Patient identifiers are a key consideration in addressing confidentiality of electronic communications. Sending outside e-mails via the Internet poses significant security challenges. Check with your privacy officer before sharing benchmarking information via e-mail.
Electronic patient records are becoming tologically reified entities that play the role of epistemic patient analogues in information space. The traditional property-model of patient records is therefore no longer appropriate. A shift in paradigm is required. This paper suggests a new paradigm, examines its ethical implications and explores ways in which these could be reflected in legal and regulatory mechanisms. Special attention is paid to privacy, security and access relative to the so-called 'fair information principles'.
OBJECTIVE: The Patient-Centered Access to Secure Systems Online (PCASSO) project is designed to apply state-of-the-art-security to the communication of clinical information over the Internet. DESIGN: The authors report the legal and regulatory issues associated with deploying the system, and results of its use by providers and patients. Human subject protection concerns raised by the Institutional Review Board focused on three areas-unauthorized access to information by persons other than the patient; the effect of startling or poorly understood information; and the effect of patient access to records on the record-keeping behavior of providers. MEASUREMENTS: Objective and subjective measures of security and usability were obtained. RESULTS: During its initial deployment phase, the project enrolled 216 physicians and 41 patients; of these, 68 physicians and 26 patients used the system one or more times. The system performed as designed, with no unauthorized information access or intrusions detected. Providers rated the usability of the system low because of the complexity of the secure login and other security features and restrictions limiting their access to those patients with whom they had a professional relationship. In contrast, patients rated the usability and functionality of the system favorably. CONCLUSION: High-assurance systems that serve both patients and providers will need to address differing expectations regarding security and ease of use.
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