TLS reserves an encrypted channel to establish negotiations between senders and receivers to send the cipher, then transfer the key using public key cryptography [111]. Then they present an EHR security reference model for managing security issues in healthcare clouds, which highlights three important core components in securing an EHR cloud: secure collection and integration, secure storage and access management, and secure usage model. vices are offered to the organization employees. In cloud computing, encryption must be considered during data in motion, data at storage, and during data deletion [110]. and anywhere. Securing the Public Cloud; Cloud Computing Challenge 1: Security. The recent rule enhances the privacy rights of individuals and gives authorities a greater power to act against noncompliant organizations. What are the cloud computing schemes used in healthcare systems?(ii)RQ2. However, security and privacy issues present a strong barrier for users to adapt into Cloud Computing systems. e, standard adopts the Plan-Do-Check-Act (PDCA) model to, structure all ISMS processes. (iii)Hybrid cloud: it combines private and public clouds, and it has trust and confidentiality issues because of the public part. Repudiation threats are concerned with the users who deny their signature authenticity after accessing health data [40]. They first provide an overview of the state of the art on cloud security. Research: the cloud is a central data repository that can be used to support national medical research, disease control, and epidemics monitoring. An, important and often overlooked aspect in the eHealth system, is the availability of data in critical situations, including the, ability to carry on operations even when some authorities, misbehave and the ability to continue operations even in the, possibility of a security breach. 105-112. This year we will introduce the topic of the security aspects of cloud implementation in eHealth systems and services. Outsourcing EMRs to the cloud introduce new security and privacy challenges. Most cryptographic protocols include some form of endpoint authentication specifically to prevent man-in-the-middle attacks. , pp. ere is a long line of research pertaining to the security. Control objectives include communications security, cryptography, and information security incident management. Different security measures like firewalls, intrusion detection, and the type of encryption and authentication techniques should be also checked. 2. This promising technology can help facilitate communication, collaboration, and coordination among different healthcare providers. We prove that our scheme is secure under cryptographic assumptions and analyze its efficiency from the patient’s perspective. Cloud computing is a promising technology that is expected to transform the healthcare industry. Authenticity in general refers to the truthfulness of origins, attributions, commitments, and intentions. Fog computing aims to process data as close as the service invoker (e.g., IoT wearable health devices), which could help reduce unnecessary latency in eHealth services. e cloud can help the healthcare industry deliver. Many healthcare providers use cloud technology with, caution due to the risks involved such as unauthorized use or, access to private and sensitive health data. Self-encrypting drive (SED) is a hard drive that contains internal circuits that encrypts and decrypts all data automatically and uses authentication procedure when the host system is powered on [110]. Before moving data into the cloud, the security challenges should be mitigated. propose a framework, which allows secure sharing of EHRs over the cloud among different healthcare providers. (ii)Interoperability: there is a need for standards to achieve proper communication, coordination, and collaboration between different healthcare providers’ platforms [7]. fication Act can affect the outcome of data analysis. A Survey on Security Challenges of Healthcare Analysis Over Cloud - written by Jaishree Jain, Dr. Ajit Singh published on 2017/04/26 download full article with reference data and citations As a result, security, privacy, efficiency, and scalability concerns are hindering the wide adoption of the cloud technology. The authors declare that they have no conflicts of interest. This architecture is based on Trusted Virtual Domains (TVDs) that extend the protection of privacy-sensitive data from centrally managed secure networks to the client platforms of the end-users. Finally, with the increasing demand for better performance and scalability of eHealth systems and the wide adoption of IoT (Internet of things), emerging technologies such as edge and fog computing are used to complement cloud computing. provide a comprehensive solution to se-, cure access to privacy-sensitive EHR data through (1) a, cryptographic role-based technique to distribute session, keys using Kerberos protocol, (2) location- and biometrics-, based authentication method to authorize the users, and (3), a wavelet-based steganographic technique to embed EHR, data securely in a trusted cloud storage. The task of aggregating health records from different sources in a single repository is a complex task since the aggregator needs to use different standards and protocols to guarantee interoperability between different stakeholders. Under the HIPAA Privacy Rule, a covered entity can deidentify public healthcare record by removing all 18 elements that could be used to identify the patient or the patient’s relatives, employers, or household members. Yarmouk University, Irbid, Jordan. Release Date: 05/21/2019 CSA’s latest survey examines information security concerns in complex cloud environment. Yazan Al-Issa, Mohammad Ashraf Ottom, and Ahmed Tamrawi. the security measures, the less comfortable the consumers, and as a result, they are going to be less inclined to use the, cloud service. [74] B. Dhivya, S. P. S. Ibrahim, and R. Kirubakaran, cryptographic access control for cloud based electronic, Research in Computer Science, Engineering and Information, [76] S. Supriya and S. Padaki, “Data security and, lenges in adopting solutions for IOT,” in, 2016 IEEE International Conference on Internet of ings, (iings) and IEEE green Computing and communications, (GreenCom) and IEEE cyber, Physical and Social Computing, IEEE 3rd International Conference on Cloud Computing, ohr, A.-R. Sadeghi, and M. Winandy, “Securing the. Improper treatment based on erroneous data can have serious consequences on patients’ health. Available security solutions are discussed in Section 5. Cloud computing is a promising technology that is expected to transform the healthcare industry. Ibrahim et al. Galletta et al. In Section 4, we survey recent work addressing security risks for eHealth systems using cloud computing. To. Is the provider compliant with the security and privacy regulatory acts? (vi)Vulnerability to attacks: the cloud is prone to different kinds of security attacks [21]. In addition , we research privacy needs for others than patients. Ibrahim et al. care stakeholders like physicians, clinics, hospitals. security issues and concerns. A systematic and comprehensive review of security and privacy-preserving challenges in e-health solutions indicates various privacy preserving approaches to ensure privacy and security of electronic health records (EHRs) in the cloud. (vii)Rapid deployment: software and hardware systems can be used almost immediately. CP-ABE scheme to minimize the overall encryption time. should prevent service disruptions due to power outages, hardware failures, system upgrade, and denial-of-service, attacks. In such a scenario, cloud consumers encrypt their data using SSS technique to ensure confidentiality and privacy. almost all cloud service providers offer a redundant. [15] VMWare, “VMWare,” 2017, Besides, it allows users to outsource the storage process by using virtual storage systems instead of local ones. The modified group based CP-ABE (G-CP-ABE) minimizes the computational overhead by reducing the number Health data are highly sensitive, and safeguarding, these data is a high priority for individuals, healthcare, providers, and cloud services providers. Based on these considerations, we store these created portions in different nodes to minimize security risks, particularly internal attacks. [77]. Cloud computing is a promising technology that is expected to transform the healthcare industry. Ibrahim et al. Figure 1: eHealth Cloud Security Challenges: A Survey. The rule also requires the covered entity to have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the patient. erefore, the security in edge and fog tech-, nologies should be tightened and enhanced by (a) utilizing, the state-of-the-art security mechanisms within the edge, computing communication environment, (b) encrypting all, data (in-move and in-rest), and (c) multifactor authenti-, survey the state-of-the-art security mechanisms for eHealth, systems on emerging fog and edge technologies and com-, pare those mechanisms with security mechanisms in, Security is one of the main problems that hinder the fast, adoption of the cloud computing technology in the, healthcare industry. GDPR is the European Union (EU) primary tool that reg-, ulates the protection of EU citizens individual data. Currently, the standard. Copyright © 2019 Yazan Al-Issa et al. J. M. Victor, “The EU general data protection regulation: toward a property regime for protecting data privacy,”, M. J. Minniti, T. R. Blue, D. Freed, and S. Ballen, “Patient-interactive healthcare management, a model for achieving patient experience excellence,” in, M. Li, S. Yu, Y. Zheng, K. Ren, and W. Lou, “Scalable and secure sharing of personal health records in cloud computing using attribute-based encryption,”, A. Sunyaev, “Evaluation of microsoft healthvault and Google health personal health records,”, A. Sunyaev, D. Chornyi, C. Mauro, and H. Krcmar, “Evaluation framework for personal health records: microsoft healthvault vs. google health,” in. This paper is survey on the security and privacy issues and available solutions. present a system developed at Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) that is claimed to address the patient’s data security and privacy. Edge computing aims at processing data at the edge of the network rather than processing data at the data center as in traditional eHealth cloud solutions. If the patient feels that the information he/she gives to his/her doctor is not protected, and that his/her privacy is threatened, he/she can be more selective about the information he/she will provide to his/her doctor in the future. 2: ISO/IEC 27000-series standards categories. Summary 6. In [33], Metri and Sarote argue that security threats to the cloud data include spoofing identity via an attacker pretending to be a valid user, tampering with the data that involve malicious alterations and modification of the content, repudiation with the users who deny their signature authenticity after performing an activity with the data, and information disclosure via the exposure of information to unauthorized users [33]. In this type of identification, there is a chance to, reidentify the patient because patient information has been, recorded at some stage (anonymized data). Relationship between delivery and service models. and Office 365 are popular examples [5–10]. present a brief overview, ) [37] states that covered entities must “, ” In a healthcare setting, services that store and, For any healthcare cloud system to serve its, Auditing is a security measure that ensures the, e HITECH Act is a healthcare legislation, category provides a practical implementation, ” [94]. Due to the increased number of parties, devices, and ap-, plications involved, there is an increase in data compromise, fectively, it is necessary for the patient to trust the healthcare, system to protect the confidentiality of his/her data. This paper tries to answer the following research questions:(i)RQ1. Unlike the old Data Protection Directive, noncompliant organizations will face severe punishment for data breaches; the most serious infringement can cost a company twenty million Euros or up to 4% of the annual worldwide turnover, whichever is greater [96]. In B. Fernandes, L. F. B. Soares, J. V. Gomes, M. M. Freire, and P. R. M. Inácio, “Security issues in cloud environments: a survey,”, P. Banerjee, R. Friedrich, C. Bash et al., “Everything as a service: powering the new information economy,”, B. P. Rimal, A. Jukan, D. Katsaros, and Y. Goeleven, “Architectural requirements for cloud computing systems: an enterprise cloud approach,”. conditions even from a resource constrained IoT device. HIPAA is a legal framework for securing healthcare systems. With the healthcare industry facing a new reality, healthcare applications are steadily impacting the mobility, In recent years, many countries have been trying to integrate electronic health data managed by each hospital to offer more efficient healthcare services. It also encourages investments in developing healthcare systems. Is the provider staff trained on risk and crisis management? The consumer has control over applications, data, middleware, and operating systems but not over the underlying cloud infrastructure. is architec-, extend the protection of privacy-sensitive data from cen-, trally managed secure networks to the client platforms of the, end-users. The rights of data subjects are expanded in the new regulation. As a result, security, privacy, efficiency, and scalability concerns are hindering the wide adoption of the cloud technology. Auditing could also, help detect attempts by hackers to break into a public, healthcare cloud system and help administrators detect. (iii)Security and privacy: open and shared environment is prone to data loss and theft [20]. data become accessible to an augmented number of parties. These included the following: More than three-quarters (76%) of security professionals said it was difficult for their organizations to maintain secure configurations in the cloud. There is a long line of research pertaining to the security requirements of healthcare cloud applications. Finally, they present some, recommendations for the development of next-generation, cloud security and assurance solutions. Results: 43 challenges and 89 solutions are identi ed from litera- ird, encoding and encrypting data; however, there is a chance to, reveal the encryption key using advanced computer tech-, nology. pharmacy information system, and medical images. Act, 42 U.S.C. Confidentiality is the act of ensuring that patients health data are kept completely undisclosed to unauthorized entities. (vi)Solving the scarcity of resources: doctors in remote areas can use telemedicine to perform consultations. However, mobile services are still not generally allowed to operate with highly sensitive and personal data, mainly due to the lack of a defined security standard, low protection of data transferred through the mobile and wireless network and no standard and widely accepted user authentication method that ensure confidentiality. Some personal data like personal healthcare records and financial records contain sensitive information which can be analyzed and mined for public researches although these records offer important human assets. ey also classify the, privacy-preserving approaches into cryptographic and, noncryptographic approaches. The categories are (1) vocabulary and terminology category that describes the fundamentals of ISMS and defines related terms, (2) requirement standards category consists of the standards that provide requirements and guidelines for the development and operation of an ISMS, (3) guideline standards category provides a practical implementation guidance for securing information from different angles, (4) sector-specific guideline standards category consists of standards that appeal to different industry sectors such as telecommunication, finance, etc. Security re-, quirements are increasingly difficult to meet without a, significant investment in infrastructure and manpower. Below we, review US (e.g., HIPAA and HITECH) and international, standards (e.g., ISO/IEC 27000 and General Data Protection, healthcare systems. e consumer can access the, software using a web browser or an application, programming interface (API). The Internet of Things (IoT) has penetrated its roots in almost every domain of life. For instance, in the healthcare scenario, neither the patients nor the doctors can deny their signature authenticity after misappropriating the health data. e model ensures that ISMS is, established, implemented, assessed, measured where ap-, plicable, and continually improved. This represents a clear advantage, since data storage on the cloud will be redundant, and in case of force majeure, different data centers will help recover from disasters. Fi-, nally, our findings and conclusions are summarized in, different people, different research groups, and different. Smithamol et al. Data availability: data are available for all healthcare stakeholders like physicians, clinics, hospitals, and insurance companies [, Availability and reliability: the service can be slow, interrupted, or down, depending on the strength of the Internet connection. Clouds were built for several reasons of which some of the most important reasons were shared computing, shared memory, and shared storage. is means that the probability of those, items being related from the attacker’s perspective stays the. Finally, the private healthcare data are accessed and stored securely by implementing a decoy technique. A survey on security of IoT in the context of eHealth and clouds Abstract: The technology of Internet of Things (IoT) and cloud has exposed devices to vulnerabilities. Their services are offered to the public. The problem is that a gain obtained in one dimension causes a loss in another dimension. (viii) Data availability: data are available for all health-. It applies on EU organizations like data controllers and data processors that collect or process the personal data of EU residents; it also applies on data controllers and data processors that reside outside the EU if they offer goods and services to data subjects that reside in the EU [96, 98, 99]. As far as we know, there are only a few works in literature that deal with availability and data recovery in cloud computing. e centralization of data on the cloud, raises many security and privacy concerns for individuals and healthcare providers. (v)Measured service: different cloud services can be measured using different metrics. Covered entities that seek to release such data must determine that the information has been deidentified using either statistical methods to verify deidentification or by removing certain parts of the data. Under the, new regulations, companies should ask for explicit consent. Marwan et al. privacy-aware role-based access control (CPRBAC) model. Measured service: different cloud services can be measured using different metrics. Thus, security threats prevail to data access and management to secure data sharing and integration. In the following subsections, we, discuss the available solutions from regulatory and technical, describe accepted characteristics of a product or service by, experts from organizations and scientific institutions. Survey respondents who actively use multiple cloud providers cited many benefits. Various approaches have been used to preserve the security of the health information in the cloud environment. The proposed model uses partially ordered set (POSET) for constructing the group based access structure plications. Washington Electronic Authentication Act, “Revised code of Washington,” vol. Essentially, the cloud service providers should deal with security concerns in the cloud to enhance the trust level between the patients and healthcare providers [22–24]. Several solutions have been proposed to address the security and access control concerns. October 2012; DOI: 10.1109/TSSA.2012.6366028. Just like electronic commerce, healthcare cloud ap-, plications can leverage digital signatures and encryption to. On contrary, the article does not discuss any, aspects of the optimal number of shares for the incurred, trade-off between efficiency and security. In the future, we will propose a holistic solution that attempts to balance all contradicting requirements. In this regard, firstly, this paper explores the regulations, ethical guidelines around the world, and domain-specific needs. are reluctant to move those data's patients in the Cloud. Therefore, the security in edge and fog technologies should be tightened and enhanced by (a) utilizing the state-of-the-art security mechanisms within the edge computing communication environment, (b) encrypting all data (in-move and in-rest), and (c) multifactor authentication access [114–119]. Data remanence may cause an unintentional data confidentiality attack. The ISO/IEC 27002 [93] standard concentrates on security during system planning and development stages. Beside the lack of standards, regula-, tions, and interoperability problems, the main obstacles that, are hindering the wide-scale adoption of the cloud by, healthcare providers are the security, confidentiality, and, Computer security is a growing field in computer science, that focuses on protecting computer systems and electronic, data against unauthorized access, hardware theft, data, manipulation, and against common threats and exposures, such as backdoors, denial-of-service (DoS) attacks, and, phishing. eHealth Cloud Security Challenges: A Survey. formation Security Agency, Heraklion, Greece, 2009. A larger number of IT companies are Patient data are available, anytime and anywhere for doctors to analyze and, hardware and software. Ensures neither user nor patient can deny the provided data. Due to many characteristics it has effect on IT budget and also impact on security, privacy and security issues .In this section all these issues are discussed. “General Data Protection Regulation,” 2016. (iv)Legislation and regulations: the wide adoption of cloud computing requires laws, regulations, and ethical and legal frameworks [21]. We identif. us, there is an immediate need for a holistic solution that balances, Cloud computing is a relatively new technology that will, have a great impact on our lives. A good example is Rackspace [, Community cloud: it is a group of entities with a common goal, share the cloud; universities usually share a single cloud. e industry can benefit from the cloud, technology to manage change and complexity. 2- Improve the performance of cooperative Q-learning algorithms using decomposition technique, Electronic Health Records (EHRs) are further driving the volume of data as patients' files, x-rays, lab results, and other sensitive medical records are transmitted across the network. Only few papers that use the cloud, official definition, cloud computing has five main charac-, teristics: resource pooling, broad network access, rapid. A good example is, common goal, share the cloud; universities usually, share a single cloud. Sneha and Asha propose to use k-anonymity for privacy preserving on eHealth records [73]. centers will help recover from disasters. However, there is no qualitative, analysis discussion on the efficiency of the approach and its. 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