CSE5810: Patient Data and Medical Data Privacy

CSE5810: Patient Data and Medical Data Privacy NitishNarainMathur nnm12001 Department of Computer Science & Engineering University of Connecticut, Storrs nitish.mathur@engineer.uconn.edu

Background • Importance of data privacy in the Biomedical? • Is it necessary for HCOs to protect data?

Introduction • With technology advancements by the day, security vulnerabilities are also increasing • Collection of sensitive data is being done through wireless devices • HCOs are working towards upgrading to such advancements and extract fruitful data from those data archives and while doing so security vulnerabilities have been bought to publics attention • Ex: HC provider looking into patients data without consent (authorization). Patient might most likely be a famous personality, relative … • With this kind of a scenario, publics faith in such systems has taken a plunge over the years

Privacy • Privacy is defined as the ability to control what information should be given out • Privacy  Anonymity, Confidentiality & Solitude • When EMRs started to get widely used, privacy was recognized as the core principle in this industry • With every individual there is a change in how data delegation should be done • Better policies and technologies are being researched upon and implemented • A solution for such a concern should be cost effective and beneficial for all • If a short term solution is used, a much longer, sustainable solution should be implemented in the near future.

Privacy • How comfortable are you that your personal health information is disclosed toa HCP when compared with some random person on the street??? – With every situation it varies • Common practice was to remove such sensitive data from the DBs and are then given out to the public • But this leads to data inconsistency and this disseminated data is useless • For this to be achieved clearly distinguish between access control & disclosure control • Just by removal of sensitive data from the data sets it is not sufficient • Data might be available in multiple locations and when combined certain features of an individual can be known

Issues in Biomedical Data Privacy • Storing sensitive information on cloud storage by HCOs when these systems are not under direct control of such systems • Unwanted disclosure of sensitive information happens in different ways • Computer Security System compromise • Breach of security in Institutional Infrastructure • Insecure transmission • Acts of disloyal employees, …

Goals of Information Security in Health Care • Ensure the privacy of patients and the confidentiality of health care data. • Ensure the integrity of health care data • Ensure the availability of health data for authorized persons. • Issues with these goals: • Access Control? • Application of cryptographic protocols • Need for authentication of user for data integrity • System reliability, backup mechanisms for data availability

Personal Health Records • Patients access to their own information • According to the Markle Foundation (Connecting for health) • Electronic application through which individuals can access, manage and share their health information in a secure and confidential environment. • According to Center for Information Technology (CITL) • An Internet based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. • HCOs and e-health services that are covered by HIPAA (Health Insurance Portability and Accountability Act) have an issue of implementing effective and cost-efficient security and privacy policies while being compliant with the regulations.

Personal Health Records • Primary responsibility is safeguard the organizations information including EMRs and EHRs • Security and privacy are 2 critical issues – both for patient and provider • Current PHRs provide essential security measures but lack in privacy measures • There are a few types of PHRs based on certain constraints. These constraints are not universal and hence lead to difficulties in implementing security and privacy controls

Personal Health Records along with HIPAA • For PHRs to be widely accepted they should be patient centric that is ensuring privacy and control by the patients over their own records. • HCOs are covered entities under HIPAA regulations and are subject to the HIPAA security and privacy rule, PHRs operated by HCOs may not be subject to HIPAA regulations • HCOs might regulate the use of PHRs by a contract (with the patient)

Security and Privacy Concerns in PHRs • Use of data by insurance companies • Medical Identity theft by misuse of data and challenges involved in preventing the same • Inappropriate use of medical data by PHR vendors for medical advertising • Risk of misuse of health information by rogue entities, payers, employers, third party care providers • Risks that arise from granting data ownership to patients (not all patients are e-friendly) • Conflicting regulatory frameworks: State and Federal • Data Access and Storage (Malicious attacks)

Evaluation of MSHV – Privacy Policy

Electronic Health Records • EHRs are a way to exchange medical data of patients between different health care providers • Existing approaches for protecting such data is insufficient. • A new security architecture is needed for EHRs • Patients should be able to authorize access to their records remotely (via phone) and should be time-independent for later processing by the physician. • Patient-controlled encryption provides the strongest security and privacy as the encryption keys are stored on the smart card

EHRs • But it comes with issues • Acceptance problems • Diagnosis writeup is done after the patient has left • After a home visit the patient is not available • Elderly people and disabled people might not be e-friendly • If patient is too ill then he/she has to give their card to a third person • Patient might be unconscious and might not be able to authorize access to the EHR • Smartcard has to be connected to a local device of a health professional. No authorization possible via internet

Solution for the issues with EHRs • Should allow patients to give an authorization secret to doctors via different communication channels. • Existing Systems: • Smartcard Encryption • New System should have the following objectives: • Patient-controlled confidentiality of EHR data • Flexible authorization of access to EHR data • Emergency Access

Solution for the issues with EHRs • Requirements for such an EHR system: • End-to-end encryption • Record-dependent encryption • Transferability of authorization secrets • Asynchronous authorization • Access to emergency data • Accountability of emergency access

Protecting Health Information on Mobile Devices • Mobile applications are getting used increasingly by health care professionals and patients • Mobile devices are having security threats and hence there is an urge to address the issue of how this data can be protected • The mobile devices are easily available and are always connected which makes them highly attractive to use and access medical data at any location and during emergencies. • It reduces cost but at the same time it also introduces the problem of protection of health data on such mobile devices

Protecting Health Information on Mobile Devices • Mobile devices are becoming easy targets of malware • Studies have shown that medical data disclosure is one of the top reasons for a breach • Goals: • Ensure that sensitive data does not flow to untrusted applications • Such data should not must not be allowed to flow outside of the device to untrusted hosts • Explicit user consent can be taken when not clear if data should be sent or no • Securely capture and process user input to avoid malware scripted events

Protecting Health Information on Mobile Devices • A new system was proposed in the paper by “Ahmed, Musheer and Ahamad, Mustaque; Protecting Health Information on Mobile Devices” • Their framework would help protect sensitive data against unsafe and unintended uses on mobile device. • Helps prevent 3rd-party health care applications from leaking sensitive medical information even after getting infected by malware • Explicit patient consent plays an important role

Protecting Health Information on Mobile Devices • Contribution: • Constrained application for the Android platform which can be used to safeguard sensitive data and prevent its flow to unauthorized entities • Propose and describe how a user consent detection mechanism can help distinguish actual user input from scripted events that are generated by malware • Use of sample health applications and a security policy to demonstrate how sensitive health data can be securely accessed • Tagging of sensitive data which is easier when it is accessed for a small number of trusted repositories

Protecting Health Information on Mobile Devices • According to HIPAA regulations, disclosures can only be made for specific purposes or situations such as a treatment, payment or other health related operation • As the health care professionals access sensitive patient medical data on mobile devices, regulatory requirements will apply to all these devices • Unintended disclosures can happen while using such a device by a malware • Another threat might be from application developers who do not take proper security measures to ensure data security • Already, from research it is known that there is unauthorized use of data from third party applications without user consent • Devices might be lost/stolen

Protecting Health Information on Mobile Devices • Security Policy: • These devices are commonly used by a single user and operate under user control • The security policy does not rely on identity credentials but deals with how information is shared • Requirements: • Primary focus is on sharing of health data • Use a 3rd party application, Sana Mobile • This proposed framework would monitor and prevent disclosure of sensitive health information to unauthorized parties • Also stop transfer of sensitive data to insecure locations

Protecting Health Information on Mobile Devices • Areas that need to be considered: • Controlling remote communication • Preventing data sharing with other applications • Controlling Insecure Data Storage • User Consent Detection • Approach: OS on the mobile device is trusted • Tagging Sensitive Data • Tag all incoming data with a label • Maintain tags properly • Data tagging can be done in multiple ways

Protecting Health Information on Mobile Devices • Monitoring Tagged Data Flow: • Once information has been tagged allow it to freely move within the constrained application • As it flows, track it • One can achieve this by using TaintDroid. It is an information flow tracking system that taints data

Overview • Security Policy • Privacy and Confidentiality in Health Care • Data Ownership and Legal Accountability • Informed consent to disclosure • Use of Medical Data • User Authentication and Access Control • Cryptography • Data Integrity • Audit Trials

Questions? Thank You

CSE5810: Patient Data and Medical Data Privacy