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					   Requirements of Secure Storage
  Systems for Healthcare Records :
                  A Position Paper


Ragib Hasan+, Marianne Winslett+, and Radu Sion++
    +Universityof Illinois at Urbana Champaign
             ++Stony Brook University
Securing Healthcare records is a difficult task

• Digital records can be copied verbatim, exposing
  confidential patient information

• Attacks can occur from both within and outside
  the organization

• Various privacy laws around the world strictly
  regulate the digital storage of healthcare records

• Our goal: Look into the regulations, and derive a
  common set of storage/security requirements for
  healthcare records

                                                   2
Finding a common theme in regulations

• Different countries around the world have
  different regulations on healthcare
  information management

• A common set of requirements can be
  derived from the requirements

• Research on healthcare records should
  follow these common criteria
                                              3
Case study: HIPAA

• HIPAA stands for Health Insurance
  Portability and Accountability Act of 1996

• Regulates insurance industry (Title I), and
  mandates the confidentiality and privacy of
  medical information (Title II)

• Compliance is mandatory for organizations
  handling healthcare information
                                               4
HIPAA’s security requirements

• Privacy:
  – Organizations must ensure reasonable
    measures for safeguarding privacy and
    confidentiality
• Security:
  – Internal audit procedures for medical data are
    mandatory for all organizations
  – Records must be disposed of in a trustworthy
    manner after the mandatory retention period
  – Data integrity must be ensured via checksums
    or signatures
                                                 5
Other requirements of HIPAA

• Media re-use:
  – All information need to be removed before re-
    use of storage media
• Accountability:
  – All data access and migration operations must
    be logged
• Backup and Storage:
  – Organizations must provide backup of all
    information

                                                    6
Other laws around the world also mandate
various security requirements
• OSHA:
   – Occupational Safety and Health Administration requires all
     employee exposure records to be maintained for 30 years
• EU Directive 95/46/EC
   – Article 6 requires accuracy guarantees of personal records, and
     guaranteed disposal after the retention period.
   – Article 17 requires measures for ensuring the confidentiality and
     availability of records.
• UK Data Protection Act of 1998
   – Requires mandatory disposal of electronic records after retention
     period,
   – Mandates accuracy of information,
   – Requires logging any changes, and strict confidentiality.



                                                                         7
A common set of requirements can be derived
from these laws

 •   Confidentiality and access control
 •   Integrity
 •   Availability and performance
 •   Logging, audit trails, and provenance
 •   Long term secure retention and migration
 •   Backup
 •   Cost effectiveness


                                                8
Existing storage models do not address all
these requirements

• Relational databases
  – Most commonly used model for healthcare
    records
  – Encryption provides confidentiality, but does
    not protect records from malicious insiders,
    and also makes queries on encrypted records
    less efficient
  – IBM’s Hippocratic Database technology can
    provide fine grained access control, and
    compliant auditing, but is still vulnerable to
    insider attacks
                                                     9
Existing storage models do not address all
these requirements (2)

• Object-based storage systems:
  – Document content hashes are used to locate
    documents
  – Allows efficient retrieval for read operations
  – Document integrity is ensured
  – But Appends and Writes are difficult, and
    inefficient




                                                     10
Existing storage models do not address all
these requirements (3)

• Regulatory Compliant WORM Storage
  – Records kept in Write-once, Read-many times
    media (optical, magnetic, etc.)
  – Trustworthy indexing, migration, and deletion
    mechanisms can ensure trustworthy retention
    and movement of records
  – But mainly suitable for data that do not
    change often, and do not require frequent
    corrections


                                               11
Wish list of features

• A storage model for healthcare records
  should be:
  – Efficient in performance, cheap in cost
  – Allow both efficient and secure reads and
    writes / updates / corrections to records
  – Handle trustworthy indexing, retention,
    migration and deletions of records
  – Provide detailed provenance information for
    records, documenting the history of the
    information

                                                  12