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Security and privacy in electronic health records: a systematic literature review.
Open accessAbstract
Objective To report the results of a systematic literature review concerning the security and privacy of electronic health record (EHR) systems.Data sources Original articles written in English found in MEDLINE, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database.Study selection Only those articles dealing with the security and privacy of EHR systems.Data extraction The extraction of 775 articles using a predefined search string, the outcome of which was reviewed by three authors and checked by a fourth.Results A total of 49 articles were selected, of which 26 used standards or regulations related to the privacy and security of EHR data. The most widely used regulations are the Health Insurance Portability and Accountability Act (HIPAA) and the European Data Protection Directive 95/46/EC. We found 23 articles that used symmetric key and/or asymmetric key schemes and 13 articles that employed the pseudo anonymity technique in EHR systems. A total of 11 articles propose the use of a digital signature scheme based on PKI (Public Key Infrastructure) and 13 articles propose a login/password (seven of them combined with a digital certificate or PIN) for authentication. The preferred access control model appears to be Role-Based Access Control (RBAC), since it is used in 27 studies. Ten of these studies discuss who should define the EHR systems' roles. Eleven studies discuss who should provide access to EHR data: patients or health entities. Sixteen of the articles reviewed indicate that it is necessary to override defined access policies in the case of an emergency. In 25 articles an audit-log of the system is produced. Only four studies mention that system users and/or health staff should be trained in security and privacy.Conclusions Recent years have witnessed the design of standards and the promulgation of directives concerning security and privacy in EHR systems. However, more work should be done to adopt these regulations and to deploy secure EHR systems.
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Metadata
- Authors
- Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A.
- Affiliations
- Universidad de Murcia (ES)
- Corresponding author
- Señor, Inmaculada Carrión
- ORCID
- Toval, Ambrosio
- Venue
- Journal of Biomedical Informatics
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 46
- Issue
- 3
- Pages
- 541-562
- ISSN
- 1532-0464 (ISSN-L)
- OpenAlex
- W2128232860
- Cited by
- 675
- References
- 127
- Citations by year
- 2026: 23 · 2025: 39 · 2024: 72 · 2023: 59 · 2022: 46 · 2021: 59 · 2020: 57 · 2019: 82 · 2018: 57 · 2017: 48 · 2016: 56 · 2015: 38 · 2014: 29 · 2013: 10
- FWCI
- 7.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Biomedical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Spanish Ministry of Science and Technology (TIN2009-13718-C02-01, TIN2009-13718-C02-02)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Physical Sciences › Computer Science › Computer Networks and Communications › Access Control and Trust
- Health Sciences › Health Professions › Health Information Management › Thoreau and American Literature
- Keywords
- electronic health records, health information security, privacy, HIPAA, Data Protection Directive 95/46/EC, public key infrastructure, digital signatures, pseudo-anonymity, role-based access control, access control, audit logging, user authentication
- MeSH terms
- Europe, United States, Computer Security, Privacy, Health Insurance Portability and Accountability Act, Electronic Health Records
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