Cited by 675Electronic Health Records SystemsAccess Control and TrustThoreau and American Literature

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Security and privacy in electronic health records: a systematic literature review.

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Fernández-Alemán, José Luis, Señor, Inmaculada Carrión, Lozoya, Pedro Ángel Oliver, Toval, Ambrosio·2013·Journal of Biomedical Informatics

DOI 10.1016/j.jbi.2012.12.003

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Abstract

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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The State of HIPAA Privacy and Security Compliance, 2006
Ahima (2006) · Cited by 10
SAMSON: Secure access for medical smart cards over networks
Hembroff, G. C., & Muftic, S. (2010) · IEEE International Symposium on a World of Wireless, Mobile and Multimedia Networks (WoWMoM) · doi:10.1109/wowmom.2010.5534982 · Cited by 10
Embedding a Hiding Function in a Portable Electronic Health Record for Privacy Preservation
Huang, L.-C., Chu, H.-C., Lien, C.-Y., Hsiao, C., & Kao, T. (2008) · Journal of Medical Systems · doi:10.1007/s10916-008-9243-8 · Cited by 9
Secure Personal Data Servers: a Vision Paper
Allard, T., Anciaux, N., Bouganim, L., Guo, Y., Folgoc, L. L., Nguyen, B., Pucheral, P., Ray, I., Ray, I., & Yin, S. (2010) · Cited by 8
A role-based delegation framework for healthcare information systems
Zhang, L., Ahn, G., & Chu, B.-T. B. (2002) · doi:10.1145/507729.507731 · Cited by 8
Discretionary Overriding of Access Control in the Privilege Calculus
Rissanen, E., Firozabadi, B. S., & Sergot, M. J. (2005) · Springer eBooks · doi:10.1007/0-387-24098-5_16 · Cited by 7
Digital signatures and the electronic health records: providing legal and security guarantees
Bos, J. J. (1996) · International Journal of Bio-Medical Computing · doi:10.1016/0020-7101(96)01195-6 · Cited by 7
Chief medical officer actions on information security in an Italian rehabilitation centre
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A secure web-based approach for accessing transitional health information for people with traumatic brain injury
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Flagged first, then by citations

4 of the 127 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

Sainz-Abajo, 2010, Evolución, beneficios y obstáculos en la implantación del Historial Clínico Electrónico en el sistema sanitario, RevistaeSalud.com, 6, 1
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Sorted by citations

A systematic review of gamification in e-Health
Sardi, L., Idri, A., & Fernández‐Alemán, J. L. (2017) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2017.05.011 · Cited by 1,041
Self-citation
Empirical Studies on Usability of mHealth Apps: A Systematic Literature Review
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“An SLR is a research technique that gathers all empirical evidence in a specific field of study [28].”
Self-citation
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“…and patients medical data sharing) have also attracted the interest of the research community ( Boonstra et al., 2014; Car-valho et al., 2016; Crameri et al., 2020; Fernández-Alemán et al., 2013a; Ho et al., 2019; Lluch, 2011; Miah et al., 2019; Strudwick and Eyasu, 2015; Tovanich et al., 2020 ).”

See all 675

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)
DOI: 10.1016/j.jbi.2012.12.003
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
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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Security and privacy in electronic health records: a systematic literature review.

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