A review of secure and privacy-preserving medical data sharing

Probably not a substantial claim: may not pass S3 (load-bearing).

HIPAA regulation covers almost every aspect of security.

“Table 1 lists a collection of technical safeguard standards along with implementation specifications, where we can see that the HIPAA regulation covers almost every aspect of security.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Zhao et al.'s fuzzy vault-based key management scheme lacks details of how their health blockchain works.

“But their work lack details of how their health blockchain works.”

• cites [59]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Peterson et al.'s blockchain-based cross-institutional health information sharing framework does not mention how medical data are organized, stored, and accessed, and its privacy-preserving keyword searches lack algorithmic details.

“However, the paper does not mention how the medical data are organized, stored, and accessed.The privacy-preserving keyword searches adopted in their framework lack algorithmic details.”

• cites [53]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Narayan et al.'s patient-centric EHR system lacked algorithmic details about the adopted bABE and PKES schemes.

“However, their design lacked algorithmic details about adopted bABE and PKES schemes.”

• cites [31]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Security and privacy protection of medical information covers confidentiality, integrity, and authenticity of data in transit and at rest, and access and privacy control.

“We observed that security and privacy protection of medical information covers confidentiality, integrity, and authenticity of data in transit and at rest, access and privacy control, etc.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

There is no strong evidence showing that one type of blockchain can completely substitute the other type.

“Despite the debate over permissioned and permissionless blockchains throughout academia and industry, there is no strong evidence showing that one type can completely substitute the other type.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The security and privacy of healthcare information should be protected not only from external attackers, but also from unauthorized access from within the network or system.

“Generally, the difficulty primarily lies in that the security and privacy of healthcare information should be protected not only from external attackers, but also from unauthorized access from within the network or system [6].”

• cites [6]Not checked yet

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May combine two claims.

t-closeness offers complete privacy but severely impairs the correlations between key attributes and confidential attributes.

“In contrast, t-closeness offers complete privacy but severely impairs the correlations between key attributes and confidential attributes.”

May combine two claims.

The multi-tenancy characteristic of public cloud services exposes data to different types of attacks, and such attacks are difficult to detect or monitor in a shared VM environment.

“However, the multi-tenancy characteristic of public cloud services decides virtual machines are shared among various applications that expose the data to different types of attacks.Worse still, it is difficult to detect or monitor such attacks in a shared VM environment.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Data interoperability remains a significant issue in cloud environments due to the incompatibility of various cloud services.

“It should be noted that data interoperability remains a significant issue in cloud environments due to the incompatibility of various cloud services.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Secure management of healthcare data is a hybrid approach, which requires various mechanisms and technical means to be incorporated to meet security and privacy targets.

“This implies that the secure management of healthcare data is a hybrid approach, which requires various mechanisms and technical means to be incorporated to meet these security and privacy targets.”

May combine two claims.

The closed-domain approach has created medical data silos scattered throughout various healthcare institutions, preventing collaborative healthcare treatment and medical research.

“This has created the medical data silos of today that are scattered throughout various healthcare institutions, preventing collaborative healthcare treatment and medical research.”

Probably not a substantial claim: may not pass S4 (based).

The cyberinfrastructure boundaries of healthcare organizations and privacy leakage threats place obstacles on the sharing of medical records.

“However, the cyberinfrastructure boundaries of healthcare organizations and privacy leakage threats place obstacles on the sharing of medical records.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Whether private or public clouds are adopted for healthcare management to guarantee data security and privacy, a basic requirement is data encryption.

“Whether private or public clouds are adopted for healthcare management to guarantee data security and privacy, a basic requirement is data encryption.”

Probably not a substantial claim: may not pass S2 (checkable).

More advanced cryptographic primitives with rich access control semantics and strict confidentiality enforcement are required for medical data sharing across multiple healthcare domains.

“Hence, more advanced cryptographic primitives with rich access control semantics and strict confidentiality enforcement are required.”

May combine two claims.

Storing data on a public blockchain can be very expensive; it is financially impractical to store detailed clinical information of millions of patients on chain.

“Storing data on a public blockchain can be very expensive.It is financially impractical to store detailed clinical information of millions of patients on chain.”

• cites [15] sourceNot checked yet

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Probably not a substantial claim: may not pass S4 (based).

Blockchain, as a public ledger characterized by transparency, tamper-evidence, trustlessness, and decentralization, can help build a secure medical data exchange network.

“Blockchain, as a public ledger characterized by its transparency, tamper-evidence, trustlessness, and decentralization, can help build a secure medical data exchange network.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

How to enforce cross-domain access control and secure sharing of medical data in a state-wide or even national scale remains a challenging task.

“However, how to enforce cross-domain access control and secure sharing of medical data in a state-wide or even national scale remains a challenging task.”

May combine two claims.

The direct consequence of the network defense perimeter is the lack of data interoperability on medical information, which further poses a barrier to medical analytics that require a large amount of clinical information.

“The direct consequence of this network defense perimeter is the lack of data interoperability on medical information, which further poses a barrier to medical analytics that require a large amount of clinical information.”

May combine two claims.

Letting cloud users manage encryption keys enhances data security and provides better control, but it burdens users with distributing keys to authorized users, limiting scalability of sharing data among many institutions.

“Letting cloud users manage encryption keys certainly will enhance data security and provide better control; however, it would be a troublesome burden for users to distribute corresponding keys to authorized users, which limits its scalability of sharing data among a large number of institutions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Public clouds support scalability and data sharing well.

“On the other hand, public clouds support scalability and data sharing well.”

May combine two claims.

Most existing healthcare systems are built on an enclosed domain with a network defense perimeter to prevent outside attacks and threats, which is a huge hurdle to cross-institutional data sharing.

“Most existing healthcare systems are built on an enclosed domain with a network defense perimeter to prevent outside attacks and threats.This is a huge hurdle to cross-institutional data sharing due to two reasons:”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Permissioned blockchain requires certain permission to access the blockchain; participants are selected in advance and only authorized nodes can access information stored on the blockchain.

“Instead, consortium blockchain requires certain permission to access the blockchain.This means that participants are selected in advance and only those authorized nodes can be allowed to access information stored on the blockchain.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The era of cloud computing and big data necessitates that medical data be shared among various users and institutions to allow analysis, so that better healthcare service and new treatment plans can be provided.

“On the other hand, the era of cloud computing and big data necessitates that medical data be shared among various users and institutions to allow analysis, so that better healthcare service and new treatment plans can be provided.”

May combine two claims.

Public blockchain is usually crypto-currency driven, so a certain amount of cryptocurrency has to be paid for transaction inclusion and block mining.

“However, public blockchain is usually crypto-currency driven (bitcoins in Bitcoin or ether in Ethereum), which means a certain amount of cryptocurrency 2 has to be paid for transaction inclusion and block mining.”

• cites [15] sourceNot checked yet

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May combine two claims.

Data immutability in public blockchain is discounted in consortium blockchain, which opens up the possibility of blockchain rollback by an attacker or a certain authority member.

“Therefore, the data immutability in public blockchain is discounted in consortium blockchain, which opens up the possibility of blockchain rollback by an attacker or a certain authority member.”

May combine two claims.

On-chain storage of medical information is not a good choice, due to the limited block size in current blockchains and the bandwidth waste required to achieve network consensus.

“From the above analysis, it can be seen that on-chain storage of medical information is not a good choice due to the limited block size in current blockchains and the bandwidth waste to achieve network consensus.”

• AssumptionRests on an assumption: The block size in Bitcoin is limited to one megabyte, which is insufficient to store medical data such as X-ray images.

May combine two claims.

Adopting permissionless blockchain for medical data sharing requires cryptocurrency, and a great amount of money is needed to run the network for healthcare data management.

“Another challenge of adopting permissionless blockchain for medical data sharing would be cryptocurrency, which is the incentive that makes the behind consensus protocol work.”

• Also stated in: § 3) PERMISSIONED OR PERMISSIONLESS BLOCKCHAIN? · plain

  “That means a great amount of money (cryptocurrency) is needed to run the network for healthcare data management.”

• AssumptionRests on an assumption: In medical data management, data access happens very frequently.

Probably not a substantial claim: may not pass S3 (load-bearing).

The permissioned blockchain setting is similar to the medical data sharing scenario, where only healthcare stakeholders (patients, healthcare providers, and authorized medical researchers) can be allowed to access information based on their authorized permissions.

“Such a setting is similar to the medical data sharing scenario, where only healthcare stakeholders (patients, healthcare providers, and authorized medical researchers) can be allowed to access that information based on their authorized permissions.”

Probably not a substantial claim: may not pass S4 (based).

Once a healthcare system is compromised, all medical information could be leaked.

“once a healthcare system is compromised, then all medical information could be leaked”

May combine two claims.

Over 50% of security breaches occur in the medical industry, with up to 90% of healthcare organizations having exposed their data or had it stolen.

“According to a 2014 study [68], over 50% of security breaches occur in the medical industry, with up to 90% of healthcare organizations having exposed their data or had it stolen.”

• cites [68]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Due to HIPAA privacy and security regulations, medical data management should provide secure storage of raw medical information (confidentiality, integrity), privacy-preserving data provision (data authenticity, user authentication, access control), auditability, traceability, and data interoperability.

“Due to the privacy and security regulations of HIPAA, medical data management should provide secure storage of raw medical information (confidentiality, integrity), privacypreserving data provision (data authenticity, user authentication, access control), auditability, traceability, and data interoperability.”

• cites [3]Not checked yet

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May combine two claims.

Storing medical information on-chain leads to poor throughput and performance because on-chain transactions and blocks must be downloaded locally by every peer node, causing great bandwidth waste.

“However, this naive approach will lead to poor throughput and performance since on-chain transactions and blocks need to be downloaded locally by every peer node, which leads to a great bandwidth waste.”

May combine two claims.

Data encryption can be the last line of defense when a healthcare system is compromised, because an attacker can learn nothing about the encrypted data without the corresponding encryption key.

“Data encryption can be the last line of defense when a healthcare system is compromised because an attacker can learn nothing about the encrypted data if one cannot obtain the corresponding encryption key.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Broadcast encryption lets an owner encrypt a small piece of data to a subset of users, and only users in the subset can decrypt the broadcast message to recover the data.

“Broadcast encryption was first introduced in [70] and improved in [71], [72], which let an owner encrypt a small piece of data to a subset of users.Only users in the subset can decrypt the broadcast message to recover the data.”

• cites [70]Not checked yet

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• cites [71]Not checked yet

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• cites [72] sourceNot checked yet

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Probably not a substantial claim: may not pass S4 (based).

Blockchain, as a secured and transparent public ledger, can guarantee the integrity of on-chain stored data (transactions and blocks).

“Blockchain itself is a secured and transparent public ledger that can guarantee the integrity of on-chain stored data (transactions and blocks).”

May combine two claims.

Li et al.'s ABE-based scheme for personal health records gives patients full control of their medical information but poses too much burden on patients because patient-side applications must generate and distribute keys to authorized users.

“Despite patients' full control of their medical information, the scheme poses too much burden on patients, since the patient side applications are required to generate and distribute corresponding keys to authorized users.”

• cites [27]Not checked yet

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May combine two claims.

Despite a strict access control policy deployed in a healthcare system, an internal IT technical staff member can still easily access the data, which makes data confidentiality difficult to guarantee.

“despite the strict access control policy deployed in a healthcare system, an internal IT technical staff member still can easily ''touch'' the data, which makes data confidentiality difficult to guarantee.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Encryption of medical data and secured key storage are two necessary steps to enhance the security and privacy of medical information.

“we believe that encryption of medical data and secured key storage are two necessary steps to enhance the security and privacy of medical information.”

May combine two claims.

Fan et al.'s MedBlock does not explicitly explain the access control policy to allow third-party researchers to access medical data, and its proposal to use asymmetric encryption for medical information is not a good option considering encryption/decryption performance.

“However, the authors did not explicitly explain the access control policy to allow third-party researchers to access medical data.Moreover, their proposal of using asymmetric encryption algorithms to encrypt medical information does not seem to be a good option considering the encryption/decryption performance of asymmetric encryption.”

• cites [52]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Secure sharing of medical data involves patients, healthcare providers, and third-party medical researchers.

“Secure sharing of medical data involves patients, healthcare providers, and third-party medical researchers.”

May combine two claims.

Guo et al.'s scheme encapsulates and stores health records in on-chain blocks, which limits its scalability because the size of on-chain stored data has a great impact on network throughput.

“However, their scheme encapsulates and stores health records in on-chain blocks, which limits its scalability since the size of on-chain stored data has a great impact on the network throughput.”

• cites [30]Not checked yet

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May combine two claims.

Most data has a life cycle, which makes it unnecessary to store such data permanently.

“Most data has its life cycle, which makes it unnecessary to store these data permanently.”

May combine two claims.

Permissioned blockchain is far from a perfect solution for secure medical data sharing; its most notable disadvantage is the necessity of a central authority.

“However, in spite of its high throughput, permissioned blockchain is far from a perfect solution for secure medical data sharing.The most notable disadvantage is the necessity of a central authority, which is usually comprised of a group of companies with a shared interest that will run the blockchain network and oversee the whole system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

On-chain stored data cannot be altered or deleted because blockchain is a continually growing public ledger.

“On-chain stored data cannot be altered or deleted because blockchain is a continually growing public ledger.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Permissioned and permissionless blockchains primarily differ in their adopted consensus protocols, which in turn greatly affect throughput, block mining time, access policies, and privacy.

“permissioned and permissionless blockchain primarily differ in their adopted consensus protocols, which in turn have a great impact on throughput, block mining time, access policies, and privacy.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Attribute-based encryption can be divided into key-policy ABE (keys associated with access policies, ciphertext with an attribute set) and ciphertext-policy ABE (keys associated with an attribute set, ciphertext with access policies).

“Generally, it can be divided into two categories: (a) key-policy attribute-based encryption (KP-ABE) [76] where keys are associated with access policies and ciphertext is associated with an attributes set; and (b) ciphertext-policy attributebased encryption (CP-ABE) [76] where keys are associated with an attributes set and ciphertext is associated with access policies.”

• cites [76]Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

As a new computing paradigm, blockchain has advantages over traditional technologies.

“As a new computing paradigm, blockchain has its advantages over traditional technologies.”

May combine two claims.

In both KP-ABE and CP-ABE a central authority is required to issue and validate private keys, which renders them unsuitable for a distributed environment where data sharing takes place across different administrative domains.

“In both schemes, a central authority is required to issue and validate private keys, rendering them unsuitable for a distributed environment where data sharing takes place across different administrative domains.”

Classified as probably not a substantial claim.

A secure healthcare system still needs to employ appropriate cryptographic primitives to achieve confidentiality, integrity, access control, and privacy protection.

“Hence, a secure healthcare system still needs to employ appropriate cryptographic primitives to achieve confidentiality, integrity, access control, and privacy protection.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Advanced cryptographic primitives (e.g., IBE, ABE, PRE) are becoming widely deployed to enforce strict and flexible access control of encryption keys.

“advanced cryptographic primitives (e.g., IBE, ABE, PRE) is becoming widely deployed to enforce strict and flexible access control of encryption keys.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Constructing a hybrid blockchain architecture may cause great complexities in the management of consensus executions, including block mining, data access control, and data provision.

“However, this may cause great complexities in the management of consensus executions, including block mining, data access control, and data provision.”

May combine two claims.

IBE eliminates the need for a public key distribution infrastructure and allows any pair of users to communicate securely without exchanging private or public keys.

“IBE eliminates the need for a public key distribution infrastructure.It allows any pair of users to communicate securely without exchanging private or public keys”

Probably not a substantial claim: may not pass S2 (checkable).

It is difficult to predict the extent to which the security and privacy mechanisms of different healthcare institutes will be compatible with each other.

“Since each healthcare institute can be regarded as an independent domain equipped with its own security and privacy mechanism, it is difficult to predict the extent to which these mechanisms will be compatible with each other.”

• AssumptionRests on an assumption: Each healthcare institute can be regarded as an independent domain equipped with its own security and privacy mechanism.

Probably not a substantial claim: may not pass S3 (load-bearing).

Smart contracts are the core element for implementing the business logic of blockchain-based medical data sharing.

“Smart contracts, as a series of self-executing contractual states without third parties, are the core element to implementing the business logic of blockchain-based medical data sharing.”

Probably not a substantial claim: may not pass S2 (checkable).

Medical data should be stored off-chain in encrypted form, for network throughput and security reasons.

“it is clear that medical data should be stored off-chain in encrypted form due to network throughput and security reasons.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Identity-based encryption was first proposed by Shamir in 1984, who suggested that a public key can be an arbitrary string, and was then improved by Boneh and Franklin using Weil pairing over elliptic curves.

“The concept of identity-based encryption (IBE) was first proposed by Shamir [73] in 1984, who suggested that a public key can be an arbitrary string, and then improved by Boneh and Franklin [74] using Weil pairing over elliptic curves.”

• cites [73]Not checked yet

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• cites [74]Not checked yet

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May combine two claims.

Multi-Authority Attribute-Based Encryption schemes need no central authority and guarantee collusion resistance.

“Multi-Authority Attribute-Based Encryption (MA-ABE) [77]- [79] schemes are proposed, where no central authority is needed and collusion resistance is guaranteed.”

• cites [77]- [79]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The question of whether to adopt permissioned or permissionless blockchain remains open with no apparent solution.

“Yet the third question-whether to adopt permissioned or permissionless blockchain-remains open with no apparent solution.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Proxy re-encryption is a cryptosystem that allows a third party (proxy) to alter a ciphertext encrypted by one party so that it can be decrypted by another authorized party.

“Proxy re-encryption (PRE), proposed by Blaze et al. [80] in 1998 and improved by Ateniese et al. [81], [82] in 2006, is a cryptosystem that allows a third party (proxy) to alter a ciphertext encrypted by one party so that it can be decrypted by another authorized party.”

• cites [80]Not checked yet

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• cites [81]Not checked yet

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• cites [82]Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable).

A practical approach for medical data sharing may need to integrate many different techniques to achieve its design goals.

“Therefore, a practical approach for medical data sharing may need to integrate many different techniques to achieve its design goals.”

May combine two claims.

Searchable symmetric encryption can enforce keyword search on outsourced encrypted data, avoiding the decryption process and thereby enhancing query efficiency without the risk of data leakage.

“Searchable symmetric encryption (SSE) [83] can enforce keyword search on outsourced encrypted data, which avoids the decryption process and thereby enhances query efficiency without the risk of data leakage.”

• cites [83]Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Differentiating various EMR fields by sensitivity is of critical importance for privacy control.

“However, the differentiation of various EMR fields in sensitivity is also of critical importance for privacy control.”

Classified as probably not a substantial claim. May combine two claims.

Centralized control by one entity creates a central point of attack, and the programmability associated with the SDN platform adds security risks.

“However, centralized control by one entity has the disadvantage of creating a central point of attack.Moreover, the programmability associated with the SDN platform adds security risks.”