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In modern healthcare domain, electronic health records (EHRs) (DesRoches et al., 2008; Eichelberg et al., 2005) have been widely adopted to enable healthcare providers, insurance companies and patients to create, manage and access patients’ healthcare information from anywhere, and at any time. Typically, a patient may have many different healthcare providers including primary care physicians, specialists, therapists, and miscellaneous medical practitioners. Besides, a patient may have different types of insurances, such as medical insurance, dental insurance and vision insurance, from different healthcare insurance companies. As a result, a patient’s EHRs can be found scattered throughout the entire healthcare sector. From the clinical perspective, in order to deliver quality patient care, it is critical to access the integrated patient care information that is often collected at the point of care to ensure the freshness of time-sensitive data (Grimson et al., 2001). This further requires an efficient, secure and low-cost mechanism for sharing EHRs among multiple healthcare providers. Particularly, in some emergency healthcare situations, immediate exchange of patient’s EHRs is crucial to save lives. However, in current healthcare settings, healthcare providers mostly establish and maintain their own electronic medical record (EMR) systems for storing and managing EHRs. Such self-managed data centers are very expensive for healthcare providers. Besides, the sharing and integration of EHRs among EMR systems managed by different healthcare providers are extremely slow and costly. Thus, a common and open infrastructure platform can play a key role in changing such a situation and improve the healthcare quality.
Cloud computing has become a promising computing paradigm drawing extensive attention from both academia and industry (Mell & Grance, 2011). This paradigm shifts the location of computing infrastructure to the network as a service associated with the management of hardware and software resources. It has shown tremendous potential to enhance collaboration, scale, agility, cost efficiency, and availability of services. Hence, healthcare providers along with many other software vendors are more and more willing to shift their EMR systems into clouds instead of building and maintaining their own data centers. Cloud computing, as cornerstone, not only increases the efficiency of medical data management and sharing process, but also enables the access to healthcare ubiquitous since patients’ healthcare related data will be always accessible from anywhere at any time. Therefore, managing healthcare applications in clouds could make revolutionary changes in the way we are dealing with healthcare information today.
It is promising for both healthcare providers and patients to have EHR applications and services in clouds. However, this adoption may also lead to many security challenges associated with authentication, identity management, access control, policy integration, trust management, compliance management and so on (Takabi et al., 2010; Wu et al., 2010). If those challenges cannot be properly resolved, they may hinder the success of tapping healthcare into clouds. Our previous work (Jin et al., 2009; Wu, 2012) focuses on tackling access control issues when EHRs are shared with various healthcare providers in cloud computing environments. Sharing EHRs is one of the key requirements in healthcare domain for delivering high quality of healthcare services. However, the sharing process could be very complex and involved with various entities in such a dynamic environment. Each EMR system in clouds is associated with multiple healthcare practitioners with different duties and objectives. Also, a shared EHR instance may consist of several sensitive portions of patient’s healthcare information such as demographic details, allergy information, medical histories, laboratory test results, and radiology images (X-rays, CTs). Access control solutions must be in place to guarantee that access to sensitive information is limited only to those entities that have a legitimate need-to-know privilege allowed by patients. For example, a patient may not be willing to share his medical information regarding a HIV/AIDS diagnosis with a dentist unless a specific treatment is required.