A systematic review of homomorphic encryption and its contributions in healthcare industry

Encrypted data-sharing for preserving privacy in wastewater-based epidemiology

The rapidly expanding use of wastewater for public health surveillance requires new strategies to protect privacy rights, while data are collected at increasingly discrete geospatial scales, i.e., city, neighborhood, campus, and building-level. Data collected at high geospatial resolution can inform on labile, short-lived biomarkers, thereby making wastewater-derived data both more actionable and more likely to cause privacy concerns and stigmatization of subpopulations. Additionally, data sharing restrictions among neighboring cities and communities can complicate efforts to balance public health protections with citizens' privacy. Here, we have created an encrypted framework that facilitates the sharing of sensitive population health data among entities that lack trust for one another (e.g., between adjacent municipalities with different governance of health monitoring and data sharing). We demonstrate the utility of this approach with two real-world cases. Our results show the feasibility of sharing encrypted data between two municipalities and a laboratory, while performing secure private computations for wastewater-based epidemiology (WBE) with high precision, fast speeds, and low data costs. This framework is amenable to other computations used by WBE researchers including population normalized mass loads, fecal indicator normalizations, and quality control measures. The Centers for Disease Control and Prevention's National Wastewater Surveillance System shows ∼8 % of the records attributed to collection before the wastewater treatment plant, illustrating an opportunity to further expand currently limited community-level sampling and public health surveillance through security and responsible data-sharing as outlined here.

Privacy-Preserving Prediction of Postoperative Mortality in Multi-Institutional Data: Development and Usability Study

BACKGROUND

To circumvent regulatory barriers that limit medical data exchange due to personal information security concerns, we use homomorphic encryption (HE) technology, enabling computation on encrypted data and enhancing privacy.

OBJECTIVE

This study explores whether using HE to integrate encrypted multi-institutional data enhances predictive power in research, focusing on the integration feasibility across institutions and determining the optimal size of hospital data sets for improved prediction models.

METHODS

We used data from 341,007 individuals aged 18 years and older who underwent noncardiac surgeries across 3 medical institutions. The study focused on predicting in-hospital mortality within 30 days postoperatively, using secure logistic regression based on HE as the prediction model. We compared the predictive performance of this model using plaintext data from a single institution against a model using encrypted data from multiple institutions.

RESULTS

The predictive model using encrypted data from all 3 institutions exhibited the best performance based on area under the receiver operating characteristic curve (0.941); the model combining Asan Medical Center (AMC) and Seoul National University Hospital (SNUH) data exhibited the best predictive performance based on area under the precision-recall curve (0.132). Both Ewha Womans University Medical Center and SNUH demonstrated improvement in predictive power for their own institutions upon their respective data's addition to the AMC data.

CONCLUSIONS

Prediction models using multi-institutional data sets processed with HE outperformed those using single-institution data sets, especially when our model adaptation approach was applied, which was further validated on a smaller host hospital with a limited data set.

GEN-RWD Sandbox: bridging the gap between hospital data privacy and external research insights with distributed analytics

BACKGROUND

Artificial intelligence (AI) has become a pivotal tool in advancing contemporary personalised medicine, with the goal of tailoring treatments to individual patient conditions. This has heightened the demand for access to diverse data from clinical practice and daily life for research, posing challenges due to the sensitive nature of medical information, including genetics and health conditions. Regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. and the General Data Protection Regulation (GDPR) in Europe aim to strike a balance between data security, privacy, and the imperative for access.

RESULTS

We present the Gemelli Generator - Real World Data (GEN-RWD) Sandbox, a modular multi-agent platform designed for distributed analytics in healthcare. Its primary objective is to empower external researchers to leverage hospital data while upholding privacy and ownership, obviating the need for direct data sharing. Docker compatibility adds an extra layer of flexibility, and scalability is assured through modular design, facilitating combinations of Proxy and Processor modules with various graphical interfaces. Security and reliability are reinforced through components like Identity and Access Management (IAM) agent, and a Blockchain-based notarisation module. Certification processes verify the identities of information senders and receivers.

CONCLUSIONS

The GEN-RWD Sandbox architecture achieves a good level of usability while ensuring a blend of flexibility, scalability, and security. Featuring a user-friendly graphical interface catering to diverse technical expertise, its external accessibility enables personnel outside the hospital to use the platform. Overall, the GEN-RWD Sandbox emerges as a comprehensive solution for healthcare distributed analytics, maintaining a delicate equilibrium between accessibility, scalability, and security.

A data-driven approach to choosing privacy parameters for clinical trial data sharing under differential privacy

OBJECTIVES

Clinical trial data sharing is crucial for promoting transparency and collaborative efforts in medical research. Differential privacy (DP) is a formal statistical technique for anonymizing shared data that balances privacy of individual records and accuracy of replicated results through a "privacy budget" parameter, ε. DP is considered the state of the art in privacy-protected data publication and is underutilized in clinical trial data sharing. This study is focused on identifying ε values for the sharing of clinical trial data.

MATERIALS AND METHODS

We analyzed 2 clinical trial datasets with privacy budget ε ranging from 0.01 to 10. Smaller values of ε entail adding greater amounts of random noise, with better privacy as a result. Comparison of rates, odds ratios, means, and mean differences between the original clinical trial datasets and the empirical distribution of the DP estimator was performed.

RESULTS

The DP rate closely approximated the original rate of 6.5% when ε > 1. The DP odds ratio closely aligned with the original odds ratio of 0.689 when ε ≥ 3. The DP mean closely approximated the original mean of 164.64 when ε ≥ 1. As ε increased to 5, both the minimum and maximum DP means converged toward the original mean.

DISCUSSION

There is no consensus on how to choose the privacy budget ε. The definition of DP does not specify the required level of privacy, and there is no established formula for determining ε.

CONCLUSION

Our findings suggest that the application of DP holds promise in the context of sharing clinical trial data.

Existing Barriers Faced by and Future Design Recommendations for Direct-to-Consumer Health Care Artificial Intelligence Apps: Scoping Review

BACKGROUND

Direct-to-consumer (DTC) health care artificial intelligence (AI) apps hold the potential to bridge the spatial and temporal disparities in health care resources, but they also come with individual and societal risks due to AI errors. Furthermore, the manner in which consumers interact directly with health care AI is reshaping traditional physician-patient relationships. However, the academic community lacks a systematic comprehension of the research overview for such apps.

OBJECTIVE

This paper systematically delineated and analyzed the characteristics of included studies, identified existing barriers and design recommendations for DTC health care AI apps mentioned in the literature and also provided a reference for future design and development.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and was conducted according to Arksey and O'Malley's 5-stage framework. Peer-reviewed papers on DTC health care AI apps published until March 27, 2023, in Web of Science, Scopus, the ACM Digital Library, IEEE Xplore, PubMed, and Google Scholar were included. The papers were analyzed using Braun and Clarke's reflective thematic analysis approach.

RESULTS

Of the 2898 papers retrieved, 32 (1.1%) covering this emerging field were included. The included papers were recently published (2018-2023), and most (23/32, 72%) were from developed countries. The medical field was mostly general practice (8/32, 25%). In terms of users and functionalities, some apps were designed solely for single-consumer groups (24/32, 75%), offering disease diagnosis (14/32, 44%), health self-management (8/32, 25%), and health care information inquiry (4/32, 13%). Other apps connected to physicians (5/32, 16%), family members (1/32, 3%), nursing staff (1/32, 3%), and health care departments (2/32, 6%), generally to alert these groups to abnormal conditions of consumer users. In addition, 8 barriers and 6 design recommendations related to DTC health care AI apps were identified. Some more subtle obstacles that are particularly worth noting and corresponding design recommendations in consumer-facing health care AI systems, including enhancing human-centered explainability, establishing calibrated trust and addressing overtrust, demonstrating empathy in AI, improving the specialization of consumer-grade products, and expanding the diversity of the test population, were further discussed.

CONCLUSIONS

The booming DTC health care AI apps present both risks and opportunities, which highlights the need to explore their current status. This paper systematically summarized and sorted the characteristics of the included studies, identified existing barriers faced by, and made future design recommendations for such apps. To the best of our knowledge, this is the first study to systematically summarize and categorize academic research on these apps. Future studies conducting the design and development of such systems could refer to the results of this study, which is crucial to improve the health care services provided by DTC health care AI apps.

Privacy-Preserving Computation for Peer-to-Peer Energy Trading on a Public Blockchain

To ensure the success of energy transition and achieve the target of reducing the carbon footprint of energy systems, the management of energy systems needs to be decentralized. Public blockchains offer favorable features to support energy sector democratization and reinforce citizens' trust, such as tamper-proof energy data registration and sharing, decentralization, transparency, and support for peer-to-peer (P2P) energy trading. However, in blockchain-based P2P energy markets, transactional data are public and accessible, which raises privacy concerns related to prosumers' energy profiles while lacking scalability and featuring high transactional costs. In this paper, we employ secure multi-party computation (MPC) to assure privacy on a P2P energy flexibility market implementation in Ethereum by combining the prosumers' flexibility orders data and storing it safely on the chain. We provide an encoding mechanism for orders on the energy market to obfuscate the amount of energy traded by creating groups of prosumers, by splitting the amount of energy from bids and offers, and by creating group-level orders. The solution wraps around the smart contracts-based implementation of an energy flexibility marketplace, assuring privacy features on all market operations such as order submission, matching bids and offers, and commitment in trading and settlement. The experimental results show that the proposed solution is effective in supporting P2P energy flexibility trading, reducing the number of transactions, and gas consumption with a limited computational time overhead.

A Review of Homomorphic Encryption for Privacy-Preserving Biometrics

The advancement of biometric technology has facilitated wide applications of biometrics in law enforcement, border control, healthcare and financial identification and verification. Given the peculiarity of biometric features (e.g., unchangeability, permanence and uniqueness), the security of biometric data is a key area of research. Security and privacy are vital to enacting integrity, reliability and availability in biometric-related applications. Homomorphic encryption (HE) is concerned with data manipulation in the cryptographic domain, thus addressing the security and privacy issues faced by biometrics. This survey provides a comprehensive review of state-of-the-art HE research in the context of biometrics. Detailed analyses and discussions are conducted on various HE approaches to biometric security according to the categories of different biometric traits. Moreover, this review presents the perspective of integrating HE with other emerging technologies (e.g., machine/deep learning and blockchain) for biometric security. Finally, based on the latest development of HE in biometrics, challenges and future research directions are put forward.