The COVID-19 pandemic further outlined the importance of global healthcare services provisioning for diagnosing and treating patients who tend to travel and live for large periods away from home and can be anywhere at any given time. Advances in technology enable healthcare practitioners to access critical data regarding a person’s health status to provide better services. Medical data are sensitive in nature, and therefore, a reliable mechanism should ensure that only authorized entities can access data when needed. This paper, through a layered consideration of a Globalized Healthcare Provisioning Ecosystem (GHPE), reveals the interdependencies among its major components and suggests a necessary abstraction to identify requirements for the design of an access control suitable for the ecosystem. These requirements are imposed by the nature of the medical data as well as by the newly introduced potentials of Internet of Medical Things (IoMT) devices. As a result, an attribute-based access control framework is proposed aiming to provide prompt and secure access to medical data globally by utilizing state-of-the-art technologies and standards, including Next-Generation Access Control (NGAC), blockchain and smart contracts. Three types of smart contracts are proposed that enable access control to implement attribute and policy stores where policy classes and attributes are decentralized and immutable. In addition, the usage of blockchain-based distributed identities allows patients to be in control of access to their medical data and also enables healthcare service providers to access medical data promptly and reliably through the proposed access control framework. The qualitative characteristics of the proposed approach toward a decentralized and patient-centric access control in GHPE are demonstrated and discussed based on an application paradigm.

Medical images are an integral and indispensable part of health care information systems. Because of the critical nature of image information and stringent privacy requirements in medical environments, the medical images database systems must provide reasonable safeguards to assure confidentiality, integrity and availability of images to be deployable. In this paper we address mainly the confidentiality issues. Only authorised users should have for example access to medical images. Access to images is usually based on certain security constraints. Security constraints processing is a widely used mechanism for obtaining the appropriate level of the security required in traditional (nonmultimedia) database systems. However, the security constraints processing in multimedia environments posses a number of interesting problems. In this paper we address the advantages and problems of using content-based security constraints on medical image databases. We also propose a methodology for the integration of security constraints into medical image databases, taking into account the true multimedia nature of the medical images (e.g. the content of the medical images).

This paper describes the methodology used and the experience gained from the application of a new secure database design approach and database security policy in a real life hospital environment. The applicability of the proposed database security policy in a major Greek general hospital is demonstrated. Moreover, the security and quality assurance of the developed prototype secure database is examined, taking into consideration the results from the study of the user acceptance.