A sharable cloud-based pancreaticoduodenectomy collaborative database for physicians: Emphasis on security and clinical rule supporting

ArticleinComputer methods and programs in biomedicine 111(2) · May 2013with36 Reads
DOI: 10.1016/j.cmpb.2013.04.019 · Source: PubMed
BACKGROUND: Pancreaticoduodenectomy (PD) is a major operation with high complication rate. Thereafter, patients may develop morbidity because of the complex reconstruction and loss of pancreatic parenchyma. A well-designed database is very important to address both the short-term and long-term outcomes after PD. OBJECTIVE: The objective of this research was to build an international PD database implemented with security and clinical rule supporting functions, which made the data-sharing easier and improve the accuracy of data. METHODS: The proposed system is a cloud-based application. To fulfill its requirements, the system comprises four subsystems: a data management subsystem, a clinical rule supporting subsystem, a short message notification subsystem, and an information security subsystem. After completing the surgery, the physicians input the data retrospectively, which are analyzed to study factors associated with post-PD common complications (delayed gastric emptying and pancreatic fistula) to validate the clinical value of this system. RESULTS: Currently, this database contains data from nearly 500 subjects. Five medical centers in Taiwan and two cancer centers in Mongolia are participating in this study. A data mining model of the decision tree analysis showed that elderly patients (>76 years) with pylorus-preserving PD (PPPD) have higher proportion of delayed gastric emptying. About the pancreatic fistula, the data mining model of the decision tree analysis revealed that cases with non-pancreaticogastrostomy (PG) reconstruction - body mass index (BMI)>29.65 or PG reconstruction - BMI>23.7 - non-classic PD have higher proportion of pancreatic fistula after PD. CONCLUSIONS: The proposed system allows medical staff to collect and store clinical data in a cloud, sharing the data with other physicians in a secure manner to achieve collaboration in research.
    • "However, their approach does not specify about the level of trust made on the CA, hence data tempering is possible. Health Personal Cards – HPC are used for the authentication of new physicians by Yu et al. [22], and for the existing physicians the healthcare data access is provided through a secure protocol like Secure Socket Layer—SSL. Eavesdropping is reduced; however this approach has interoperability issues. "
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    • "Accordingly, we classified the literature into two categories: theoretical and empirical. The theoretical category covered articles delivering general statements about CCS in hospitals (e.g., [31]) or proposing CCS that are not yet deployed in practice (e.g., [2]), while the empirical category contained articles describing concrete CCS for hospitals (e.g., [32]). We observed that some articles deliver general statements or features about CC and then apply them to concrete CCS for hospitals (e.g., [33]). "
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    • "Nevertheless, the DIRECT messaging to access request does not specify whether a certificate authority is trusted or not and, therefore, can potentially lead to tampering. Yu et al. [59] presented a methodology that permits the physicians to collect the patients' evidence-based data and share it with other physicians. The privacy of the data is preserved through a secure authentication mechanism. "
    [Show abstract] [Hide abstract] ABSTRACT: Cloud based solutions have permeated in the healthcare domain due to a broad range of benefits offered by the cloud computing. Besides the financial advantages to the healthcare organizations, cloud computing also offers large-scale and on-demand storage and processing services to various entities of the cloud based health ecosystem. However, outsourcing the sensitive health information to the third-party cloud providers can result in serious privacy concerns. This chapter highlights the privacy issues related to the health data and also presents privacy preserving requirements. Besides the benefits of the cloud computing in healthcare, cloud computing deployment models are also discussed from the perspective of healthcare systems. Moreover, some recently developed strategies to mitigate the privacy concerns and to fulfil the privacy preserving requirements are also discussed in detail. Furthermore, strengths and weaknesses of each of the presented strategies are reported and some open issues for the future research are also presented.
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