This survey paper aims to discuss, analyze security challenges and available solutions in cloud computing. Health data are highly sensitive, and safeguarding these data is a high priority for individuals, healthcare providers, and cloud services providers. Security is still critical challenge in the cloud computing Cloud computing is a promising technology that is expected to transform the healthcare industry. The HIPAA Security Rule (Section 164.312(c) (1) Integrity)  states that covered entities must “implement policies and procedures to protect electronic personal healthcare information from improper alteration or destruction.” In a healthcare setting, services that store and manipulate patient data must implement integrity and verification functionality, like nonmedical applications, via the means of a checksum or a hash, before using the data. at storage, and during data deletion . The ultimate vision for working with health Big Data is to support the process of improving the quality of service in healthcare providers, reduce the medical-mistakes, and to provide a promote consultation and answers when needed. e model ensures that ISMS is, established, implemented, assessed, measured where ap-, plicable, and continually improved. This means that the probability of those items being related from the attacker’s perspective stays the same before and after the attacker’s observation . J. M. Victor, “The EU general data protection regulation: toward a property regime for protecting data privacy,”, M. J. Minniti, T. R. Blue, D. Freed, and S. Ballen, “Patient-interactive healthcare management, a model for achieving patient experience excellence,” in, M. Li, S. Yu, Y. Zheng, K. Ren, and W. Lou, “Scalable and secure sharing of personal health records in cloud computing using attribute-based encryption,”, A. Sunyaev, “Evaluation of microsoft healthvault and Google health personal health records,”, A. Sunyaev, D. Chornyi, C. Mauro, and H. Krcmar, “Evaluation framework for personal health records: microsoft healthvault vs. google health,” in. Fog computing aims to process data as close as the service invoker (e.g., IoT wearable health devices), which could help reduce unnecessary latency in eHealth services. ey, should apply the appropriate personal and organizational, measures. Furthermore, respondents indicated that their biggest challenges when connecting between cloud providers for a shared workload are security (54%), reliability (44%), and performance (39%). Establishing information ownership is necessary, for protection against unauthorized access or misuse of, patient’s medical information. Software as a service (SaaS): it is the most popular cloud service, and the software resides on the provider platform. propose a conceptual privacy framework for healthcare, applications. (vi)Solving the scarcity of resources: doctors in remote areas can use telemedicine to perform consultations. ISO/IEC 27001 certification secures information assets and restores patients trust in cloud service providers. Overall, patients will obtain better care because of up-to-date health, records and continuous interactions between diﬀerent, healthcare providers. §§300jj et seq. In this study, we propose a novel method based on Shamir's Secret Share Scheme and multi-cloud concept to avoid data loss and unauthorized access. The main features of cloud computing is that the user does not have any setup of expensive computing infrastructure and the cost of its services is less. More than half of that group said that their cloud usage would be higher than initially planned because of the growing demands posed by remote … The system also provides extra features such as populating EHR from different EHR cloud systems using ABE. Due to many characteristics it has effect on IT budget and also impact on security, privacy and security issues .In this section all these issues are discussed. Infrastructure as a service (IaaS): it provides the infrastructure, operating systems, and applications. It ensures that the entity requesting access is authentic. Currently, various cryptographic techniques have been used to ensure data confidentiality and to avoid data disclosure. If the patient feels that the information he/she gives to his/her doctor is not protected, and that his/her privacy is threatened, he/she can be more selective about the information he/she will provide to his/her doctor in the future. SECURITY ISSUES, CHALLENGES, and METHODS In cloud different types of security issues and challenges are available. Besides mutlicloud architecture, data are spread across, diﬀerent cloud storage systems. Their services are offered to the organization employees. In this paper, the authors discover some cloud benefits in the education sector and discuss limitations of main cloud services as well as highlight security challenges that institutions face when utilizing cloud technologies. The dilemma is that security is negatively proportional to consumer convenience. However, there is no qualitative analysis discussion on the efficiency of the approach and its mitigation to security and privacy attacks . Essentially, the cloud service providers should deal with security concerns in the cloud to enhance the trust level between the patients and healthcare providers [22–24]. pharmacy information system, and medical images. Most of those solutions address part of the problem, and they failed to balance all contradicting security requirements. Edge computing aims at processing data at the edge of the network rather than processing data at the data center as in traditional eHealth cloud solutions. reasons of which some of the most important reasons were. The proposed system uses k-anonymity and Advanced Encryption Standard (AES) [68–70]. and Ciphertext-Policy Attribute-Based Encryption (CP-ABE) to provide fine-grained EMR access control. In this work, we found that the state-, of-the art solutions address only a subset of those concerns. Is the service provider willing to sign a strong HIPAA Business Associate Agreement (BAA) that contains severe punishment in case of terms violation. Breach notiﬁcation is mandatory in all member states, the, new act expects a company to report data breaches to the, penalties. system or provided to any entity are accurate and consistent, with the intended information and have not been modiﬁed, in any way . CLOUD SECURITY ISSUES AND CHALLENGES Cloud computing is a emerging technology with shared resources, lower cost and rely on pay per use according to the user demand. Some. rough an extensive survey of literature, Avancha, et al. e cloud can help the healthcare industry deliver. HIPAA is a legal framework for securing healthcare systems. All eHealth cloud services and data must be error-free. In , Ardagna et al. For example, when healthcare providers use secure systems to communicate with patients about their health, rather than transmitting health data via personal e-mail accounts, this type of data communication is an example of a secure implementation. Yazan Al-Issa, Mohammad Ashraf Ottom, Ahmed Tamrawi, "eHealth Cloud Security Challenges: A Survey", Journal of Healthcare Engineering, vol. proposed model, making it suitable for practical use [71, 72]. eHealth Cloud Security Challenges: A Survey. Security issues are limited; a good example is, Internet, and usually managed by a cloud service, provider. Giving the patient the ability, to edit his/her own medical records might collide with the, doctor’s requirement to guarantee data originality, widespread connectivity have increased the risk of data, breaches. Many healthcare providers use cloud technology with caution due to the risks involved such as unauthorized use or access to private and sensitive health data. Also, the proposed G-CP-ABE framework merges symmetric encryption and Encryption is a technique that is used to scramble cleartext data into ciphertext with a key. The cloud computing provides on demand services over the Internet with the help of a large amount of virtual storage. The proposed protocol can generate a session key among the participants to communicate securely. present a brief overview, )  states that covered entities must “, ” In a healthcare setting, services that store and, For any healthcare cloud system to serve its, Auditing is a security measure that ensures the, e HITECH Act is a healthcare legislation, category provides a practical implementation, ” . Many companies, such as Amazon, Google, Microsoft and so on, accelerate their paces in developing Cloud Computing systems and enhancing their services to provide for a larger amount of users. © 2008-2020 ResearchGate GmbH. head on system performance and resource usage. data become accessible to an augmented number of parties. Cloud computing has many, beneﬁts like ﬂexibility, cost and energy savings, resource sharing, and fast deployment. Below, we outline the important, security and privacy requirements for healthcare application, that patients health data are kept completely undisclosed to, unauthorized entities. Data Routing In Oceanstore:An architecture for global-scale persistent storage, data is secured through replication methods and cryptographic methods. This leads to a substantial use of health data sharing for the improved, accurate, and timely diagnosis. In the present era of Information Technology, almost all big and small scale companies are moving towards cloud to store and manage the data. With the healthcare industry facing a new reality, healthcare applications are steadily impacting the mobility, In recent years, many countries have been trying to integrate electronic health data managed by each hospital to offer more efficient healthcare services. e, ISO/IEC 27000-series brings best practices on information, security management within an Information Security, Figure 2 shows the relationship between diﬀerent ISO/, IEC 27000-series standards. Applying multilayer security measures to guarantee that only authorized users can access the system might slow the system down and collides with the doctors need for fast and quick systems. Globally, this model uses traditional cryptosystems such as AES, RSA to address security issues in cloud storage.  examine the privacy requirements of mobile computing, technologies that have the potential to transform healthcare, industry. In fact, we need just certain shares to reconstruct the secret data rather than using all parts. RQ2. e proposed approach minimizes the computa-, tional overhead and the overall encryption time. erations, models, threats, and precautions. We are committed to sharing findings related to COVID-19 as quickly as possible. e, cloud applications are often generic, and custom, (vi) Vulnerability to attacks: the cloud is prone to dif-, Nowadays, healthcare is centered on accessing medical re-, cords anytime and anywhere. This paper introduces the background and service model of cloud computing. However, security and privacy issues present a Figure 4: eHealth Cloud Security Challenges: A Survey. Diﬀerent security measures like ﬁrewalls, intrusion detection, and the type of encryption and au-. It shows that the ISO/IEC 27000-series standards can be grouped into 4 different categories based on the purpose and scope of each standard. Different security measures like firewalls, intrusion detection, and the type of encryption and authentication techniques should be also checked. same before and after the attacker’s observation . Cloud Security Complexity. Since patient PHR stored in the cloud or at third party, there have been wide privacy issues because patient private, health data could be used by third-party servers or un-, enhance security, it is highly recommended to encrypt, patient data before outsourcing . Section 3 discusses the security requirements, needed by healthcare providers for adopting cloud com-, puting. In this section, we discuss important, security requirements for eHealth systems to address the, arising security and privacy issues hindering the wide-scale. Amazon EC2 is a good example . 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Volterra , an innovator in distributed cloud services, today announced the results of a new survey on cloud-native app, Kubernetes and microservices adoption. Anonymization in healthcare data setting is an active area of, research, with extensive literature; Appari et al. Shah and Prasad list various methods of encryption and, also addresses security and privacy challenges in healthcare, cloud by deploying a novel framework with cloud-based. Removing these data to meet De-identi-.  have proposed the use of 21. trees to store public healthcare records. Keywords: Security Challenges, Electronic Healthcare Record, (iii)Infrastructure as a service (IaaS): it provides the infrastructure, operating systems, and applications.  examine the privacy requirements of mobile computing technologies that have the potential to transform healthcare industry. This article reviews some of the challenges in development and implementation that may create barriers to the safe utilization of these technologies and prevent quality care for patients. Thus, only authorized clinical operators can access data over the cloud. Furthermore, the strengths. It is the service of choice for companies that do not have the necessary capital to buy hardware. For example, section 10 in Figure 3 states “there should be a policy on the use of encryption, plus cryptographic authentication and integrity controls such as digital signatures and message authentication codes, and cryptographic key management” . Markets Community Platform (Figure 1) . (i)Shared resources: clients can share resources like networks, servers, storage, software, memory, and processing simultaneously. In such a scenario, cloud consumers encrypt their data using SSS technique to ensure confidentiality and privacy. This massive amount of data can bring benefits and draw knowledge to individuals, governments, industries, and assess in the process of decisions making. and their alignment with the organization’s strategic goals. What are the security challenges hindering the wide-scale adoption of cloud computing by healthcare providers?(iii)RQ3. CP-ABE scheme to minimize the overall encryption time. design their processes to accommodate consumer privacy, should comply with protection laws, and should monitor, what personal data they hold, where it came from, whom. “Nyse capital markets community platform,” 2017, E. AbuKhousa, N. Mohamed, and J. Al-Jaroodi, “e-health cloud: opportunities and challenges,”, N. Dong, H. Jonker, and J. Pang, “Challenges in eHealth: from enabling to enforcing privacy,” in, S. Allen, “Cloud Computing and Health Care Security,”, S. Haas, S. Wohlgemuth, I. Echizen, N. Sonehara, and G. Müller, “Aspects of privacy for electronic health records,”, A. Abbas and S. U. Khan, “A review on the state-of-the-art privacy-preserving approaches in the e-health clouds,”. Most of data volume have been generated in the past two years. 105-112. A good example is NYSE Capital Markets Community Platform (Figure 1) . Finally, they present some, recommendations for the development of next-generation, cloud security and assurance solutions. Through an extensive survey of literature, Avancha et al. e article also, shows the resilience of the proposed solution to man-in-the-, middle and replay attacks. pp. Cloud computing oﬀers opportunities and challenges. Privacy by design means that service providers should. We are committed to sharing findings related to COVID-19 as quickly as possible. As health care providers begin to explore these opportunities, organizations must develop an understanding of how implementing AI tools will impact patient safety. Consumers do not need to, worry about the software upgrades and mainte-, nance; some limited application conﬁguration ca-, pability might be available to consumers. Smithamol et al. Overall, the goal of using edge and fog computing technologies is to (1) enable fast and prompt interactions for responsive healthcare services as the latency imposed in such services could define the margin between death and life in some critical cases and (2) an increase in the computing power for such services without overwhelming the data center.