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Deploying SMC in Practice
Khaled El EmamElectronic Health Information Laboratory & uOttawa
EXAMPLES IN HEALTHCARE SETTINGS
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Researchers’ Need for Data• Digitization, performance-based funding, greater
inter-operability and fiscal pressures make more data available for research
• Linked data allows analyses to span more of the continuum of care and look at social determinants of health
• Severe competition for research funding means there is an urgency to providing access to data to support proposals, funding, and delivery of results
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Benefits of Sharing Research Data
• Confirmation of published results• Availability for meta-analyses• Feedback to improve data quality• Cost savings from not collecting the data
again• Minimize need for participants to provide
data repeatedly• Data for instruction and education
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Benefits of Sharing Data: Commercial• Software testing• Targeted marketing campaigns• Post marketing surveillance• Monetization of data• Information product development• Internal analytics (models for decision
support)• Device diagnostics
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Regulatory Framework
• Legislation and regulations cover personally-identifiable health data
• When not mandated or permitted, use and disclosure of health data for secondary purposes requires either consent or anonymization in accordance with regulations
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Secondary Purposes
• Secondary purposes means non-direct care uses of personal health information including:– Research– Public health– Quality/safety measurement– Payment– Provider certification or accreditation– Marketing– Other commercial activities
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Safran C, Bloomrosen M, Hammond E, Labkoff S, S K-F, Tang P, Detmer D. Toward a national framework for the secondary use of health data: An American Medical Informatics Association white paper. Journal of the American Medical Informatics Association, 2007; 14:1-9.
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Types of Data Flows
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Data Flows
• Uses by an agent/affiliate for secondary purposes (e.g., financial analysis, human resources planning)
• Mandatory disclosures (e.g., communicable diseases, gunshot wounds)
• Permitted discretionary disclosures for secondary purposes (e.g., public health and research)
• Other disclosures for secondary purposes (e.g., marketing)
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Facilitating Disclosure• Privacy and confidentiality concerns have
made many health organizations very reluctant to share data and to take advantage of large scale analytics on the cloud. Three factors contribute:• Regulations that limit disclosure of personal
information• Legitimate concerns
about potential data leaks• Compelled disclosures
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Methods to Facilitate Disclosure• Two options now exist for disclosing
personal information for complex analytics to avoid being the “creepy guy in the room”– Anonymization– Secure multi-party
computation
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
ANONYMIZATION
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
De-identification
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
PARAT
Providing organizations with a scalable solution to automate the anonymization of structured & unstructured data
• Measure risk of re-identification under different attacks
• Transform data to ensure that the risk is below a given threshold
• Configure re-identification risk threshold settings directly from Privacy Analytics’ online Risk Assessment application
• Determine enterprise policies for data sharing to ensure that administrative controls are in place to manage risk
• Automate data sharing agreements and certifications that confirm risks are “very small” for re-identification
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
PARAT Software
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
SECURE COMPUTATION
What is secure computation?
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Secure Computation• A set of techniques (protocols) developed to
allow computations to be performed on encrypted data – do analytics without knowing or exposing the raw data
• Example computations: Public health surveillance: rates, categorical data analysis Rare adverse drug event detection using regression
models (GLM and GEE) for distributed data Secure matching: record lookup without revealing the
record details, matching databases without revealing matching keys
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
SECURE COMPUTATION
How does secure computation work?
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Public key
Encryption
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Randomized Public key
Encryption
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Randomized Public key
Encryption
1 2 1 2 ,If r r then c c but 1 2sk skDec c Dec c m
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Randomized Public key
Encryption
Notation denoting an encrypted
plaintext
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Additively Homomorphic
Encryption
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Additively Homomorphic
Encryption
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Additively Homomorphic
Encryption
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
SECURE SURVEILLANCE
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
ARO Surveillance from Long Term Care Homes in Ontario
Disclosure of Colonization / Infection RatesNot Currently Legally RequiredFrom LTCHs in Ontario
Objective:
Compute colonization rates without knowing the values for any single LTCH
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
DISEASE SURVEILLANCE
Data Aggregator
Key holder[count1] x [count2] x[count3] x [count4] =
[count1 + count2 +count3 + count4]
[count1]
[count2]
[count3]
[count4]
(count1 + count2 +count3 + count4) / 4
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
DISEASE SURVEILLANCE
High Response Rate = 82%
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
DISEASE SURVEILLANCE
Region 0-60 61-120 121-180 180 + Facilities participating / total (%)
North 15 / 18 19 / 25 10 / 15 5 / 5 49 / 63 (77.7)East 23 / 23 34 / 34 25 / 25 13 /15 95 / 97 (97.9)Central East 16 / 16 35 / 41 43 / 49 30 / 34 124 / 140 (88.6)Toronto 3 / 6 5 /7 10 / 12 12 / 13 27 / 38 (71.1)Central West 12 / 13 40 / 46 51 / 56 19 / 22 122 / 137 (89.1)West 23 / 34 42 / 68 23 / 34 7 /10 95 / 146 (65.1)Total(%)
89 / 110 (80.9)
175 / 221 (79.2)
162 / 191 (84.8)
86 / 99 (86.7)
512 / 621 (82.4)
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
DISEASE SURVEILLANCE (MRSA)
Regions
Facility number of beds
Central West
North East Toronto West Central East
Bed group prevalence
0-60 3.31 1.57 3.17 -- 8.38 0.72 3.87
61-120 2.73 1.07 2.04 -- 7.88 1.8 3.34
121-180 3.15 0.56 2.54 0.91 7.83 1.08 2.94
180 + 2.91 -- 2.37 2.58 8.63 1.68 2.61
Regional prevalence
3.00 0.79 2.42 1.86 8.04 1.44
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
ANONYMOUS LINKING
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Anonymous Linking
• Typical use cases:– The best fields to link databases on are quite
sensitive: health insurance number, social security/insurance number, medical record number
– Organizations do not have the authority to exchange data, but need to de-duplicate databases or do lookups
• Anonymous linking allows the linking of records in remote databases without sharing any sensitive or personal information or sharing any secrets
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Generation and
distribution of keys
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Encryption of OHIP# using a
public key
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Encryption of local OHIP# using the
same
public key
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Perform homomorphic
equality test on the two
encrypted values
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Decrypt the results of the equality tests
using the
private key
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Results of matches can be used to de-duplicate, link, or return a lookup
outcome
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
ONLINE & OFFLINE PURCHASES
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Chlamidya Screening
Objective: compute screening rates and evaluate impact of interventions to improve them
Pulling data out of EMRs (family doctors) about females 14-24 eligible for Chlamidya screening and match that with lab data to determine how many have been screened (match rates)
Matching on OHIP#, name, DoB
No release of personal information in the process
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Critical Success Factors / Risks• Embedding within a healthcare environment• Large multi-disciplinary teams• Supporting software after the initial prototype• Academic evaluation criteria• Publishing outside the traditional computer
science community• Managing and protecting IP
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Electronic Health Information Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Ontario; www.ehealthinformation.ca
Contact
@kelemam
www.ehealthinformation.ca