Security and Communication Networks
Volume 2020 (2020), Article ID 8899409, 18 pages
https://doi.org/10.1155/2020/8899409

Research Article

Enhancing Transaction Security for Handling Accountability in Electronic Health Records

Chian Techapanupreed and Werasak Kurutach

Faculty of Information Science and Technology, Mahanakorn University of Technology, Bangkok 10530, Thailand

Correspondence should be addressed to Chian Techapanupreed; wiztech_ict@yahoo.com

Received 14 March 2020; Revised 28 July 2020; Accepted 8 August 2020; Published 1 September 2020

Academic Editor: Petros Nicopolitidis

Copyright © 2020 Chian Techapanupreed and Werasak Kurutach. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Electronic healthcare systems have received extensive attention during the last decade due to the advancement of digital technology. Using these systems in the healthcare industry can improve the quality of healthcare services tremendously. However, a major issue that needs to be concerned, when utilizing this kind of system, is accountability. Employments of electronic health records, the core of the systems, without accountability can be a big risk to both patients and service personals and, consequently, to the entire society. Accountability in electronic health records is essential to creating trust among parties. Many researchers have been introduced to the accountability protocol. However, most of them still lack some essential security property that is mutual authentication. This leads to both information traceability and nonrepudiation which are necessary for resolving any conflict that may arise. In this paper, we propose accountability protocol for electronic health records; the protocol employs both asymmetric and symmetric encryptions to ensure that the electronic health records are having confidentiality, integrity, authentication, and authorization. The accountability analysis and performance analysis show that the proposed protocol is more capable and effective than others. The novel aspect of this idea lies in the inclusion of certain forms of security that are necessary to protect the patient’s electronic health records. To the best of our knowledge, the proposed protocol consumes less cost, energy, and time compared with the existing protocols. A proof of concept of our protocol is also presented in this paper by using BAN logic, an automated security protocol proof tool named Scyther, and AVISPA

1. Introduction

During the past decade, electronic health records (EHRs) have been an attractive topic in the healthcare industry. It has been recognized that EHRs can improve the quality of healthcare services tremendously. However, the realization of the systems in the real world is not straightforward because it still faces a major obstacle to transaction accountability concerning patient data. Obviously, with no accountability, patient privacy could be violated and confidential data could be leaked. As a result, their personal life could be ruined. Thus, in order to implement EHRs successfully, the accountability issue needs to be treated properly. The formal definitions of accountability in information systems have been presented in various ways. For example, Feigenbaum et al. and Weitzner et al. [1, 2] defined accountability as referring to an entity that is accountable concerning a certain policy. If this entity violates accountability, a punishment will be raised. According to Gajanayake et al. [3–5], information accountability concerns the use of information where the user is held liable to explain, justify, or answer for its use when so requested by the party to whom the information belongs. Accountability in the computer security systems is the requirement that actions of an entity may be traced uniquely to that entity and directly supports nonrepudiation, deterrence, fault isolation, intrusion detection and prevention, and after-action recovery and legal action that involve confidentiality, integrity, authentication, and authorization of the transaction by all relevant parties [6]. However, the accountability in healthcare is an audit trail, a record of exactly what was done, who did it, and how they did it; in other words, verify, analyze, and investigate users’ actions [7, 8].

Basically, the systems must be able to authenticate every party who is authorized to carry out a transaction and also to keep all transactional data confidential and integrity. When a dispute arises, the systems can disclose necessary information to clarify all activities within the transaction in order to resolve it. This will make all involved parties unable to deny their actions in the transaction. Until recently, there have been a lot of researchers investigating accountability in healthcare records. However, most of them [9–16] proposed protocols that cannot handle full accountability because of the lack of mutual authentication, which is a preliminary mechanism for nonrepudiation. Hence, when a dispute arises, transactional information cannot be traced, and an engaging party may be able to deny its action. That is to say, the dispute cannot be resolved, and therefore, there is no accountability in the system. In this paper, we proposed an accountability model and a novel protocol that can handle the accountability, as defined by the model, in healthcare records and their transactions. The protocol possesses all necessary properties of security and can provide confidential evidence to a trustworthy party in case of a dispute. The details of existing protocols will be discussed in Section 2, and the comparison of the existing protocols and the proposed protocol is given in Section 4.

This paper is organized as follows. Section 2 discusses some related works and existing protocols. Section 3 presents the techniques of our proposed protocol. Section 4 discusses security analysis using BAN logic, Scyther tool, and AVISPA. Section 5 discusses the accountability analysis of the protocol. Finally, Section 6 concludes our work.

2. Related Works

Accountability in computer security is a crucial security property that leads to nonrepudiation of engaging parties relevant to the transactions. Hence, many researchers have proposed a security protocol for electronic health records to eliminate any barriers or disputes that may arise after the transaction is complete. Although accountability has been used in many different ways in terms of information accountability for electronic health records, all of these approaches have the same goal. Gajanayake et al. [15, 17, 18] proposed the role-based access control to control the use of patient health records by designing fixed roles for each position in the hospital. Anyway, the role can be replaced by the administrator of the system. This can lead to a serious security problem. Mashima and Ahamad [9, 10] proposed a patient’s centric protocol for monitoring the uses of patient health records. The protocol was flexible and helpful to the patient for monitoring who was using his/her health records. However, the protocol still lacks integrity and nonrepudiation properties. Hou and Yeh [11] proposed authentication schemes to ensure authentication between the user, the authentication server, and a trusted third-party authority before using the patient’s data. The proposed schemes were lightweight but lacked integrity, nonmutualize authentication, and did not support accountability. Al Alkeem et al. and Al Ameen et al. [12, 19] proposed the systems using the cryptographic protocol to send and receive the patient’s data via the cloud system. The system was well proposed but with weak authentication. The strong asymmetric encryption protocol was proposed by Lo et al. [13] with fourteen messages sent via the network. This makes the authors’ protocol very secure and encountered all security properties; however, it is rising the computational cost, cryptographic operations cost, energy consumption and time consumption. However, Ibrahim et al. [14] proposed a framework to exchange information between healthcare providers using a hybrid cryptographic operation to offer the security of the system. The proposed framework is complying with most security properties but still lacks accountability, is not resistant for a replay attack and man-in-the-middle attack, and does not support mutual authentication. Hu et al. [20] proposed the hybrid public key infrastructure solution for HIPPA privacy and security regulations. The proposed method was very strong and secure which was complied with confidentiality, integrity, patient control, and consent exception when in emergencies by using mutual authentication. However, the proposed methods were affecting the performance of the system. Blobel et al. [21] proposed the cross-security platform that consists of seven basic components using a public key infrastructure for authentication and a prototypical privilege management infrastructure for authorization and access control to secure web-based electronic health applications. The author applied an idea from their research in [22, 23]. The proposed system was secure as designed; however, it requires greater computation, communication cost, energy consumption, and time consumption. As discussed above, many proposed protocols are secure and with strong encryption. Nevertheless, some protocols are weak in accountability and security properties such as confidentiality, integrity, and authentication. Meanwhile, some protocols are secure and achieve all security properties but have affected the performance of the systems. Moreover, when a dispute arises, these protocols cannot resolve.

3. Proposed Model and Protocol for Electronic Health Records

In the context of information security, many researchers define accountability as involving confidentiality, authorization, authentication, integrity, and nonrepudiation. However, we argue that traceability is also one of the most important features that needs to be part of the systems’ accountability. It allows the trustworthy proof of the identity of any participating party and his/her activities in transaction processing. This traceable information will help to solve any dispute that may arise after the end of the transaction. This notion is essential for the success of any electronic healthcare records. Therefore, in our work, we will concentrate on a model of accountability and its supporting protocol to accommodate traceability in electronic health records. In this section, the proposed model and protocol for electronic health records are described.

Figure 1 illustrates conceptually how three engaging parties interact with each other in the healthcare transaction. Whenever C (a hospital, insurance company, or technical lab) needs to access P’s health records, a request is sent to the HCP for authorization (Step 1). When the HCP receives the request from C, the identity of C is validated. If correct, the HCP will forward a request to P (Step 2); if not, the HCP sends a notification back to C, and the transaction will end. When the patient receives a request for authorization from the HCP, he/she decides whether to accept or reject this request. P will then notify the HCP of this decision (Step 3). In case of acceptance, the encrypted patient health records are sent to both C and P (Steps 4 and 5, respectively). If rejected, HCP will send a denial of the request to C, and the transaction will end. The details of the protocol are explained in the next section.

Figure 1: The conceptual view of the healthcare transaction.

3.1. Accountability Model

In this section, we propose a new accountability model for electronic health records. As illustrated previously in Figure 1, there are three parties involved in the healthcare transactions: healthcare professional (HCP), the patient (P), and an information consumer (C). The model defines the accountability of each party and is a baseline to design the proposed protocol of healthcare transactions. The details of the proposed model are described as follows.

Healthcare professional’s accountability:

 HCP CanProve (C authorized ReqPHR(C, HCP)) to V ⋀ HCP CanProve (P authorized PHR(P, HCP)) to V ⋀ HCP CanProve (HCP authorized PHR(HCP, C)) to V ⟶ HCP is accountable for PHR to V

The above statements show that the HCP is accountable for a PHR. The details of HCP’s accountability can be explained as follows. First, HCP needs to prove that the request to access the P’s health records is sent from C. Second, HCP must also prove that the HCP is allowed by P to provide the health records to C. Finally, HCP needs to prove that the health records have been sent to C on behalf of P’s authorization.

Patient’s accountability:

 P CanProve (HCP authorized ReqPHR(HCP, P)) to V ⋀ P CanProve (P authorized PHR(P, HCP) to V⋀ P CanProve (HCP authorized PHR(HCP, C)) to V ⟶ P is accountable for PHR to V

The above messages show that P is accountable for a PHR. The details of the patient’s accountability are explained as follows. First, P must prove that the request to use his/her personal health record has come from the HCP. Second, P needs to prove that he/she gives the authorization to use his/her personal health records to the HCP. Finally, P also needs to prove that his/her personal health records are sent to C by the HCP as requested.

Information consumer’s accountability:

 C CanProve (HCP authorized PHR(HCP, C)) to V ⋀ C CanProve (P authorized PHR(P, C)) to V ⋀ ⟶ C is accountable for PHR to V

From the above statements, C is accountable for a PHR if C can prove that HCP, on behalf of P, allows C to use P’s health records and, also, C is allowed to use P’s health records via HCP.

3.2. Accountability Protocol

Based on the accountability model introduced in Section 3.1, electronic healthcare records need a protocol that allows access to P’s health records with traceability and confidentiality. In designing the protocol that is correct and complete, the accountability aspects consisting of, as mentioned in [24], accountability confidentiality, integrity, authorization, authentication, and nonrepudiation need to be considered. The existing protocol in [16] is secure and complete and can protect P’s health records but to improve our proposed protocol to consuming fewer resources than the protocol proposed in [16]. So, we decide to propose such an accountability protocol that is based on both symmetric and asymmetric operations. The mechanism of the protocol will be discussed in detail in the following sections, and the notations used to describe it are summarized in Table 1.

Table 1: Notations used in the proposed protocol.

Symbol
Definition

P
The subject and owner of the health records. A patient may have more than one PHR and EHR

C
Information consumer: an external entity that accesses PHRs, for example, a hospital, a lab, an emergency medical technician (EMT), or an insurance company

HCP
Healthcare professional: a hospital-based or clinical issuer of patient EHRs

Q
Any party that is involved in the transaction

V
Verifier, external third party

PID
Identity of the patient

CID
Identity of the information consumer

HCPID
Identity of healthcare professionals

Pri-Q
A private key of party Q, issued by a certificate authority

Pub-Q
A public key of party Q, issued by a certificate authority

T₁, T₂
Timestamps

h(M)
One-way hash function of message M

{M}Pub-Q
Message M encrypted with the public key of Q

{M}Pri-Q
Message M signed with the private key of Q

SK(A-B)
The session keys shared between party A and party B

ReqPHR
The request to use patient health records sent from the information consumer

PHR
Patients’ health information required by an involved party

Allow/NotAllow
The message status is sent from the patient to the healthcare professional to notify that the patient is allowed or not allowed to use the patient health records

3.2.1. The Session Keys’ Generation and Update

Session keys are one of the core components employed in our protocol. Basically, the session keys need to be generated and shared between two communicating entities. Therefore, before starting the protocol, it is necessary to create and update the session keys between involved parties. This section will describe how this process works.

(i)C and HCP:

 Step 1: C ⟶ HCP: CID, HCPID, {{n₁}Pri-C}Pub-HCP, h(CID, HCPID, n₁) Step 2: HCP ⟶ C: n₂, EXPTC-HCP, h(CID, HCPID, n₁, n₂) Step 3: C ⟶ HCP: {EXPTC-HCP}SKC-HCP, where SKC-HCP = h(CID, HCPID, n₁, n₂, EXPTC-HCP)

In Step 1, C sends information, including the identities of C (CID) and HCP (HCPID), the nonce n₁ doubly encrypted with the C’s private key and the HCP’s public key, respectively, and the hash value of CID, HCPID, and n₁, to HCP. The double encryption is to ensure the mutual authentication between C and HCP, and the hash value is to ensure message integrity.

In Step 2, after receiving the message in Step 1, HCP will decrypt {{n₁}Pri-C}Pub-HCP to obtain n₁ so that it can validate the hash value h(CID, HCPID, n₁). Moreover, after integrity of the message has been confirmed, HCP will generate a nonce n₂ and, then, send information, composed of n₂, EXPTC-HCP (expiry date and time of the session key), and the hash value of h(CID, HCPID, n₁, n₂), to C. In contrast, if integrity is disconfirmed, HCP will terminate the connection with C.

In Step 3, after receiving the message from HCP, C will check the correctness of the hash value h(CID, HCPID, n₁, n₂). If the hash value is invalid, C will decline communication. Otherwise, C sends the encrypted message {EXPTC-HCP}SKC-HCP to HCP. Note that SKC-HCP denotes the hash value of CID, HCPID, n₁, n₂, and EXPTC-HCP that is the shared session key of C and HCP.

(ii)C and P:

 Step 1: C ⟶ P: CID, PID, {{n₁}Pri-C}Pub-P, h(CID, PID, n₁)s Step 2: P ⟶ C: n₂, EXPTC-P, h(CID, PID, n₁, n₂) Step 3: C ⟶ P: {EXPTC-P}SKC-P, where, SKC-P = h(CID, PID, n₁, n₂, EXPTC-P)

In Step 1, C sends information, including the identities of C (CID) and P (PID), the nonce n₁ doubly encrypted with the C’s private key and the P’s public key, respectively, and the hash value of CID, PID, and n₁, to P. The double encryption is to ensure the mutual authentication between C and P, and the last hash value is to ensure message integrity.

In Step 2, after receiving the message in Step 1, P will decrypt {{n₁}Pri-C}Pub-P to obtain n₁ so that it can validate the hash value h(CID, PID, n₁). Moreover, after integrity of the message has been confirmed, P will generate a nonce n₂ and, then, send information, composed of n₂, EXPTC-P (expiry date and time of the session key), and the hash value of h(CID, PID, n₁, n₂), to C. In contrast, if integrity is disconfirmed, P will terminate the connection with C.

In Step 3, after receiving the message from P, C will check the correctness of the hash value h(CID, PID, n₁, n₂). If the hash value is invalid, C will decline communication. Otherwise, C will send the encrypted message {EXPTC-P}SKC-P to P. Note that SKC-P denotes the hash value of CID, PID, n₁, n₂, and EXPTC-P that is the shared session key of C and P.

(iii)HCP and P:

 Step 1: HCP ⟶ P: HCPID, PID, {{n₁}Pri-HCP}Pub-P, h(HCPID, PID, n₁) Step 2: P ⟶ HCP: n₂, EXPTHCP-P, h(HCPID, PID, n₁, n₂) Step 3: HCP ⟶ P: {EXPTHCP-P}SKHCP-P, where, SKHCP-P = h(HCPID, PID, n₁, n₂, EXPTHCP-P)

In Step 1, HCP sends information, including the identities of HCP (HCPID) and P (PID), the nonce n₁ doubly encrypted with the HCP’s private key and the P’s public key, respectively, and the hash value of HCPID, PID, and n₁, to P. The double encryption is to ensure the mutual authentication between HCP and P, and the last hash value is to ensure message integrity.

In Step 2, after receiving the message in Step 1, P will decrypt {{n₁}Pri-HCP}Pub-P to obtain n₁ so that it can validate the hash value h(HCPID, PID, n₁). Moreover, after integrity of the message has been confirmed, P will generate a nonce n₂ and, then, send information, composed of n₂, EXPTHCP-P (expiry date and time of the session key), and the hash value of h(HCPID, PID, n₁, n₂), to HCP. In contrast, if integrity is disconfirmed, P will terminate the connection with HCP.

In Step 3, after receiving the message from P, HCP will check the correctness of the hash value h(HCPID, PID, n₁, n₂). If the hash value is invalid, HCP will decline communication. Otherwise, HCP will send the encrypted message {EXPTHCP-P}SKHCP-P to P. Note that SKHCP-P denotes the hash value of HCPID, PID, n₁, n₂, and EXPTHCP-P that is the shared session key of HCP and P.

3.2.2. The Proposed Protocol

The proposed protocol designed based on the proposed model is explained in Section 3.1. The proposed protocol will be used in the case that whenever C (a hospital, patient, insurance company, or technical lab) needs to use P’s health records, a request is sent to the HCP for authorization. When the HCP receives the request from C, the identity of C is checked. If correct, the HCP will forward a request to P; if not, the HCP sends a notification back to C, and the transaction will end. When P receives a request for authorization from an HCP, he/she decides whether to accept or reject this request. P will then notify the HCP of this decision. In the event of acceptance, HCP will send the message of confirmation and request information to C and also to P for confirmation what information is sent to C. If rejected, the HCP will send a denial of the request to C, and the transaction will end. The proposed protocol handled all security properties with cryptographic techniques, especially for confidentiality, integrity, and authentication. For the confidentiality of the message, we use the public key of the receiver to ensure that only who has the private key can read the message. The integrity of the message can be satisfied by using a hash function. However, for authentication of the message, we use an asymmetric key with a symmetric key to ensure that the sender and the receiver can be identified. The details of the proposed protocol can be explained as follows.

 Step 1: C ⟶ HCP: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P) In Step 1, C generates a request and sends it to HCP to get permission for accessing P personal health records. This message consists of the following data:

(i){h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C: the data package (ReqPHR, CID, PID, HCPID, T₁) is hashed and, then, encrypted by C’s private key. This is to ensure that C is the creator of the message and to validate the message integrity.(ii)h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP): these data are considered as a message authentication code between C and HCP. They can also ensure the integrity of the transmitted data.(iii)h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P): these data are considered as a message authentication code between C and P. Due to the inclusion of the session key SKC-P, they can ensure that the originator and the receiver of the message are C and P, respectively.

 Step 2: HCP ⟶ P: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h(h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P), SKHCP-P) From Step 1, after receiving the message from C, HCP will compute the hash value from the plaintext ReqPHR, CID, PID, HCPID, and T₁ and, then, compare it with the received hash value h(ReqPHR, CID, PID, HCPID, T₁). If both hash values are not equivalent, HCP will terminate the session. Otherwise, HCP will proceed to Step 2, where it will forward the plaintext message as well as the two hash values, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, and h(h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P), SKHCP-P), to P. The first hash value is used to authenticate C as the message generator and the second to mutually authenticate the sender (HCP) and the receiver (P). Step 3: P ⟶ HCP: Allow, T₂, {h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P, h({h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P, SKP-HCP), h({h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P, SKC-P) From Step 2, after receiving the message from HCP, P will compute the hash value from ReqPHR, CID, PID, HCPID, T₁, and session key of SKC-P and SKP-HCP and, then, compare it with h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P, SKP-HCP). If they are a mismatch, P will send NotAllow a message and reject this session. The step to reject the session is described in Step 3 of the reject session. Otherwise, P will decide whether to give consent to use his/her personal health records or not and send the message to HCP as in Step 3. The message includes the following:

(i)Allow, T2, h({h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P, SKP-HCP): P will send this message to HCP to inform HCP that P allows C to use the personal health record as requested. Also, due to the use of the private key of P in encrypting the hash value, the message ensures that P is its originator.(ii)h({h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P, SKC-P): P also sends the hash value of {h(Allow, CID, PID, HCPID, T₁, T₂)}Pri-P encrypted with SKC-P. The purpose of this message is to ensure the integrity of the message and to ensure that P is the sender, and HCP is the receiver.

 Step 4: HCP ⟶ C: Allow, T₂, {Allow, CID, PID, HCPID, T₁, T₂, PHR}SKC-HCP, {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}Pri-HCP After receiving consent from P (via Allow message) in Step 3, HCP will proceed to Step 4, where PHR is confidentially sent to C. More specifically, the following are included in the sent message:

(i){Allow, CID, PID, HCPID, T₁, T₂, PHR}SKC-HCP: this message is the encryption of the data, consisting of Allow, CID, PID, HCPID, T₁, T₂, and PHR, using the session key SKC-HCP to ensure that C is the only person who can decrypt the message and read the data.(ii){h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}Pri-HCP: this message is the encryption of the hash value using the HCP’s private key in order to authenticate HCP as the creator of the message.

 In the event that the message in Step 2 is incorrect or P is an inconvenience to allow C to use his/her PHR, he/she will send the notification message to HCP that P is not allowed to use his/her PHR and terminate this communication. The message on Step 3 and Step 4 is described as follows: Step 3: P ⟶ HCP: NotAllow, T₂, {NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, h({NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, SKP-HCP), h({NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, SKC-P) From Step 2, after receiving the message from HCP, P will compute a hash value from ReqPHR, CID, PID, HCPID, T₁, and session key of SKC-P, SKP-HCP and compare with h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P, SKP-HCP) that is received from HCP. If P found that the comparison is incorrect, P will send the following message to HCP and terminate the session.

(i)h({NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, SKP-HCP): P will send this message to HCP to inform HCP that P does not allow C to use his/her personal health record as requested. Besides, due to the use of the private key of P in encrypting the hash value, the message ensures that P is its originator, while the session key SKP-HCP is to ensure that P is the sender, and HCP is the receiver of the message.(ii)h({NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, SKC-P): P also sends the hash value of {h(NotAllow, CID, PID, HCPID, T₁, T₂)}Pri-P encrypted with session key SKC-P to HCP. The purpose of this message is to ensure the integrity of the message and to ensure that P is the sender, and C is the receiver and notify HCP that P does not allow C to use his/her personal health records. When HCP received the message from P, HCP will forward the message to C. This can be sure that HCP cannot see the message. This is because the session key SKC-P is shared only between P and C.

 Step 4: HCP ⟶ C: NotAllow, T₂, {NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, h({NotAllow, CID, PID, HCPID, T₁, T2}Pri-P, SKC-P) After receiving dissent from P (via NotAllow message) in Step 3, HCP will send the following message to C:

(i){NotAllow, CID, PID, HCPID, T₁, T₂}Pri-P: this message is the encryption of the data, consisting of NotAllow, CID, PID, HCPID, T₁, and T₂, using P’s private key to ensure that P is the originator of the message.(ii)h({NotAllow, CID, PID, HCPID, T₁, T₂}Pri-P, SKC-P): this message will send NotAllow, CID, PID, HCPID, T₁, T₂ encrypt with P’s private key and session key SKC-P to ensure that P is the creator of the message, and C is the only person who can open the message.

 Step 5: HCP ⟶ P: Allow, T₂, {Allow, CID, PID, HCPID, T₁, T₂, PHR}SKP-HCP, {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}Pri-HCP After receiving consent from P (via Allow message) in Step 3, HCP will proceed to Step 5, where PHR is confidentially sent to P to confirm that P’s health records are sent to C. More specifically, the following are included in the sent message:

(i){Allow, CID, PID, HCPID, T₁, T₂, PHR}SKP-HCP: this message is the encryption of the data, consisting of Allow, CID, PID, HCPID, T₁, T₂, and PHR, using session key SKP-HCP to ensure that P is the only person who can decrypt the message and read the data.(ii){h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}Pri-HCP: this message is the encryption of the hash value using the HCP’s private key to authenticate HCP as the creator of the message.

If any dispute arises, the originating party may need to resolve it. In this case, the party can send the transaction to the third party to investigate the problem. The third party may be a court, lawyer, or trusted company. For example, in case that C needs to prove that HCP has already been granted to provide P health records to C, C needs to send the message, in Step 4, to the third party, while HCP needs to send the message, in Step 2 and Step 3, to the third party to prove that P has permitted his/her P health records to HCP. After the third party receives all implicated evidence, they will consider the evidence and notify the result to the involved parties. On the contrary, if P needs to prove that P did not give any consent to HCP and C, P needs to send a transaction message to the third party to prove that HCP or C violates P’s health records.

4. Security Analysis and Performance Analysis

To analyze the security of the proposed protocol, we address the security concerns of patients: the confidentiality and the integrity of PHRs, authentication, authorization, and nonrepudiation of the transactions between the parties involved. An analysis of the proposed protocol is given in the following.

4.1. Security Analysis

The proposed protocol uses asymmetric encryption to ensure that the involved party cannot deny their action. The advantages of using asymmetric encryption are that there is no need to exchange keys, message authentication and nonrepudiation (in which the user cannot deny sending a message) are ensured, and tampering can be detected if the message is altered by an intruder or hacker. This assumes that the private key of each party is not compromised, and the message was successfully sent to the involved party.

The details of security analysis are given as follows:

(a)Confidentiality of the message: this is to protect the message from unauthorized disclosure. For example, in Step 4, HCP sends the message Allow, T₂, {Allow, CID, PID, HCPID, T₁, T₂, PHR}SKC-HCP, {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}Pri-HCP. The confidentiality of the message can be satisfied by using the secret key SKC-HCP shared between C and HCP since the key is held only by C and HCP, meaning that HCP and C can read this message.(b)Message integrity: this is to assure that information is changed only in a specified and authorized manner of the message. This can be ensured by the message authentication code value. For example, in Step 1, C sends the message ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P) to HCP. This is used to check whether or not the hash values are equal. If the hash values of the message are equal, the message integrity is satisfied; if not, HCP will reject the message.(c)Mutual authentication: this is a two-way authentication, i.e., the information in a message can authenticate both originator and receiver. The session key shared between two parties is a mechanism for the mutual authentication. In our protocol, we employ three session keys SKC-HCP, SKC-P, and SKP-HCP. Consider the following message: Step 1: C ⟶ HCP: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P)

In the proposed protocol, it can be seen that the originator and the receiver of any message can be identified and authenticated. C and HCP share the session key SKC-HCP, C, and P shares the secret key SKC-P. It can be seen that C cannot deny that C is the originator of the message. This is because C possesses the shared key SKC-HCP and SKC-P that indicates C is the only one who can create this message. So, this can infer that C is the originator of this message because both SKC-HCP and SKC-P are known only by C. It can be seen that our proposed protocol satisfies all necessary properties. Moreover, the proposed protocol can prevent the replay attack by using a fresh timestamp [25] that can be used only once and man-in-the-middle attack. By using asymmetric cryptography to authenticate transmission and the secret key shared between the sender and the receiver, an attacker cannot impersonate a relevant party. This is proved using the Scyther verification tool [26], and the results of the proposed protocol are shown in Figures 2 and 3. Table 2 shows the security comparison of the proposed protocol and existing protocols.

Figure 2: Scyther verification of the proposed protocol.

Figure 3: Scyther autoverification of the proposed protocol.

Table 2: Security comparison of the proposed protocol and existing protocols.

Security aspects
[9]
[11]
[19]
[12]
[13]
[14]
[20]
[21]
[15]
[16]
Proposed

Confidentiality
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Integrity
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Mutual authentication
No
No
No
No
No
No
Yes
Yes
No
Yes
Yes

Authorization
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Nonrepudiation
No
No
No
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes

Replay attack
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes

Man-in-the-middle
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes

Dispute resolution
No
No
No
No
No
No
Yes
Yes
No
Yes
Yes

4.2. Security Proof

In this section, we use the traditional and well-known authentication approach known as BAN logic [27], the Scyther verification tool [26], and AVISPA [28] to prove the soundness and security of the proposed protocol.

4.2.1. Authentication Proof Based on BAN Logic

BAN logic is an authentication proof of a protocol for both symmetric and asymmetric encryption algorithms. BAN logic is proposed to verify the security protocol in [27, 29–35]. The details of the formalization of this logic can be found in [27]. In this section, we will describe only an encryption algorithm as used in the proposed protocol. The notations used in BAN logic are given in Table 3.

Table 3: Notations of BAN logic [27].

Symbol
Definition

P, Q, R
Principals (parties)

X, Y
Statements

K
Encryption keys

P believes X
P believes X or is entitled to believe X

P sees X
P can read and repeat the message containing X

P said X
P has said X (P believes X)

P controls X
P has jurisdiction over X

Fresh (X)
Formula X is fresh

Public key

Private key

Formula X is encrypted by the public key

Formula X is encrypted by the private key

(X)K
The hash value of X using K as a key

BAN logic rules:

 R1: message meaning rule:

 R2: nonce verification rule:

 R3: juristic rule:

 R4: freshness rule:

 R5: decryption rule:

 R6: belief rule:

Idealizing the protocol:

 Step 1: C ⟶ HCP: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)} , h({h(ReqPHR, CID, PID, HCPID, T₁)} ,), h({h(ReqPHR, CID, PID, HCPID, T₁)} ,) Step 2: HCP ⟶ P: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}  h({h(ReqPHR, CID, PID, HCPID, T₁)} ,,) Step 3: P ⟶ HCP: Allow, T₂, {h(Allow, CID, PID, HCPID, T₁, T₂)} , h({h(Allow, CID, PID, HCPID, T₁, T₂)} ,), h({h(Allow, CID, PID, HCPID, T₁, T₂)} ,) Step 4: HCP ⟶ C: Allow, T₂, {Allow, CID, PID, HCPID, T₁, T₂, PHR} , {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)}  Step 5: HCP ⟶ P: Allow, T₂, {Allow, CID, PID, HCPID, T₁, T₂, PHR} , {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)} 

Initial assumptions:

 A. C believes , B. C believes , C. HCP believes  D. HCP believes , E. HCP believes , F. P believes  G. P believes , H. C believes fresh (T1), I. HCP believes fresh (T1) J. P believes fresh (T1), K. C believes fresh (T2), L. HCP believes fresh (T2) M. P fresh (T2) The goal of the analysis is to prove the correlation between the relevant parties. We set five goals for the analysis given as follows: G1: HCP believes {h(ReqPHR, CID, PID, HCPID, T₁)}  from Step 1 G2: P believes h({h(ReqPHR, CID, PID, HCPID, T₁)} ,,) from Step 2 G3: HCP believes h({h(Allow, CID, PID, HCPID, T₁, T₂)} ,) from Step 3 G4: C believes {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)} , from Step 4 G5: P believes {h(Allow, CID, PID, HCPID, T₁, T₂, PHR)} from Step 5 Due to the limited space, the details of this proof will explain only G1 and G2 to prove that HCP and C are interacting with each other. That is, C sends a request to HCP, and HCP sends back the required P health records to C (with consent from P). However, we can provide some guidelines to prove G1 and G2 of our protocol as follows: G1: HCP believes {h(CID, PID, T1)} :(1)(2)(3)(4)(5) 5, R6: HCP believes {h(CID, PID, T1)}  It can be seen that goal G1 is proven. This is because HCP believes that {h(CID, PID, T1)}  is sent from C to HCP by believing rule R6. The proof of the relevant transaction between HCP and C is given in goal G2. G2: C believes HCPID, CID, PID,{{PHR, T₁} (1)(2)(3) 3, C believes {PHR, T₁}Pri-HCP

As shown above, C believes that HCPID, CID, PID,{{PHR, T₁}  is sent from HCP. Thus, C believes that P health records are sent from HCP. It can be inferred that goal G2 is successfully proven. Thus, it can be concluded that all parties have satisfied secure mutual authentication.

4.2.2. Authentication Proof Based on Scyther Verification

There are many tools for formal verification, as shown in the survey in [36], but the most popular for verification are ProVerif, Scyther, and the AVISPA project. Each of these tools has certain advantages and disadvantages, and the reader can find more information in [36]. The advantage of the Scyther verification tool [26] is its graphical user interface for verification, falsification, and analysis of the cryptographic protocol. We, therefore, used the Scyther verification tool to analyze our proposed protocol. As shown in Figures 2 and 3, the proposed protocol is verified as allowing no attacks. More information about authentication claims such as Alive, Weakagree, Niagree, and Nisynch can be found in [26, 37, 38].

4.2.3. Authentication Proof Based on AVISPA

The AVISPA tool is a well-known tool in which many researchers [39–42] used to verify protocol falsification and specific goal defined in high-level protocol specification language (HLPSL) to prove the security protocol, which also allows us to indicate the protocol’s security properties to be verified. The on-the-fly model checker (OMFC) back-end can be employed for efficient checking falsification of protocols and proving the correctness of the protocol. However, constraint-logic-based attack searcher (ATSE) back-end is used to find attacks to the protocol, and attack trace generation is used to find attack of our proposed protocol. The result of the proposed protocol simulation of OFMC is shown in Figure 4, and ATSE is shown in Figure 5. Figure 6 shows attack trace generation and that our proposed protocol is safe, and Figure 7 shows the HLPSL code specific goal for authentication and goal for secrecy are specified in the goal section. The output shows that the proposed protocol is safe as the specified goals. AVISPA is described more in detail in [28, 43].

Figure 4: AVISPA OFMC result.

Figure 5: AVISPA ATSE result.

Figure 6: AVISPA attack trace generation.

Figure 7: HLPSL specification of role environment.

4.3. Performance Analysis

In this section, our proposed protocol is evaluated since this protocol employs asymmetric and symmetric encryption and may require a greater computation, communication cost, energy consumption, and time consumption. The communication and computational cost are evaluated to show that our proposed protocol can run in any environment, either on a personal computer or a mobile phone. Meanwhile, energy and time consumption are also appraised.

4.3.1. Communication Cost

The communication cost is calculated from the transmitted message size in our proposed protocol and protocols given in [9, 11–16, 20, 21]. The total bits of the transmitted message are calculated using the size specified in Table 4. The total number of bits of the messages transmitted in each protocol is as follows:

 [9]:  (M1)  +  (M2)  +   (M3)   +   (M4)  +  (M5)  +  (M6)  + (M7) + (M8) = (80 + 512 + 80) + (80 + 1024 + 512 + 512) + (80 + 1024 + 512 + 128) + (80 + 1024 + 128 + 64 + 128) +  (1024  +  128 + 128 + 64)  +  (512 + 1024)  +  (64 + 84 + (64 + 64) = 9104 ∗ n [11]: (M1)  +  (M2)  +  (M3)  +  (M4)  + (M5) + (M6) =  = (5 + 64 + 128 + 5 + 64 + 128)  +  (80 + 80 + 80 + 80 + 80 + 80)  +  (128 + 128 + 128 + 64 + 128 + 80)  +  (80 + 1024 + 128  +  1024 + 80)  +  (80 + 1024)  +  (80 + 1024)  +  (80  + 80 + 1024 + 1024) = 8282 ∗ n [12]: (M1) + (M2) + (M3) + (M4) + (M5) + (M6) = (80 + 80 + 80 + 128)  +  (80 + 80 + 80 + 80 + 80 + 128) + (128 + 80 + 128 + 80 + 80 + 80 + 128 + 128 + 80 + 128 + 80 +  80+ 80 + 128)  +  (128  +  80 + 128  +  80 + 80  +  80  +  128  + 128 + 80  +  128 + 80 + 80  +  80)  +  (128 + 80 + 80 + 80 + 80 + 128) + (128 + 1024) = 5312 ∗ n [13]:   (M1)  +  (M2)  +  (M3)  +  (M4)  +  (M5)  +  (M6)  + (M7) + (M8) + (M9) + (M10) + (M11) + (M12) + (M13)+ (M14)  =  (8 + 8 + 160 + 64 + 128) + (8 + 8 + 160 + 64 +128) + (8 + 128 + 8 + 160 + 64 + 128) + (8 + 8 + 160 + 64)+ (8 + 128 + 1024 + 512 + 128 + 512 + 128 + 160 + 128) + (8 + 8 + 128 + 128 + 1024 + 128  +  160 + 128)  +  (8 + 8 + 160 + 64) + (8 + 160 + 64) + (8 + 128 + 128 + 160 + 64) + (8 + 8 + 128 + 128 + 160 + 64) + (8 + 8 + 160 + 64) + (8 + 8 + 512 + 64)  +  (8 + 8 + 128  +  128 + 512 + 160  +  64)  + (8 + 128 + 512 + 160) = 10016 ∗ n [14]: (M1)  +  (M2)  +  (M3) + (M4) + (R1) = (128 + 80 + 80 + 80)  +  (128 + 80 + 80 + 80 + 160)  +  (128 + 80 + 7) + (128  +  1024  +  128)  +   (160   +  1024   +  1024  +  128)   = 4727 ∗ n [20]:  (M1)  +   (M2)  +   (M3)  +   (M4) +  (M5) +  (M6)  + (M7)  +  (M8) + (M9)  +  (M10)  = (80 + 128 + 128 + 80  + 1024)  +  (128 + 128 + 80 + 128)  + (128 + 128 + 80 + 128) + (128  +  128 + 80 + 128 + 128)  + (128 + 80 + 80 + 128 + 128 + 1024)  +  (80 + 6 + 128 + 128 + 80)  +  (128  + 128  + 80 + 128)  +  (128 + 128 + 80 + 128)  +  (128 + 128  + 80  + 128 + 128)  +  (128 + 80 + 80 + 128 + 128  +  1024 + 128 + 160) = 8326 ∗ n [21]: (M1) + (M2) + (M3) + (M4) + (M5) + (M6) + (M7)+ (M8) + (M1) + (M2) + (M3) + (M4) + (M5)  +  (M6) + (M7) + (M8)  +  ((100 + 420 + 420 + 1024 + 420  + 500  + 40 + 1024) + (40 + 40 + 40 + 40 + 40 + 40 + 1124 + 332 + 332 + 332 + 3 + 3 + 1024) [15]: (M1) + (M2) + (M3) + (M4) + (M5) + (M6) + (M7) =  (80) + (80 + 1024) + (80)  +  (1024 + 1024)  +  (1024) + (1024) + (1024) = 6384 ∗ n [16]: (M1) + (M2) + (M3) + (M4) + (M5) + (M6) = The proposed protocol: (M1)  +  (M2)  +  (M3) + (M4) + (M5)  =  (6 + 80  +  80 + 80 + 64 + 128 + 160 + 160) + (6 + 80 + 80 + 80  +  64 + 128 + 160)  +  (5 + 64 + 128  +  160  + 160)  +  (5 + 64 + 5 + 80 + 80 + 80 + 64 + 64 + 1024 + 128+ 128)  +  (5  +  64+5 + 80 + 80 + 80 + 64  +  64  +  1024  + 128 + 128) = 5317 ∗ n

Table 4: Abbreviations and definition of symbols used in the existing and proposed protocols.

Symbol
Definition
Bits

CID/HCPID/PID/IDS/Cj/IDi
Consumer/healthcare professionals/patient and health authority identity
80

Ti, Ts
Timestamp
64

H/Hash(d)/H(.)/H()
Hash
160

{}Pub/Pub/PKEk(p)//
Public key
128

{}Pri/Pri/PKE (p)//
Private key
128

SK/SKEk(p)/Signk(d)/KS/
Session key
128

PHR/D(i)/Doc
Personal health records
1024

Allow
Message allowed from the patient
5

ReqPHR/m
Request using patient health records
6

Nonce
An arbitrary number that can be used just once
128

As shown in Figure 8, on the one hand, our proposed protocol takes communication costs less than the protocols proposed in [9, 11, 13, 15, 16, 20, 21]. On the other hand, the proposed protocol takes communication costs more than the protocols proposed in [12, 14]. However, the proposed protocols in [12, 14] lack authentication, authorization, nonrepudiation, and accountability.

Figure 8: Communication cost.

4.3.2. Cryptographic Operations’ Cost

The cryptographic operations’ cost is compared between our proposed protocol and existing protocols [9, 11–16, 20, 21]. The definitions of the cryptographic operations used are presented in Table 4. The security functions used for authentication in these protocols are calculated as follows:

 [9]: (SK, SK,{}Pub, {}Pri, {}Pri), (SK, SK, H), ({}Pub, SK, H), ({}Pub,{}Pub, SK), (SK, SK, {}Pri), ({}Pri), (SK, H) = (5 + 3+3 + 3+3 + 1+2 = 20) = 20 ∗ n [11]: (SK, H), (SK, H, H), (SK, H, H), (SK, H, H) = (2 + 3+3 + 3 = 11) = 11 ∗ n [12]: (SK), (SK), ({}Pub, SK, SK,{}Pub, SK, {}Pub), ({}Pub, SK, SK, {}Pub, SK), ({}Pub, SK), ({}Pub) = (1 + 1 + 6 + 5 + 2 + 1 = 16) = 16 ∗ n [13]: ({}Pub, H, SK), ({}Pub, H, SK), ({}Pub, {}Pub, H), ({}Pub, H), ({} Pub, {}Pub, {}Pub, {}Pri, {}Pub, {}Pub, H, SK), ({}Pub, {}Pub, H), ({}Pub, H), ({}Pub, {}Pub, {} Pub, {}Pri, {}Pub, {}Pub, H, SK), ({}Pub, H)}, {}Pub, H, SK, {}Pub), ({}Pub, {}Pub, SK, SK), ({}Pub, {}Pub, SK, H), ({}Pub, SK), ({}Pub, {}Pri), ({}Pub, {}Pub, {}Pri, {}Pri, {}Pri, {}Pub, {}Pub, ({}Pub, {}Pub, {}Pub, {}Pri, {}Pri, {}Pri, {}Pub, {}Pri,{} Pri, H) = (3 + 3+3 + 10+3 + 2+8 + 2+4 + 4+4 + 2+8 + 9+10 = 67) = 67 ∗ n [14]: ({}Pub), ({}Pub, H), ({}Pub, H, {}Pub), ({}Pub, {}Pri) = (1 + 2 + 3 + 2 = 8) = 8 ∗ n [20]: ({}Pub), ({}Pub), ({}Pub), ({}Pub, SK), (SK,{}Pub, H), ({}Pub), ({}Pub), ({}Pub), ({}Pub), ({}Pub, SK, SK) = (1 + 1 + 1 + 2 + 3 + 1 + 1 + 1 + 1 + 3 = 15) = 15 ∗ n [21]: ({}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub) = (1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 = 11) = 11 ∗ n [15]: ({}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub, {}Pub) = (1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 + 1 = 9) = 9 ∗ n [16] ({Pri}, H, {Pub}), ({Pri}, {Pub}), ({Pri}, H, {Pri}, {Pub}), ({Pri}),({Pri}, H, {Pub}, {Pri}, {Pub}), (H, {Pri}) = (3 + 2 + 4 + 1 + 5 + 2 = 17) = 17 ∗ n The proposed protocol: (H, {}Pri, H, SK, SK), ({}Pub, H), (H, {}Pri, SK, SK), (SK, {}Pri), (SK) = (5 + 2 +4 + 3 = 14) = 14 ∗ n

Figure 9 shows cryptographic operations’ cost comparison of previous protocols in [9, 11–16, 20, 21]. It can be seen that the protocols [9, 12, 13, 16, 20] have more cryptographic operation cost than our proposed protocol. However, the proposed protocol used cryptographic operation cost more than the existing protocols given in [11, 14, 15, 21]. Nonetheless, protocols given in [11, 14, 15] lack confidentiality, integrity, authorization, nonrepudiation, and accountability. Furthermore, the proposed protocol [9, 11–15] cannot resolve any dispute because they do not provide the dispute resolution phase as mentioned in Table 2.

Figure 9: Cryptographic operations’ cost.

4.3.3. Energy Consumption

The energy consumption comparison is a comparison of the proposed protocol with the other in [9, 11–16, 20, 21]. The total bits of the transmitted message are also calculated using the size specified in Table 4. The number of messages exchanged in each protocol is 8, 6, 6, 14, 5, 10, 23, 7, and 6, respectively. Table 5 and Figure 10 show the proposed protocol and the other protocols in terms of energy consumption comparison. The comparison shows that the proposed protocol consumes less energy than [9, 12–16, 20, 21]. However, the proposed protocol consumes more energy than [11]. However, the protocol given in [11] still lacks some essential security properties.

Table 5: Energy consumption comparisons.

Protocol
AES (1.21 μ · J/byte)
RSA (546.5 μ · J/byte)
SHA1 (0.76 μ · J/byte)
Total

[9]
10.89
4,372.00
2.28
4,385.17

[11]
4.84
—
5.32
10.16

[12]
10.89
3,825.50
—
3,836.39

[13]
10.89
25,139.00
9.12
25,159.01

[14]
—
3,279.00
1.52
3,280.52

[20]
4.84
5,465.00
0.76
5,470.60

[21]
—
6,011.50
—
6,011.50

[15]
—
4,918.50
—
4,918.50

[16]
—
7,104.50
3.04
7,107.54

Proposed
7.26
2,186.00
3.04
2,196.30

Figure 10: Energy consumption.

4.3.4. Time Consumption

Table 6 and Figure 11 show time consumption comparisons between the proposed protocol and other protocols defined in [9, 11–16, 20, 21]. The comparisons are visible that the proposed protocol is consuming more time than [11]. However, notwithstanding this, the proposed protocol consumes less time than [9, 11–16, 20, 21], and our protocol fully complies with all required security properties.

Table 6: Time consumption comparisons.

Protocol
AES (1.71 ms/byte)
RSA (15.21 ms/byte)
SHA1 (1.28 ms/byte)
Total

[9]
15.39
121.68
3.84
140.91

[11]
6.84
—
8.96
15.80

[12]
15.39
106.47
—
121.86

[13]
15.39
699.66
15.36
730.41

[14]
—
91.26
2.56
93.82

[20]
6.84
152.10
1.28
160.22

[21]
—
167.31
—
167.31

[15]
—
136.89
—
136.89

[16]
—
197.73
5.12
202.85

Proposed
10.26
60.84
5.12
76.22

Figure 11: Time consumption.

5. Accountability Analysis

In this section, we investigate the proposed protocol regarding accountability properties. We also provide some guidance to prove the accountability of our proposed protocol. According to the model specified in Section 3.1, it can be seen that our protocol satisfies the accountability properties for all relevant parties: HCP, C, and P. In this, the logic of accountability analysis is derived and is adapted from Wang et al. and Thammarat and Kurutach [33, 34].

5.1. Terms

(i)(Q, R, V, W): the set of parties that communicate with one another in a protocol.(ii)(X, Y): the set of messages or message components in a protocol.(iii)(ɸ, ѱ): the statements derived from protocol messages.(iv){KW, }: the set of the public key and private key of a party W.(v){X}KW: the message X encrypted with the public key of a party W.(vi){X}SK: the message X symmetrically encrypted with a shared key SK.(vii)h(X): the hash value of the message X.(viii): the key K can be used to refer to the party Q.(ix): the key SK is a shared key between the parties W and Q.(x)X-is-fingerprint-of-Y: the message X can be used as a representative (fingerprint) of Y (for example, X may be the hashed form of Y).(xi)K-is-decrypting-key-for-{X}K: the key SK can be used to decrypt the message {X}SK.(xii): the message M signed with the private key of the party.(xiii)MAC(X, SK): message authentication code (MAC) of the message X with the key SK.(xiv)(X)K: the message X applied with a single-key cryptographic operation with the key SK. (X)K can be symmetric-key encryption (X)SK, message authentication code MAC(X, SK), or hash function h(SK).

5.2. Formulae

(i)W believes ɸ: W believes that the statement ɸ is true.(ii)W sees X: some party has sent the message X to W, and W is able to read X.(iii)W has X: W possesses the message X. W can send X to other parties or use it for further processing.(iv)W says X: W has sent the message X.(v)W CanProve ɸ to Q: W can prove to Q that the statement ɸ is true.(vi)W authorized ReqPHR(W, Q, PHR, T₁): W has authorization on ReqPHR to Q on the date of transaction timestamp.(vii)W authorized PHR(W, Q, PHR, T₁): W has authorization on requesting Q to use PHR on the date of transaction timestamp.

5.3. Axioms

5.3.1. Inference Rules

 M: if ɸ is a theorem, then P believes ɸ is a theorem, where theorem is a formula that can be derived from axioms alone

5.3.2. Comprehensions

 C1: W sees X ⟶ W believes W sees X C2: W says X ⟶ W believes W says X

5.3.3. Possessions

 H1: W sees X ⟶ W has X H2: (W has X₁ ⋀…⋀ W has Xn) ⟶ W has (X₁, :::, Xn), where (X₁, :::, Xn) stand for a list of messages X₁, X₂, :::, Xn, respectively H3: W has X ⟶ W has h(X) H4: (W has ({X}SK, SK) ⋀ P believes ) ⟶ W has X H5: (W has ({X}KW, ) ⋀ W believes ) ⟶ W has X. H6: (W has ({X} , KW) ⋀ P believes ) ⟶ W has X

5.3.4. Provability

 P1: (W CanProve (ɸ ⟶ ѱ) to V) ⟶ (W CanProve ɸ to V ⟶ W CanProve ѱ to V) P2: V-is-external-party ⋀ W has X ⋀ (V sees X ⟶ V believes ɸ) ⟶ W CanProve ɸ to V P3: W CanProve (Q says {X}KR) to V ⋀ W CanProve () to V ⋀ W CanProve (-is-decrypting-key-for-{X}KR) to V  W CanProve (Q says (X, IDR)) to V P4: W CanProve (Q says (X₁, :::, Xn)) to V [W CanProve (Q says X₁) to V ⋀…⋀ W CanProve (Q says Xn) to V]

5.4. Initial Assumptions

5.4.1. Protocol-Specific Assumption

 A1: W believes [(V believes () ⋀ V has ((X)SK, SK′) ⋀ X = ((X)SK, SK′)  V believes ()] A2: W believes (V believes W′ sees (X)SK ⋀ V believes () ⋀ V has ((X)SK, SK′) ⋀ X = ((X)SK)SK′  V believes Q says (X, IDW′)) A3: W believes (V has {}PriQ ⟶  V believes ()) A4: W believes [(V has (X, Y) ⋀ X = h(Y))  V believes X-is-fingerprint-of-Y] A5: W believes (V has ({X}SK, SK′) ⋀ X = {{X}SK}SK′.  V believes SK′-is-decrypting-key-for-{X}SK)

5.4.2. Shared Secrets

 A6: W believes (), W believes () W believes (), W believes () W believes (), W believes () A7: W believes ¬ P sees SKC-HCP, W believes ¬ HCP sees SKC-P W believes ¬ C sees SKP-HCP

5.4.3. Accountability Information

 A8: W believes W has (PHR) The HCP and C believe that they possess personal health records of P, where W denotes HCP and C. Note that C has PHR because P is authorized to use his/her PHR via the request that C sends through HCP.

5.4.4. Personal Health Record Authorizations

 A9: every involved party believes that he/she can prove to the verifier that if the HCP has sent the message containing P’s health records, C has authorization to use PHR from P.

W believes W CanProve (C says (CID, PHR, T₁) ⟶ HCP authorized PHR(HCP, PHR, T₁)) to V: each party believes that he/she can prove to V that if C has sent the message containing HCPID, PID, and the timestamp of the transaction, C has the authorization to requite to use PHR from HCP.

W believes W CanProve (P says (PID, PHR, T₁) ⟶ HCP authorized PHR(HCP, P, PHR, T₁)) to V: each party believes that he/she can prove to V that if HCP has sent the message containing HCPID, PID, PHR, and the timestamp T₁, HCP has the authorization to use PHR from P.

W believes W CanProve (P says (PID, PHR, T₁) ⟶ C authorized PHR(C, P, PHR, T₁)) to V: each party believes that he/she can prove to V that if P has sent the message containing CID, PID, PHR, and the timestamp T₁, C has the authorization to use PHR from P.

5.4.5. Goals of the Analysis

To evaluate the accountability of our proposed protocol, we have to specify the goals that must be satisfied by each engaging party when completing each transaction. Denote that G1, G2, G3, G4, G5, and G6 are our goals. All goals have to be proved according to the proposed model described in section 3.1. The goal of the analysis defines as follows

 G1: HCP believes HCP CanProve(C authorized ReqPHR(HCP, C)) to V ⟶ consider Step 1 G2: P believes P CanProve(C authorized ReqPHR(P, C)) to V ⟶ consider Step 2 G3: HCP believes HCP CanProve(P authorized PHR(HCP, P)) to V ⟶ consider Step 3 G4: C believes C CanProve(P authorized PHR(C, P)) to V ⟶ consider Step 4 G5: P believes P CanProve(HCP authorized PHR(P, HCP)) to V ⟶ consider Step 5 G6: C believes C CanProve(HCP authorized PHR(C, HCP)) to V ⟶ consider Step 4

5.5. Details of the Proof

Due to the limitation of space, we give only the analysis of accountability in G1. However, we will provide some guidelines to prove the accountability of our proposed protocol on G1 as follows:

 G1: HCP believes HCP CanProve(C authorized ReqPHR(HCP, C)) to V Consider message Step 1: C ⟶ HCP: ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P) It can be transformed into the following: HCP sees ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P)(1)HCP sees ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P)(2)1, C1, M: HCP sees ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P)(3)2, H1, H2, M: HCP believes HCP has ReqPHR, CID, PID, HCPID, T₁, {h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP), h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-P)(4)3, H6, M: HCP believes HCP has Pub-C(5)3, 4, P3, A3, K, M: HCP believes HCP CanProve (Pub-C-is-decrypting-key-for-({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C)) to V(6)3, H4, A6, M: HCP believes HCP has h({h(ReqPHR, CID, PID, HCPID, T₁)}Pri-C, SKC-HCP)(7)5, 6, A4, P2, H2, M: HCP believes HCP CanProve() to V(8)7, P4, M: HCP believes HCP CanProve(C says (CID, ReqPHR, T₁)) to V(9)8, A8, M: HCP believes HCP CanProve(C authorized ReqPHR(HCP, C)) to V

It can be seen that goal G1 is successfully proved. Thus, it can be concluded that the HCP can prove that HCP has given authorization to C, and it satisfied with the accountability between HCP and C. Note that the details of goals G2 to G6 were successfully analyzed.

6. Conclusions

In this paper, we use a BAN logic, Scyther tool, and AVISPA verification tool to prove the completeness and the soundness of the protocol. The results show that the proposed accountability model and accountability protocol achieve our goals in terms of accountability. Firstly, we ensure that the actions of each party can be traced throughout the movement of data. Secondly, we can identify and trace the user, data source, and transactions between parties. Finally, the model and protocol meet the requirements of all crucial securities, that is, confidentiality, authorization, integrity, mutual-authentication, and nonrepudiation. The advantage of our proposed protocol is safe and robust from attack. Moreover, it is having the accountability security property to ensure that the involved party will be confident in using electronic health records and having dispute resolution to resolve any argument that may arise in the future.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this article.

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