Keywords
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            | Cloud Computing, Personal Health Records (PHRs), MyPHRMachines, Medical data, Virtual       Machine | 
        
        
            
            INTRODUCTION
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            | Cloud computing offers unique opportunities for supporting long-term record preservation. MyPHRMachines [1], a       patient owned health record system prototype based on remote virtual machines hosted in the cloud. MyPHRMachines       is particularly promising for countries with a very heterogeneous architecture of systems across hospitals and other care       institutions. In the view of developer PHRs should be portable. PHR systems typically offer functionality to share,       visualize and analyze PHR data. Secure lifelong management of patient medical records since data are stored in the       cloud and do not have to be carried around by patients. | 
        
        
            | The remainder of the paper is organized as follows. Literature review of several techniques prevailing in literature       aimed to secure the electronic methods over past 15 years are discussed in Section 2. Section 3 gives the architectural       representation of cloud based PHR storage systems. Section 4 gives a broad overview of discussion of experimental       results carried out. Section 5 concludes the paper and outlines the future work. | 
        
        
            
            LITERARY REVIEW
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            | Jeffrey J. Clawson (2000 b) [20] projected “Method and system for giving remote emergency medical counsel       to choking patients” defined that Medical system provided for emergency medical counsel to choking patients       remotely. Gather emergency medical information including medical dispatch services to choking victims and providing       qualified emergency medical information to callers thereby permitting "zero time" response. Advantage of using this       technique is a choking victim injuries can be treated with appropriate guidance. It is mostly useful for the remote       emergency sufferers they provide a “zero time” response at the case of emergency. | 
        
        
            | Marc Edward Chicorel (2001) [21] proposes medical progress note a doctor can utilize the base of about 350,000 bytes       of medical descriptive to paradigm particular medical progress note. During completion of the patient meeting, the       doctor proceeds to write a short “code” should have at least two letters in the suitable box on a predesigned form.       Basically this process uses approximately 15 to 90 seconds of the doctor's time. The code is then entered into the programmed processor and information corresponding to the code is printed, analyzed and signed by the doctor. The       printed and signed text is then entered into the patient's medical chart. | 
        
        
            | Charlyn Jordan (2002) [22] proposed “Health analysis and forecast of abnormal conditions” said Health record signals       are been stored and processed for the predetermined health function or parameter to define value in the abnormal range.       Also future health signal record is to trend the predetermined function and assume a value in abnormal range and       condition. Jeffrey J. Clawson (2003) [23] defined Standard process is involved in gathering and processing emergency       medical information, categorizing such information into various basis levels for correct response and for providing       qualified emergency medical information to callers thereby permitting “zero-time” response. Important function of this       system is dispatcher is guided through the examination of callers, meeting the critical information dispatching the       mobile care when needed and giving the appropriate guidance to the caller. It has universal entry protocol for accessing       medical complaints. | 
        
        
            | PekkaRuotsalainen (2004) [24] in “A cross-platform model for secure Electronic Health Record communication”       defined an Enhanced cross security platform is proposed which support a platform for communication through the       adhoc network to access the distributed electronic health records. Roger J. Quy (2005) [25] in “Method and apparatus       for health and disease management combining patient data monitoring with wireless internet connectivity” said the       health related data is communicated from the WWD to a server using standard internet protocols. Server calculates the       response time and further it reviewed by a physician or health care provider. User and server interaction takes place the       server transmits a response to the WWD and the user may answer the response. | 
        
        
            | Avner Amir, Avner Man (2006 ) [26] in “System and method for administration of on-line healthcare” defined the endunit       device is guided by the CMIP so that anamnesis, diagnosis treatment is provided, monitored, recorded and       clinically investigated. This system is useful for the management of medical records. Christopher Alban, KhiangSeow       (2007) [27] defines a single electronic database it stores clinical patient notes, provides multiple points of read/write       access through user interface operating on single or more client computers that are in real time communication with the       repository. Brian A. Rosenfeld, Michael Breslow (2008) [28] in “System and method for accounting and billing       patients in a hospital environment” explored if the billable service is provided by a specialist, a specialist identifier is       also associated with the billable service. The hospitalized patient is counted and a current procedural terminology       (CPT) manager assigns CPT codes to the billable service. A bill generator receives all the details of the patient data,       insurance information and CPT codes which generate a bill for the billable services provided to the hospitalized patient.       Jacquelyn Suzanne Hunt, Joseph Siemienczuk (2009) [29] in “Process and system for enhancing medical patient care”       explored the fact that a data warehouse receives the extracted information and reformats that information. Information’s       are analyzed by a health care provider having that medical condition. It further collects the data of the selected patients       for multiple health care providers and enables comparisons of health care provider’s success for such patients to       promote advance of the treatment by less successful providers. | 
        
        
            | Richard J. Schuman (2010) [30] defines “Health care computer system” which define the A hospital bed, patient and       nurse call system. A hospital network is provided. Communication is provided over a packet based communication       network. Kanagaraj, G.Sumathi, A.C. (2011) [31] in “Proposal of an open-source Cloud computing system for       exchanging medical images of a Hospital Information System” proposed clinical information system through the cloud       can provide the essential details to the health care and the patient can seek the treatment in different hospital, reduce       computational resource maintenance in the hospital also existing medical equipment’s can be reconstructed to be more       efficient and low-cost. | 
        
        
            | J. Vidhyalakshmi, J. Prassanna (2012 b) [33] proposed “Providing a trustable healthcare cloud using an enhanced       accountability framework” explored that Security and accountability of patient’s personal health record maintenance it       handle the Privacy protection problem. They define Distributed accountability framework to control and monitor user       data in cloud. It also handle the object centric which automatically trigger an object to create a log record and access       over distributed data. Log file corruptions are handled, log manager maintenance and verify corrupted log records.       With the introduction of cloud computing in medical data capital expenditure is converted to operational expenditure. | 
        
        
            | Carmelo Pino and Roberto Di Salvo (2013) [37] in “A Survey of Cloud Computing Architecture and Applications in       Health” explained Cloud computing provide resource management and computation capabilities, hybrid cloud can       increase the development of the health sector. Abhishek Kumar Gupta, Kulvinder Singh Mann (2014 b) [41] defined       “Sharing of Medical Information on Cloud Platform” explored that basically hospitals store the patient details in paper       format now in the migration to next level medical information are stored in cloud computing which provide a secure       way to share. It results in the setting the platform for the exchange and collaboration of medical information. | 
        
        
            
            ARCHITECTURAL REPRESENTATION
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            | The architectural representation of cloud based PHR storage is represented in Fig 1. The portal plays an important role       in uploading copy of data, remote access maintenence, start/stop operation. PCAS access is used to provide and show       copies. The cloud takes the responsibility of mounting the PHRs. | 
        
        
            | Architectural representation of MyPHR Machine consists of two components evolution and storage with which client       directly interacts with MyPHR Machine. The first component of MyPHR Machine consists of web portal which in turn       interacts with Virtual Box Hypervisor. Virtual Machines are connected together with Virtual Box Hypervisor. The       second component of MyPHR Machine, storage consists of VM Repository which houses VM Data and Private       Network folders as indicated in Figure 2. | 
        
        
            
            DISCUSSION AND RESULTS
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            | MyPHRMachines allows patients to build PHRs which are robust across two dimensions namely: | 
        
        
            | i. Space Dimensions and ii. Time Dimensions | 
        
        
            | Two Use cases are also taken into consideration: | 
        
        
            | i. Spatial and Temporal pervasiveness and ii. Privacy related aspects. | 
        
        
            | The basic network model for the cloud data storage and four different network entities | 
        
        
            | 1. User | 
        
        
            | 2. Cloud Storage Server (CSS) | 
        
        
            | 3. Cloud Service Provider (CSP) | 
        
        
            | 4. Data owner | 
        
        
            | The process of multi authority based encryption with MyPHR system starts with a cloud system representation. After       outsourcing of data the functionalities of MyPHR machine are carried out. | 
        
        
            | The basic network model for the cloud data storage and three different network entities User: an entity, which has large       data files to be stored in the cloud and relies on the cloud for data maintenance and computation, can be either       individual consumers or organizations. Cloud Storage Server (CSS): an entity, which is managed by Cloud Service       Provider (CSP), has significant storage space and computation resource to maintain the user data. The Data owner       encrypted some keywords about his data, and service provider supported the owner to retrieve his data by keywords       and not allow others to retrieve. | 
        
        
            | Cloud storage services to users, where users can have access to very large volume of storage. Data kept on clouds can       also be shared by users giving that the sharing is authorized by the data owners Alice has a piece of data that is kept on the cloud. Secure data sharing needs to be achieved via an un trusted cloud storage provider. It is necessary that the       cloud storage provider helps to enforce the authorization policy for data access but the enforcement should not reveal       any information to the cloud storage provider or enable the cloud storage provider have excessive privileges to allow       unauthorized access.Cloud storage services provide, very large volume of storage to outsource user data. Data kept on       clouds can also be shared to users that the sharing is authorized by the data owners. Cloud storage provider helps to       enforce the authorization policy for data access. | 
        
        
            
            CONCLUSION AND FUTURE WORK
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            | In this paper, an extensive study is carried out on managing medical database in cloud for the past 15 years. Several       approaches of cloud computing and high-performance computing models have been studied and the results were       observed. Algorithms pertaining to ensuring security to electronic health records in cloud have been studied along with       the computation overhead involved in implementing the algorithms for real and synthetic patient medical records. Also       we have implemented the modular workflow based PHRs storage in Cloud Environment. | 
        
        
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            Tables at a glance
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            Figures at a glance
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