Improve The Performance and Security of Medical Records using

Fingerprint and Advance Encryption Standart

Ach. Khozaimi, Sigit Susanto Putro and Ainul Yaqin

Informatics Engineering Department, University of Trunojoyo Madura East Java, Indonesia

Keywords: Electronic medical records, Cryptography, Biometrics, Data security, Advance encryption standard.

Abstract: Medical record (MR) is privacy and sensitive data. MR can be read by a doctor, nurse, and that patient only.

MR must be store in safety documents and protected from others. MR is stored and identified by a patient's

unique id. In Public Health Center Socah, Bangkalan East Java Indonesia uses card medical treatment as a

patient's unique id to determine their medical record data. The patient's card medical treatment is easy to lose.

In this study will be implemented Advanced Encryption Standard (AES) 256 to protect data electronic medical

record, because AES has better performance than Data Encryption Standard (DES), 3DES and RSA (Rivest–

Shamir–Adleman). On the other hand, the biometric fingerprint is used as a patient's unique id because the

fingerprint is not easy to lose from patients. From the result, this system more efficient in time consumption

by 61% when compared to using the administrative system and writing medical record data manually, besides

that this system also protects the patient's EMR data from irresponsible parties, because the Electronic medical

record (EMR) data is encrypted by AES 256, so EMR data cannot be read directly.

1 INTRODUCTION

According to the regulations Minister of Health

Indonesia No. 269/Menkes/PER/III 2008, Medical

Record is data containing patient information

includes: patient identification, examination,

treatment, administration actions, and other services

performed by medical personnel to the patient (Rusli

et al., 2006). Medical record data is sensitive data and

confidential (Dubovitskaya et al., 2017), medical

records can be used for various purposes, such as for

Memory aid, Communication devices, Quality

assurance instrument, Risk reduction aid,

reimbursement aid, Evaluation tool and Research tool

(Dehn & Asprey, 2007). In addition, medical record

data can be used to plan treatment or further

examination in the future (Marutha et al., 2017).

Besides, the electronic medical record is also used as

evidence of disease diagnosis and medical care of

patients.

Based on Indonesian law and the importance of

medical record data, the data must be stored and

protected, so it cannot be accessed by unauthorized

parties (Benaloh et al., 2009). Medical record data is

stored based on each patient's unique code,

handwritten into sheets of paper, and has not used a

database (Putra & Mulyono, 2013). Much research

has been done to overcome this problem, one of

which is to provide an identity card that is listed with

a medical record number (RM). But this method is

still not effective enough, because it risks losing the

card. This also happened in the public health center

Socah, Bangkalan Regency, Indonesia.

This research will apply two methods, namely

biometric fingerprint authentication and Advance

Encryption Standard (AES). This research use AES

256, because 256 AES is more secure than the other

types (Pancholi & Patel, 2016). The biometric

fingerprint algorithm is used as a unique code that

will mark the medical records of each patient because

the fingerprint is an authentication technology based

on individual physiological and behavioural

characteristics (Soni & Goyani, 2018)(S. Tarare,

2015). So that the unique code will always be there

with the owner and will not be lost, AES 256

cryptography algorithm is used to encrypt medical

record data because AES 256 has better performance

than Data Encryption Standard (DES), 3DES, and

RSA (Ahmed Khalid & Rihan, 2017) The acronym

of RSA stands for Rivest, Shamir, and Adelman, the

inventors of the technique, so medical record data is

safe and cannot be read directly. Including the case of

theft of medical records database.

Khozaimi, A., Putro, S. and Yaqin, A.

Improve the Performance and Security of Medical Records using Fingerprint and Advance Encryption Standart.

DOI: 10.5220/0010333102850290

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 285-290

ISBN: 978-989-758-500-5

285

2 BACKGROUND

In this section, we will discuss the theoretical basis

and methods used in this study. Theories and methods

that will be discussed include medical records, public

health centers, fingerprints, cryptography, and

advanced encryption standards (AES).

2.1 Medical Record

Data privacy of medical records of each patient

consists of personal data, medical history, and others.

The medical record is sensitive of data and privacy

(Dubovitskaya et al., 2017), medical record data can

be used for various purposes, such as for Memory aid,

Communication devices, instrument Quality

Assurance, Risk reduction aid, aid reimbursement,

Evaluation and Research tool (Dehn & Asprey,

2007). Besides, medical record data can be used to

plan further treatment or investigation at a later date.

Medical record data is also used as evidence of

disease diagnosis and medical care of patients.

The benefits of medical records very much, and it

is essential for the well-managed so that these

benefits can be felt by the service provider and the

service recipient. Benefits include medical records,

first as a basis for planning treatment, care, and

preventive action. Secondly, to improve the quality of

service and to protect medical personnel. The third

medical records can be used for education and

research. Fourth, care financing will be more

transparent and accountable. Fifth medical records

can be used as health statistics. Sixth medical record

data can be used for evidentiary law, discipline, and

ethics of health personnel (Dehn & Asprey, 2007).

2.2 Public Health Center

Puskesmas stand for public health center, According

to the DEPKES-RI Puskesmas Work Guidelines, the

Puskesmas is a functional health organization which

is a center for community health development which

also fosters community participation in addition to

providing comprehensive and integrated services to

the community in its working area in the form of main

activities. puskesmas has three main functions:

1. As a centre for community health development

in the working area. The Puskesmas is in the

middle of a community that can quickly find

out the successes and obstacles faced in

building public health.

2. Fostering community participation in the

working area for increasing the ability to live

healthy.

3. Providing comprehensive and integrated health

services to the community in its working area.

2.3 Fingerprint

The fingerprint is a technology that can easily identify

someone. Even today fingerprints are widely used by

the world's technological development because the

use of fingerprints is relatively safe, accurate and

convenient for the authentication process compared

to other authentication methods, this is because the

fingerprint is feasible, distinct, permanent, accurate,

reliable, and acceptable(S. Tarare, 2015).

Fingerprint has a function as a verification

medium, just like a password or pin. It's just that the

fingerprint uses a human fingerprint pattern as the

primary key stored in the database (Sifaunajah, 2015).

The work process of the fingerprint is to compare the

current fingerprint feature with some fingerprint

features that have been stored in the database before

(Ngantung et al., 2014). Many methods can match the

current fingerprint with the fingerprint that has been

stored in the database (Soni & Goyani, 2018)(H.

kumar, 2013), such as template matching (Leksono et

al., 2011), Bank Gabor Filter (Verifikasi et al., 2009),

Minutiae Feature (H. kumar, 2013), and so on.

Figure 1: Fingerprint Patterns

Template matching is an image processing

technique to find small parts of the image that

matches a model that has saved previously. The

essential idea template matching explains how the

brain recognizes re-shapes or patterns that known

before. The Bank Gabor Filter method works by

finding fingerprint features based on the Average

Absolute Deviation (AAD) value of the fingerprint

image. These features are known as finger codes

(Verifikasi et al., 2009). Minutiae are some lines that

form a pattern of the fingerprint pattern. At one

fingerprint may be formed of hundreds of minutiae as

an individual characteristic.

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Fingerprint has three characteristics, i.e.,

Perennial nature, Immutability, and individuality.

Based on the pattern, fingerprints classified into three

forms, namely arch, loop, and whorl (Leksono et al.,

2011). A fingerprint is widely used for security access

and authentication method.

2.4 Cryptography

Cryptography is a technique for hiding and protecting

data information and messages, so that data or

messages cannot be read by unauthorized user. The

main function of cryptography is not only to protect

data, but also to provide solutions for other problems

like: data integrity, authentication, non-repudiation

(Sharma & Gupta, 2017). Cryptography can be used

and implemented in various media, such as software,

graphics and. Figure 2 can be seen the cryptography

process.

Figure 2: Cryptography Process

There are two key based cryptography techniques

used are: symmetric encryption such as DES, 3DES,

AES and asymmetric encryption such as RSA, DSA,

ECC. Symmetric encryption also called secret key

encryption and the second one called public key

encryption.

2.5 Advanced Encryption Standard

Advanced Encryption Standard (AES) is a

cryptography algorithm to secure and protect files or

data information. AES was developed by Vincent

Rijmen and John Daemen from Belgia, and it's called

the Rijndael algorithm (Ahmed Khalid & Rihan,

2017). AES is a symmetric-key algorithm to encrypt

and decrypt data or information. Advanced

encryption standard (AES) is the next generation of

Data Encryption Standard (DES), and AES is

deference than DES (Ahmed Khalid & Rihan, 2017).

In 1997, the National Institute of Standard and

Technology (NIST) of the United States had released

Advanced Encryption Standard (AES) to replace

Data Encryption Standard (DES), because DES has

been deemed insecure.

Figure 3: AES Illustration

AES can be implemented in hardware and

software, especially in the small device (Emori,

1973), AES has the same performance in both

(Padmavathi & Kumari, 2013). AES has a better

performance than another cryptography algorithm

such as DES, 3DES, and RSA in time consumption,

throughput (Patil et al., 2016)(Darma Udayana &

Sastra, 2016) , and CPU Usage (Ahmed Khalid &

Rihan, 2017).

AES is a block cipher algorithm with a

permutation (P-Box) and substitution(S-Box) system.

AES is deference than the usual block cipher system.

They are three kinds of AES, i.e., (Darma Udayana &

Sastra, 2016):

• . AES-128 with 10 rounds.

• AES-192 with 12 rounds.

• AES-256 with 14 rounds

Figure 4: S-BOX of AES Algorithm

Figure 5. Show the step of the AES algorithm to

encryption and decryption. AES Encryption step has

four states in each round, i.e., SubBytes, ShiftRows,

Mixcolumns, and AddRoundKey.

• SubBytes: Byte substitution using S-Box

(Figure 4).

• ShiftRows: Shifting lines are wrapping state

array.

Improve the Performance and Security of Medical Records using Fingerprint and Advance Encryption Standart

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• MixColumns: scrambles the data in each

column of the array state.

• AddRoundKey: do XOR between the first step

(plain text) and cipher key. This step also called

initial round Sub Bytes.

Figure 5. AES Encryption and Decryption

AES Decryption Process is a cipher

transformation that is in the opposite direction of the

encryption process. It’s called an inverse cipher.

Transportation proses that used in the inverse cipher

are InvShiftRows, InvSubBytes, InvMixColumns,

and AddRoundKey (Muharram et al., 2018).

3 IMPLEMENTATION

In this study, two special methods used to identify and

protect the electronic medical record. First, the

fingerprint is used to identify the patients and their

data electronic medical records. Fig. 4. Second, the

Advanced Encryption Standard (AES) 256 Algorithm

to encrypt Patient's Electronic Medical record (EMR)

that stores in the database Figure 6.

The fingerprint is used to identify patients and

their electronic medical records, the fingerprint is

implemented in this system. When a patient comes to

Public Health Center Socah Bangkalan, they will be

scanned their finger to identify they have ever visited

and get treatment before or not. If they ever visited,

they will get the queue code and will get treatment.

But if the new patient first came to Public Health

Center Socah Bangkalan, then the patient will

fingerprint is scanned and registered in advance.

After the data collection process and the registration

is completed, the patient will receive a code queue.

Figure 6: Fingerprint as patient's id

The process of health services will be given if the

patient had had his share. All information on the

results of testing, treatment, and all the services that

have been granted is inserted into the electronic

medical record database.

Figure 7: AES 256 to Encrypt the patient's EMR.

Each patient’s information after got treatment

from the doctor, such as diagnosis, treatment,

medicine, follow-up, and other information will be

encrypted and stored to the database using the AES

algorithm. AES will protect the electronic medical

record. Data electronic medical record that stores in

the database can be read by the user whose AES key.

See Figure 7.

4 RESULT AND DISCUSSION

This session will explain the result of the application

and discussion. In this system, the verification and

authentication process uses fingerprint, see figure 8.

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if the patient has visited and treated at public health

center Socah Bangkalan, Indonesia, before, he will be

directed to the Poly registration page, and they will

get queue code. However, if they have never visited

and treated before, it will be directed to the new

patient registration page. After registration is

complete, the patient will be registered at the

destination poly and will get the queue code.

Figure 8: Authentication Process using fingerprint

The results of the examination and treatment of

each patient's medical records will be generated.

Medical record data entered into the database is

encrypted using the Cryptographic Algorithm

Advanced Encryption Standard (AES) 256. See

Figure 9.

Figure 9: EMR Encrypted by AES 256

5 CONCLUSION

This application can improve the performance of the

service since it can efficiency time by 61% when

compared to the service without the system. In

addition, this system can increase the number of

services each day.

This application can secure the patient's electronic

medical record. Electronic medical records that store

in the database can be read by the user who has the

key only. It’s mean the data in the database cannot be

read directly.

ACKNOWLEDGEMENTS

Thanks delivered to the Informatics Engineering

Department, the University of Trunojoyo Madura,

who has supported this research. Special thanks to the

director of the Public Health Service Socah

Bangkalan, Indonesia as a case study of the research.

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