ABSTRACT
Electronic Health Records (EHRs) have transformed modern healthcare by enabling efficient data storage, access, and sharing across providers and institutions. However, the rapid digitization of sensitive patient information has introduced significant security, privacy, and compliance challenges that threaten patient trust, data integrity, and regulatory adherence. This systematic review critically examines current practices, emerging threats, and future directions concerning the protection of EHRs within healthcare systems. A comprehensive literature search was conducted across major databases, including PubMed, IEEE Xplore, Scopus, and ScienceDirect, targeting peer-reviewed articles published between 2015 and 2024. A total of 86 relevant studies were selected and analyzed based on inclusion criteria focused on EHR security frameworks, privacy-preserving techniques, legal compliance (e.g., HIPAA, GDPR), and case studies of healthcare data breaches. The review categorizes challenges into technical, organizational, and regulatory domains and evaluates the effectiveness of various mitigation strategies. Findings reveal that while encryption, access control, and anonymization are widely adopted technical safeguards, many implementations remain vulnerable to insider threats, misconfigurations, and inadequate monitoring. Privacy concerns are further amplified by third-party integrations and the growing use of mobile health applications, which often fall outside traditional compliance oversight. From a regulatory perspective, inconsistencies in global standards and the complexity of compliance obligations hinder seamless adoption and enforcement. Emerging solutions, including blockchain, federated learning, and differential privacy, show promise in enhancing security and privacy without compromising data utility. However, their scalability and integration into legacy systems remain ongoing challenges. The review highlights the need for harmonized regulatory frameworks, continuous staff training, real-time monitoring, and multidisciplinary collaboration to address evolving cybersecurity threats. This study provides a comprehensive synthesis of the state of EHR security, offering valuable insights for healthcare providers, policymakers, and technology developers. It emphasizes the urgency of proactive strategies to safeguard digital health infrastructures while fostering innovation and patient-centered care.
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