1 Abstract – Healthcare applications involve complex structures of interacting processes and professionals that need to exchange information to provide the care services. In this kind of systems many different professional competencies, ethical and sensibility requirements as well a legal frameworks coexist and because of that the information managed inside the system should not be freely accessed, on the contrary it must be subject to very complex privacy restrictions. This is particularly critical in distributed systems, where additionally, security in remote transmissions must be ensured. In the paper we address the fundamental security issues that must be considered in design of a distributed healthcare application. The particular case of the K4CARE system is presented as an example of an application to the medical domain of homecare assistance. Homecare involves professionals from different institutions (hospital, social work organisms, etc) structurally independent, which must interact around any particular patient, and which use to be located in different physical places having their own and independent information systems. Index Terms - security, information system, data privacy, healthcare information system I. INTRODUCTION Medical environments use to involve highly complex structures of interacting processes and professionals where a large volume of information is managed and exchanged. With the development of technological infrastructure, the utilization of large information systems in health care has been permanently growing for several decades. The demand on data and information sharing among institutions has increased as well. Thus, the issue of data and information security becomes more and more important because most of the medical data and information is not regarded public. We have to differentiate because not all information is equal and it may require different degree of protection. Common information may be: Public: information that is already a matter of public record or knowledge, for example names and sex of politicians or artists. Personal: it belongs to a private individual. It depends on his/her decision to share this information with others, for example, address, phone number and e-mail address. Private: information associated with an individual and whose disclosure may not be in the individual’s interest, for example credit card number or bank account number. Sensitive: Some types of private information are considered sensitive and may be protected by privacy laws This concerns person’s health record, ethnic origin, religion, political attitude. Confidential: information whose disclosure may harm business or personal integrity. In homecare this concerns information, for example, about psychic state of a person, about oncological diagnosis, or HIV. Protection methods differ according to place of information – security during data transmissions, storage, or even during data processing in the system environment. In medical environments, most pieces of information are usually very sensitive, private or even confidential and special care is required when dealing with it. An important aspect of information security and risk management is recognizing the value of information and defining appropriate procedures and protection requirements for the information. Moreover, in most countries there exist legal regulations that define basic security and data privacy requirements laid on healthcare information systems. In the paper we address some elements to guarantee security and privacy preserving in distributed IT applications which provide some kind of support to complex medical domains. In this kind of systems many different professional competencies, ethical and sensibility requirements as well legal frameworks coexist and, because of that, the information managed inside the system must be subject to very complex privacy restrictions. This is particularly critical in distributed systems, where additionally security in remote transmissions must be ensured. In a medical system, design has to solve all levels of determining user rights – identification, authentication and authorization. The particular case of the medical domain of homecare assistance is presented as an example of an application. It is especially interesting because of its inherent complexity. Homecare is a service focused on the patient. Homecare has to be properly addressed to the individuals who can derive the higher benefit: the average homecare patient is an elderly patient, with co-morbid conditions and diseases, cognitive and/or physical impairment, functional SECURITY RECOMMENDATIONS FOR IMPLEMENTATION IN DISTRIBUTED HEALTHCARE SYSTEMS Lenka Lhotska Petr Aubrecht Aida Valls Karina Gibert Member, IEEE Dept. Cybernetics Dept. Comp.Science Dept. Statistics and Dept. Cybernetics Czech Technical University and Mathematics Operations Research Czech Technical University in Prague Universitat Rovira I Virgili Universitat Politècnica de in Prague Prague Tarragona Catalunya Prague Czech Republic Spain Barcelona Czech Republic. aubrech@labe.felk.cvut.cz aida.valls@urv.cat Spain lhotska@fel.cvut.cz karina.gibert@upc.edu