Abstract
With the widespread use of electronic health record (EHR), building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructure for facilitating EHR sharing and EHR integration. In this paper we discuss important concepts related to EHR sharing and integration in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs. We describe an EHR security reference model for managing security issues in healthcare clouds, which highlights three important core components in securing an EHR cloud. We illustrate the development of the EHR security reference model through a use-case scenario and describe the corresponding security countermeasures and state of art security techniques that can be applied as basic security guards.

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