A comprehensive survey on secure healthcare data processing with homomorphic encryption: attacks and defenses

Healthcare data has risen as a top target for cyberattacks due to the rich amount of sensitive patient information. This negatively affects the potential of advanced analytics and collaborative research in healthcare. Homomorphic encryption (HE) has emerged as a promising technology for securing sensitive healthcare data while enabling computations on encrypted information. This paper conducts a background survey of HE and its various types. It discusses Partially Homomorphic Encryption (PHE), Somewhat Homomorphic Encryption (SHE), Fully Homomorphic Encryption (FHE) and Fully Leveled Homomorphic Encryption (FLHE). A critical analysis of these encryption paradigms’ theoretical foundations, implementation schemes, and practical applications in healthcare contexts is presented. The survey encompasses diverse healthcare domains. It demonstrates HE’s versatility in securing electronic health records (EHRs), enabling privacy-preserving genomic data analysis, protecting medical imaging, facilitating privacy-preserving machine learning (ML), supporting secure federated learning, ensuring confidentiality in clinical trials, and enhancing remote monitoring and telehealth services. A comprehensive examination of potential vulnerabilities in HE systems is conducted. The research systematically investigates various attack vectors, including side-channel attacks, key recovery attacks, chosen plaintext attacks (CPA), chosen ciphertext attacks (CCA), known plaintext attacks (KPA), fault injection attacks (FIA), and lattice attacks. A detailed analysis of potential defense mechanisms and mitigation strategies is provided for each identified threat. The analysis underscores the importance of HE for long-term security and sustainability in healthcare systems.