Security and Privacy-Preserving Data Sharing Mechanisms for Cloud-based Personal Health Records: A Systematic and Comparative Review

Abstract

Cloud computing has become a prominent platform for storing and sharing Personal Health Records (PHRs) due to its scalability and cost efficiency. However, outsourcing sensitive medical data introduces security challenges such as unauthorized access, data breaches, and complex key management. This paper presents a systematic review of secure data sharing mechanisms for cloud-based PHR systems published between 2016 and 2026. A total of 70 peer-reviewed articles were analyzed and categorized into cryptography-based approaches, blockchain frameworks, authentication mechanisms, AI-integrated models, and hybrid architectures. The findings reveal that attribute-based encryption and blockchain technologies are widely adopted to enhance confidentiality and access control, while recent studies emphasize AI-driven and federated learning-based security solutions. Despite advancements, issues related to computational overhead, scalability, and key management persist. This review identifies existing research gaps and highlights future directions toward lightweight encryption and adaptive healthcare security frameworks.