Digital watermarking for healthcare: A survey of ECG watermarking methods in telemedicine

Innovations in healthcare have introduced a radical change in medical environment including patient diagnostic data and patient biological signal facilities and processing. The adoption of telemedicine services usually leads to an incremental trend in transmission of electronic sensitive data over insecure infrastructures. Since integrity, authenticity and confidentiality are mandatory features in telemedicine, the need to guarantee these requirements with end-to-end control arises. Among the various techniques implemented for data security, digital watermarking has gained considerable popularity in healthcare oriented applications. The challenge the watermarking insertion has to overcome is to avoid changes in health and medical history of a patient to a level where a decision maker can make a misdiagnosis. This paper presents a survey of different applications of electrocardiogram watermarking for telemedicine. The most recent and significant electrocardiogram watermarking schemes are reviewed, various issues related to each approach are discussed and some aspects of the adopted technique, including classification and performance measures, are analysed.