Electronic Health Record Architecture: A Systematic Review

Numerous advantages are derived from the electronic health record (EHR).Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015).  Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture

Patient Consent for Health Information Exchange: Blockchain-driven Innovation

Health information exchange (HIE) is vital to improving care delivery and outcomes, and patient consent is an important component of HIE. Existing consent processes that involve completing forms at a provider, along with poor interoperability between HIEs, give patients limited control of their consent management. We developed and deployed a survey to assess how people perceive the value of HIE, the importance of controlling access to their protected health information (PHI), and how they would prefer to manage consent for the exchange of their PHI. Given the option, 70% of the participants would prefer to use a consent application (app) to manage their consent. Based on the current U.S. HIE environment, we argue that the most viable architecture for implementing an HIE consent app would be a permissioned blockchain. We describe and illustrate a consent management app prototype that is blockchain-based as an effective alternative to current HIE consent practices

Collaboration through Patient Data Access and sharing in the cloud

(c) 2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.There have been many socio-political and technological developments in the area of Electronic Patient Records (EPR). The technological aspects include EPR implemented using Online Transaction Processing (OTP) using Internet and Internet based systems, more recently via Cloud- Based systems (CBS) exploiting Cloud Service Models (CSM). Additionally, there are many socio-political considerations comprising: (1) political moves, including UK Government policy, which aims to deliver for patients 27/7 online access to their patient record, (2) considerations around ethical issues and informed permission and acceptance by the public and non-governmental organizations (NGO), (3) technological considerations about identification of suitable CBS and data structures in distributed systems characterized by unstructured data and, finally (4) sharing and collaboration as means of increasing efficiency, security, privacy, etc. In all, the aim is to provide professionals in medical domain with advanced platforms to not only access but also most importantly to share and collaborate at a wide scale level (e.g. National level). Addressing these aspects of EPR requires collaboration between all stakeholders in EPR, this paper considers these and concludes that such collaboration is essential if EPR are ever to become a reality.Peer ReviewedPostprint (author's final draft

Architecture of a consent management suite and integration into IHE-based regional health information networks

<p>Abstract</p> <p>Background</p> <p>The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment.</p> <p>Methods</p> <p>Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR.</p> <p>Results</p> <p>The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents.</p> <p>Conclusions</p> <p>Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general.</p

The INCA System: A Further Step Towards a Telemedical Artificial Pancreas

Biomedical engineering research efforts have accomplished another level of a ldquotechnological solutionrdquo for diabetes: an artificial pancreas to be used by patients and supervised by healthcare professionals at any time and place. Reliability of continuous glucose monitoring, availability of real-time programmable insulin pumps, and validation of safe and efficient control algorithms are critical components for achieving that goal. Nevertheless, the development and integration of these new technologies within a telemedicine system can be the basis of a future artificial pancreas. This paper introduces the concept, design, and evaluation of the ldquointelligent control assistant for diabetes, INCArdquo system. INCA is a personal digital assistant (PDA)-based personal smart assistant to provide patients with closed-loop control strategies (personal and remote loop), based on a real-time continuous glucose sensor (Guardian RT, Medtronic), an insulin pump (D-TRON, Disetronic Medical Systems), and a mobile general packet radio service (GPRS)-based telemedicine communication system. Patient therapeutic decision making is supervised by doctors through a multiaccess telemedicine central server that provides to diabetics and doctors a Web-based access to continuous glucose monitoring and insulin infusion data. The INCA system has been technically and clinically evaluated in two randomized and crossover clinical trials showing an improvement on glycaemic control of diabetic patients

Uncovering Research Opportunities in the Medical Informatics Field: A Quantitative Content Analysis

With rapid improvements in technology, the ever-pressing need to reduce healthcare costs, and continuing legislation emphasizing medical reforms, the demand for research within the healthcare/information systems interface is growing. In this study, we ascertain the prevalent themes from the extant medical informatics literature in an effort to motivate research beyond the traditional domain of health information technology research so information systems scholars can better understand where their expertise might contribute to advancements in healthcare. We used a quantitative content analysis method to systematically explore 2,188 article texts from journals in medical informatics, medicine, and MIS published over a ten-year period. Texts were analyzed using centering resonance analysis and factor analysis and the following themes emerged from the literature: Analytics; Healthcare Operations and Standards (with sub-themes: Operations, Project Management, and Information Assurance); Knowledge Transfer/Communication (with sub-themes: Extending beyond the Organization, Internal to the Organization, and Patient-Provider); Perceptions and Managing Expectations of Information Technology; Advancements in Research; and Software as a Service. In this article, we discuss these themes in greater detail and offer directions for future research

Design Requirements for a Patient Administered Personal Electronic Health Record

Published version of a chapter in the book: Biomedical engineering, trends in electronics, communications and software. Intech, 2011 Open Acces

An application of the Privacy Management Reference Model & Methodology (PMRM) to HL7 consent directive use cases

1 online resource (iii, 39, [6], 32 p.) : col. ill.Includes abstract and appendix.Includes bibliographical references (p. [40-45]).The importance and sensitivity of personal health information has led to an increased focus on privacy protection measures as personal health records are digitized. Systems and legislation are rapidly adapting to meet both technology and consumer concerns. An application of the Privacy Management Reference Model & Methodology (PMRM) to assess HL7 Consent Directive Use Cases will provide policy makers, health care providers, and consenters alike the ability to assess the effectiveness of current practices when it comes to the interoperability and the protection of Individually Identifiable Health Information. A solid foundation will be provided to recommend how all stakeholders can work together to improve the consent processes, and ultimately improve the effectiveness of privacy protection measures as they relate to personal health information