Compliance of Open Source EHR Applications with HIPAA and ONC Security and Privacy Requirements

Electronic Health Records (EHRs) are digital versions of paper-based patient\u27s health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. EHR applications are guided by measures of the Health Insurance Portability and Accountability Act (HIPAA) to ensure confidentiality, integrity, and availability. However, there have been reported breaches of Protected Health Identifier (PHI) data stored by EHR applications. In many reported breaches, improper use of EHRs has resulted in disclosure of patient’s PHI data. Inefficient application design threatens the integrity of EHRs, which leads to fraud and endangering patient\u27s health. The goal of this paper is to identify HIPAA technical requirements, evaluate an open source EHR application (OpenEMR) for security vulnerabilities using an open-source scanner tool (RIPS), and map identified vulnerabilities to HIPAA technical requirements

Sharing and viewing segments of electronic patient records service (SVSEPRS) using multidimensional database model

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The concentration on healthcare information technology has never been determined than it is today. This awareness arises from the efforts to accomplish the extreme utilization of Electronic Health Record (EHR). Due to the greater mobility of the population, EHR will be constructed and continuously updated from the contribution of one or many EPRs that are created and stored at different healthcare locations such as acute Hospitals, community services, Mental Health and Social Services. The challenge is to provide healthcare professionals, remotely among heterogeneous interoperable systems, with a complete view of the selective relevant and vital EPRs fragments of each patient during their care. Obtaining extensive EPRs at the point of delivery, together with ability to search for and view vital, valuable, accurate and relevant EPRs fragments can be still challenging. It is needed to reduce redundancy, enhance the quality of medical decision making, decrease the time needed to navigate through very high number of EPRs, which consequently promote the workflow and ease the extra work needed by clinicians. These demands was evaluated through introducing a system model named SVSEPRS (Searching and Viewing Segments of Electronic Patient Records Service) to enable healthcare providers supply high quality and more efficient services, redundant clinical diagnostic tests. Also inappropriate medical decision making process should be avoided via allowing all patients‟ previous clinical tests and healthcare information to be shared between various healthcare organizations. Multidimensional data model, which lie at the core of On-Line Analytical Processing (OLAP) systems can handle the duplication of healthcare services. This is done by allowing quick search and access to vital and relevant fragments from scattered EPRs to view more comprehensive picture and promote advances in the diagnosis and treatment of illnesses. SVSEPRS is a web based system model that helps participant to search for and view virtual EPR segments, using an endowed and well structured Centralised Multidimensional Search Mapping (CMDSM). This defines different quantitative values (measures), and descriptive categories (dimensions) allows clinicians to slice and dice or drill down to more detailed levels or roll up to higher levels to meet clinicians required fragment

Análisis comparativo entre ASP.NETy PHP

La tecnología avanza cada día con más velocidad, hace pocos años el uso del internet no era un asunto de primera necesidad como lo es ahora, si alguien indicaba que la internet desplazaría a la prensa escrita, hubiese sido ignorado, pero esa es la realidad actual, por lo cual la carrera hacia el uso de la web se ha vuelto muy competitiva y todas las empresas se están encaminando en esa dirección. Los desarrolladores informáticos se orientan al desarrollo web y es una necesidad conocer cuál lenguaje de programación es el idóneo para la elaboración de un sitio web. A través del método comparativo de investigación este trabajo se orientó hacia el reconocimiento y análisis de dos de las herramientas de desarrollo web más utilizadas en la actualidad como son ASP.NET y PHP. Se presentan los beneficios y falencias de cada una de ellas, exploradas por diversos autores, dándole al lector una idea general de lo que se puede alcanzar. Es un apoyo importante para la definición de la herramienta más adecuada para el desarrollador de aplicaciones web. Se consideran los aspectos más relevantes de ambas herramientas para dar mayor claridad al momento de decidir cuál escoger. Es importante conocer las opciones que brinda el lenguaje de programación por seleccionar ya sean estas funcionales o administrativas. Se concluye que a la hora de seleccionar el lenguaje de programación se debe de tener en cuenta todas las características y definiciones planteadas que harán del software un producto de calidad que agregue valor a la operación de la empresa.   Palabras clave: ASP.NET, PHP, herramientas, desarrollo, programació

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

Patient-Centred Culturally-Aware Design Approach for e-Health Acceptance

The importance of information and communication technology in healthcare has recently grown to an unprecedented dimension as more people are empowered by technology to participate more actively in their healthcare processes. New online applications for accessing healthcare information and for self-diagnosis have become increasingly available to diverse patient groups of different languages, educational backgrounds, and cultural orientations. However, the design of these applications typically follows Western cultural orientations. This approach has created a gap, which makes it difficult for users, who use the systems within their own cultural contexts, to derive maximum benefits from such use. As a result, the gap impedes the uptake, market success, and effective adoption of these e-Health applications in various cultural contexts. Moreover, as healthcare organisations increasingly seek to interact with patients, often in real-time, through enhanced web-based services, patient experiences often become tied to a largely ‘Western-driven’ style of patient interfaces, interaction, and look and feel that negatively impact the overall acceptance of these services across different cultures. This poses a tremendous challenge to technology adoption, in particular with regard to how to design culturally-aware and patientcentred e-Health applications that reflect the cultural diversity of today’s users and meaningfully empower them to better utilise such tools to enhance their day-to-day life. This research proposes to investigate the impact of a patient-centred culturally-aware design approach on the patient acceptance of e-Health web-based services, in particular, how e-Health web-based applications can be designed in a way that maximises their usability and ‘fits’ them into the cultural fabrics of individuals in different cultural contexts. To address this challenge, this research work examined existing literature in the fields of culture, technology acceptance and HCI, and identified relevant constructs that were used to develop a culturally-aware technology acceptance model for electronic health. Subsequently, the model provided a means for understanding the influence of different factors affecting patient acceptance and usage which were used as a foundation to inform the design of the Patient-Centred Culturally-aware e-Health Design Approach (PCCeDA) framework for e-Health web-based services developments. The novelty in PCCeDA is the notion of cultural awareness, which allows systems to personalise themselves according to a patient’s cultural profile while adhering to usability principles. As a result, the interface and contents presented to a patient are both dynamically tailored to better suit that patient’s cultural preferences, thereby increasing patient adoption. Based on PCCeDA, a proof of concept prototype called i-Diagnose was developed primarily to assess the validity of the framework and to answer the central questions of this research study. Evaluation results show that a patient-centred culturally-aware design approach enhances the effectiveness, usefulness and patient acceptance of e-Health web-based services in different cultural contexts. The main contributions of this work include: (i) a culturally sensitive technology acceptance model for e-Health (‘e-HTAM’) where both technology acceptance model and cultural dimensions are integrated to develop the e-HTAM model. The model highlighted various issues that need to be taken into consideration when designing patient-centred culturally-aware e-Health Design Approach applications; and (ii) a patient-centred Culturally-aware e-Health Design Approach framework that allows systems to personalise both the patient interface and the contents provided to a patient to better suit that patient’s cultural background. The research also includes a number of other minor contributions such as: (i) an approach for solving the static nature of Hofstede’s dimensions’ indexation, through the use of cultural parameters to dynamically model users’ cultural states, (ii) the introduction of personalisation based on cultural factors into the e-Health web-based services domain, and (iii) shed light on the electronic health acceptance state in the UAE as compared to the UK

Interoperability between information systems of the results of clinical analysis and electronic record of the patient

The issue of interoperability between institutions in underdeveloped countries always presents good opportunities for science to contribute to substantial improvements in real-world issues. Basic support systems, such as health institutions, are among those that can benefit most from scientific advances. This paper reports an analysis made on the lack of interoperability between health institutions, specifically with regard to the interaction between physicians' offices and clinical analysis laboratory. This research was validated with a real practical use case that is presented in this paper. In order to make the information stored in different computer applications of the health information system (HIS), more specifically in the Hospital Center Dr. Ayres de Menezes, in São Tomé and Príncipe, interoperable, two distinct applications were developed, Patient Management System (PMS) and Clinical Analysis Laboratory Management System (LMS) to implement interoperability between them. In this way, take advantage of the interoperability logic implemented between these two applications and later integrate other systems. The PMS requests medical exams through your Medical Consultation panel. The second system, LMS receives the exam request and after the exams are processed and validated, the results are sent to the requesting system. To make the interoperability service effective, the SOAP protocol was used, which allowed the exchange of information synchronously between these two applications, allowing for faster transactions of patients' pathological data, and greater confidentiality of this same information. And as the work progressed, we felt the need to create a functional prototype with REST to meet the cloud model proposal.A questão da interoperabilidade entre instituições em países subdesenvolvidos sempre apresenta boas oportunidades para a ciência contribuir para melhorias substanciais em questões do mundo real. Os sistemas de apoio básico, como as instituições de saúde, estão entre os que mais podem se beneficiar dos avanços científicos. Este trabalho relata uma análise feita sobre a falta de interoperabilidade entre instituições de saúde, especificamente no que diz respeito à interação entre consultórios médicos e laboratórios de análises clínicas. Esta pesquisa foi validada com um caso de uso prático real que é apresentado neste trabalho. De forma a tornar a informação armazenada nas diferentes aplicações informáticas do sistema nacional de saúde (SIS), mais concretamente no Centro Hospitalar Dr. Ayres de Menezes, em São Tomé e Príncipe, interoperáveis, foram desenvolvidas duas aplicações distintas, Sistema de Gestão de Pacientes (SGP) e Sistema de Gestão do Laboratório de Análises Clínicas (SGL) para implementar a interoperabilidade entre eles. Desta forma, aproveitar a lógica implementada entre estas duas aplicações e posteriormente integrar outros sistemas. O SGP solicita exames médicos através do seu painel de Consulta Médica. O segundo sistema, o SGL, recebe a solicitação dos exames e após os exames serem processados e validados, os resultados são enviados ao sistema solicitante. Para tornar o serviço de interoperabilidade efetivo, foi utilizado o protocolo SOAP, que permitiu a troca de informações de forma síncrona entre essas duas aplicações. Por outro lado, sentimos a necessidade de criar um protótipo funcional com REST para atender a proposta do modelo em nuvem

Aplicaciones web para móvil: Estudio y desarrollo de una plataforma web orientada a la telemedicina

En el presente Trabajo Fin de Máster, se realiza un estudio y desarrollo de una plataforma web para dispositivos móviles orientada a la telemedicina, concretamente en el campo de la salud mental. Las aplicaciones mHealth (Mobile Health) se encuentran en auge y continuarán siendo un factor importante en la asistencia sanitaria, dado que existe una constante evolución en las técnicas médicas y psiquiátricas que necesitan de un apoyo telemático. También cabe destacar que la evolución de las tecnologías hará que los pacientes y el personal sanitario puedan beneficiarse del intercambio de datos e información entre pacientes y el personal sanitario y el personal sanitario entre ellos mismos. Esta evolución trae consigo que las aplicaciones de mHealth dan al personal sanitario una nueva visión en la forma de trabajo y comunicación con sus compañeros, beneficiando por lo tanto a los pacientes que sufren enfermedades crónicas neurodegenerativas o enfermedades neurológicas. Con el inicio de una nueva línea de investigación, se hace un estudio detallado enmarcada en el campo del entorno móvil en la telemedicina centrándonos en los pacientes con algún tipo de discapacidad cognitiva. El propósito general de la investigación es el uso de los dispositivos móviles con conexión a Internet, para poder compartir y obtener información en relación a los historiales clínicos de los pacientes.Departamento de Teoría de la Señal, Comunicaciones e Ingeniería TelemáticaMáster en Investigación en Tecnologías de la Información y las Comunicacione

An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network