The Fast Health Interoperability Resources (FHIR) standard and homecare, a scoping review

The scoping review reported by this article aimed to analyze the state of the art of the use of Fast Health Interoperability Resources (FHIR) in the development of homecare applications and was informed by the following research questions: (i) what type of homecare applications benefit from the use of FHIR?; (ii) what FHIR resources are being implemented?; (iii) what publicly available development tools are being used?; and (iv) how privacy and security issues are being addressed? An electronic search was conducted, and 27 studies were included in the scoping review after the selection process. The results show a current interest in using FHIR to implement: i) applications to provide interoperable measurement devices for home monitoring; (ii) applications to remotely collected Patient Reported Outcome Measures (PROM); (iii) Personal Health Records (PHR); and (iv) specific applications for self-management. According to the results, the FHIR resources being implemented are quite diverse and contribute for the challenge of handling the variability caused by diverse healthcare processes. However, the use of publicly available development tools (e.g., SMART on FHIR or HAPI) is not yet generalized. Moreover, just a small number of studies reported the validation of the implemented resources using publicly available FHIR validators. Finally, in terms of privacy and security issues, different approaches were identified: authentication and authorizations mechanisms, end-to-end encrypted messaging mechanisms, and decentralized management and audit trail based on blockchain technologies.publishe

Designing a HL7 compatible personal health record for mobile devices

Personal health records (PHRs) support health self-management for any individual. Currently, smart phones and tablets are widespread among the population and can collect and visualize health data, and get home care plan instructions. In this paper we describe an Android based PHR system that guarantees technological and structural interoperability using technological and communicational standards, respectively. Grounded on the standard-based architecture by the Health Level Seven (HL7) organization, we describe a prototype implementing a HL7 compatible personal health record system. We considered some functionalities that may support the discovery of potential risk of cardiovascular diseases, the leading cause of death in industrialized countries according to the WHO (World Health Organization). This work aims at helping people raising their lives quality by participating in vital parameters' examinations. Individuals install a mobile Health app (called mHealth) on their devices and can directly exchange clinical and medical data with health care services through HL7 Fast Healthcare Interoperability Resources (FHIR). FHIR compliant JSON (Java Script Object Notation) encrypted files implement the integration architecture. Direct and standard information exchange based on a regular home care plan between a PHR system used by patients and a healthcare information system used by physicians can boost the active contribution of patients and caregivers to a safe homecare management. The proposed solution may provide faster and better care, reduce economic costs for National Health Services (NHS), and increase quality of individual's life. Moreover, by delivering healthcare services through a mobile application we can also overcome temporal and geographical barriers

An access control model for a South African National Electronic Health Record System

Countries such as South Africa have attempted to leverage eHealth by digitising patients’ medical records with the ultimate goal of improving the delivery of healthcare. This involves the use of the Electronic Health Record (EHR) which is a longitudinal electronic record of a patient’s information. The EHR is comprised of all of the encounters that have been made at different health facilities. In the national context, the EHR is also known as a national EHR which enables the sharing of patient information between points of care. Despite this, the realisation of a national EHR system puts patients' EHRs at risk. This is because patients’ information, which was once only available at local health facilities in the form of paper-based records, can be accessed anywhere within the country as a national EHR. This results in security and privacy issues since patients’ EHRs are shared with an increasing number of parties who are geographically distributed. This study proposes an access control model that will address the security and privacy issues by providing the right level of secure access to authorised clinicians. The proposed model is based on a combination of Role-Based Access Control (RBAC) and Attribute-Based Access Control (ABAC). The study found that RBAC is the most common access control model that is used within the healthcare domain where users’ job functions are based on roles. While RBAC is not able to handle dynamic events such as emergencies, the proposed model’s use of ABAC addresses this limitation. The development of the proposed model followed the design science research paradigm and was informed by the results of the content analysis plus an expert review. The content analysis sample was retrieved by conducting a systematic literature review and the analysis of this sample resulted in 6743 tags. The proposed model was evaluated using an evaluation framework via an expert review