Investigation of the viability of an integrated cloud-based electronic medical record for health clinics in Free State, South Africa

Thesis (Master of Information Technology) -- Central University of Technology, Free State, 2019The use of paper-based medical records leads to gaps in patient healthcare. Paper-based records are prone to challenges such as lack of real-time access to patient data, and inability to share and exchange medical data among different health institutions. A solution to address most of the challenges associated with paper-based medical records is to have an information system, such as an Electronic Medical Record (EMR) system. EMRs have proven to be more complete and quicker to access as opposed to paper records. Although EMRs may help resolve some of the problems with paper-based medical records, if the EMR systems are not linked or integrated, the problem of real-time accessibility and exchange of patient data remains unresolved. This leads to challenges in monitoring a patient’s health progress and providing continuity of care. The emerging cloud-computing model, which leverages the Internet to allow the sharing of IT resources as online services, may offer a cost-effective solution of integrating diverse EMR systems. It can serve as an electronic medical record storage centre which simplifies the complexities with EMR exchange methods between different systems and saves the equipment setup expenses for smaller healthcare facilities. In addition, cloud computing may improve healthcare services and benefit medical research. Despite the benefits offered by cloud computing, the adoption of cloud computing in the healthcare industry is the slowest compared to other industries. Further, adopting cloud computing involves many factors which require rigorous evaluation prior to introducing the new computing model to an organization. Very few empirical studies have focused on exploring factors influencing the adoption of cloud computing, especially in the public health sector. This study aimed to investigate the viability of an integrated cloud-based EMR system by exploring factors which influence the intent to adopt cloud computing at public healthcare facilities in the Free State province, South Africa. Through a review of literature on existing studies on the adoption of cloud computing and the Technology-Organization-Environment (TOE) framework, TOE factors were identified and adopted to suit the study’s context. The study carried out a quantitative cross-sectional research by collecting data using a questionnaire which was surveyed to a sample of five principal network controllers from all districts of the Free State and 31 public healthcare facilities in the Free State (FS), South Africa. The data collected was analyzed using SPSS version 19. The study’s hypotheses were tested by conducting a Spearman’s Coefficient Correlation. Results of the study revealed that most of the public healthcare facilities are using paper-based medical records with some form of IT to record basic patient information. Further, results of the study showed that some of the Health Information Systems (HIS) utilized at these healthcare facilities in the FS include Meditech, PADS, PharmAssist, Tier.net, HPRS, Rx Solutions, RDM, ETR and DHIS. According to this study, investments into IT infrastructure need to be considered by these health facilities as the current internet facilities will not be able to accommodate the use of cloud computing and only some facilities have internet facilities in place. Despite these challenges, these healthcare facilities are willing to adopt a cloud-based EMR system. Lastly, results of the study revealed that the factors associated with the intent to adopt cloud computing included relative advantage, security concern, organization readiness and top management support

Cloud enabled data analytics and visualization framework for health-shocks prediction

In this paper, we present a data analytics and visualization framework for health-shocks prediction based on large-scale health informatics dataset. The framework is developed using cloud computing services based on Amazon web services (AWS) integrated with geographical information systems (GIS) to facilitate big data capture, storage, index and visualization of data through smart devices for different stakeholders. In order to develop a predictive model for health-shocks, we have collected a unique data from 1000 households, in rural and remotely accessible regions of Pakistan, focusing on factors like health, social, economic, environment and accessibility to healthcare facilities. We have used the collected data to generate a predictive model of health-shock using a fuzzy rule summarization technique, which can provide stakeholders with interpretable linguistic rules to explain the causal factors affecting health-shocks. The evaluation of the proposed system in terms of the interpret-ability and accuracy of the generated data models for classifying health-shock shows promising results. The prediction accuracy of the fuzzy model based on a k-fold cross-validation of the data samples shows above 89% performance in predicting health-shocks based on the given factors

Healthcare support for underserved communities using a mobile social media platform

© 2017 Elsevier Ltd Emerging digital technologies for healthcare information support have already contributed to reducing the digital divide among rural communities. Although mobile health (m-health) applications facilitate provision of support for treatment consultation in real-time, their substantial potential has not yet been operationalised for decision support to meet citizen demand in developing nations. Modern healthcare information access, especially in rural areas of developing countries, is critical to effective healthcare, since both information and expert opinions are limited. Mobile phone and social media penetration, however, is often extensive. In this paper, we design and evaluate an innovative mobile decision support system (MDSS) solution for rural citizens healthcare decision support and information dissemination. Developed using a design science approach, the instantiated artifact connects underserved rural patients in Bangladesh to general practitioners (GPs) – allowing GPs, based on queries and information support provided, to evaluate patient conditions virtually and provide answers for further diagnosis or treatment. A cloud platform using social media embodies health record information and is used with a rating technique that matches queries to profiled remote experts, participating asynchronously. A comprehensive evaluation of the MDSS artifact ensures its utility, efficacy, and reliability

Perencanaan Arsitektur Sistem Informasi Rekam Medis dan Monitoring Gizi Buruk Berbasis Cloud Computing (Studi Kasus: Dinas Kesehatan Propinsi Jawa Barat)

Abstract. West Java Provincial Health Office still faces difficulties in managing information, especially in medical records. Recording and reporting of malnutrition are still done in some stages starting from collecting data from village midwives, puskesmas, Regency/City Health Office then Provincial Health Office and forwarded to the the central office. It is necessary to manage information through service system by utilizing Cloud Computing based on information technology. This research uses The Open Group Architecture Framework (TOGAF) approach in Architecture Development Method (ADM), from Architecture Capability Iteration to  Architecture Development Iteration. Monitoring and Evaluation (M & E) are two integrated activities in the context of controlling a program. The results of this research are planning a medical record information system architecture and monitoring malnutrition based on Cloud Computing with the name of M2Rec (Medical Record and Monitoring) in the form of integrated recommendation and development between current information system and proposed information system architecture.Keywords: togaf adm, medical record and monitoring, cloud computing Abstrak. Perencanaan Arsitektur Sistem Informasi Rekam Medis dan Monitoring Gizi Buruk Berbasis Cloud Computing. Dinas Kesehatan Propinsi Jawa Barat masih mengalami kesulitan dalam pengelolaan informasi yang baik, terutama pada proses rekam medis, pencatatan dan pelaporan gizi buruk masih dilakukan secara bertingkat mulai pengumpulan data dari bidan desa, puskesmas, Dinas Kesehatan Kabupaten/Kota kemudian Dinas Kesehatan Propinsi dan diteruskan ke pusat. Sehingga perlu diupayakan pengelolaan informasi melalui sistem pelayanan dengan memanfaatkan teknologi informasi berbasis Cloud Computing. Penelitian ini menggunakan pendekatan framework The Open Group Architecture Framework (TOGAF) Architecture Development Method (ADM), yaitu iterasi ke satu pada Architecture Capability Iteration daniterasi ke dua pada Architecture Development Iteration. Monitoring dan Evaluasi (M&E) merupakan dua kegiatan terpadu dalam rangka pengendalian suatu program. Hasil dari penelitian ini adalah perencanaan arsitektur sistem informasi rekam medis dan monitoring gizi buruk berbasis Cloud Computing dengan nama M2Rec (Medical Record and Monitoring) yang berupa rekomendasi integrasi dan pengembangan antara sistem informasi berjalan saat ini dengan arsitektur sistem informasi yang diusulkan.Kata kunci: togaf adm, medical record and monitoring, cloud computing

Providing security and fault tolerance in P2P connections between clouds for mHealth services

[EN] The mobile health (mHealth) and electronic health (eHealth) systems are useful to maintain a correct administration of health information and services. However, it is mandatory to ensure a secure data transmission and in case of a node failure, the system should not fall down. This fact is important because several vital systems could depend on this infrastructure. On the other hand, a cloud does not have infinite computational and storage resources in its infrastructure or would not provide all type of services. For this reason, it is important to establish an interrelation between clouds using communication protocols in order to provide scalability, efficiency, higher service availability and flexibility which allow the use of services, computing and storage resources of other clouds. In this paper, we propose the architecture and its secure protocol that allows exchanging information, data, services, computing and storage resources between all interconnected mHealth clouds. The system is based on a hierarchic architecture of two layers composed by nodes with different roles. The routing algorithm used to establish the connectivity between the nodes is the shortest path first (SPF), but it can be easily changed by any other one. Our architecture is highly scalable and allows adding new nodes and mHealth clouds easily, while it tries to maintain the load of the cloud balanced. Our protocol design includes node discovery, authentication and fault tolerance. We show the protocol operation and the secure system design. Finally we provide the performance results in a controlled test bench.Lloret, J.; Sendra, S.; Jimenez, JM.; Parra-Boronat, L. (2016). Providing security and fault tolerance in P2P connections between clouds for mHealth services. Peer-to-Peer Networking and Applications. 9(5):876-893. doi:10.1007/s12083-015-0378-3S87689395The Fifty-eighth World Health Assembly, Resolutions and Decisions. Document: A58/21. 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Facilitating coordinated care for multi-morbidity patients through integrated preventive Clinical Decision Support (C3-Cloud)

Introduction: A growing share of the population in OECD countries is of age 65 and over, expected to reach 22% by 2030 (compared to 15% in 2010). Life expectancy has also significantly increased. People at age of 65 are expected to live for an average of 21 and 17 years for women and men; an almost 40% increase since 1960. The profound success in improving life expectancy has resulted in a new set of challenges. Challenge: Shift of resources was necessary, redirected to address the complex needs of multi-morbidity patients. Furthermore, patients’ needs are not effectively met by current care models, which tend to operate in isolation. This results in static services that patients need to wander. It is common for patients to revisit all levels of care discussing their needs, and reconciling potentially conflicting objectives amongst their conditions (e.g., incompatible lifestyle goals, adverse drug effects and side-effects, undetected conditions). Optimal collaboration and coordination between professionals in the delivery of integrated care have become essential requirements for the provision of high-quality care. Coordinated care aims for the orderly arrangement of individual and group efforts providing unity of action in pursuit of a common goal. Method: C3-Cloud is an e-health based ICT system, offering integrated, patient-centred care, considering all aspects of multi-morbidity and creating a collaborative environment, for all involved stakeholders. The navel of the system consists of the patient care plan, a digital shared picture of the patients’ needs and care regime. The care plan allows all professionals to review and understand the implications of one condition in the presence of others; this by its nature is complex, containing a considerable amount of diverse information. Navigating, understanding, and interpreting all the information can be confounding. The C3-Cloud Clinical Decision Support Service (CDS) offers an automated means of interpreting the available data. CDSS connects to the care plan repository, and continuously searches records for relevant data. The algorithms and integration of recommendations to the service were reviewed and validated by clinicians. Human computer interaction methods were employed to ensure optimal interaction between C3-Cloud and its users. Results: C3-Cloud offers CDSS for diabetes, renal failure, depression and congenital heart failure, with over 300 rules and checks that deliver four best practice guidelines in parallel; whilst reconciling their objectives, and monitoring their outcomes. It creates warnings or recommendations for the patient as well as for formal and informal carers. Discussion and Conclusions: C3-Cloud offers a powerful way to ensure that subtle, as well as critical, information about the patient, is presented to healthcare professionals, along with guideline based recommendations. The rules reconcile potential conflicts amongst conditions. Combined with a single patient and professionals interface, it provides a seamless experience throughout the health and care service. The C3-Cloud CDS service provides support to three pilot sites throughout Europe, currently undergoing evaluation. Acknowledgements: C3-Cloud is funded from the EU Horizon 2020 research and innovation project C3-Cloud, under grant agreement No 6891810. This abstract is based on the work and material of the entire C3-Cloud consortium

Consortium blockchain management with a peer reputation system for critical information sharing

Blockchain technology based applications are emerging to establish distributed trust amongst organizations who want to share critical information for mutual benefit amongst their peers. There is a growing need for consortium based blockchain schemes that avoid issues such as false reporting and free riding that impact cooperative behavior between multiple domains/entities. Specifically, customizable mechanisms need to be developed to setup and manage consortiums with economic models and cloud-based data storage schemes to suit various application requirements. In this MS Thesis, we address the above issues by proposing a novel consortium blockchain architecture and related protocols that allow critical information sharing using a reputation system that manages co-operation amongst peers using off-chain cloud data storage and on-chain transaction records. We show the effectiveness of our consortium blockchain management approach for two use cases: (i) threat information sharing for cyber defense collaboration system viz., DefenseChain, and (ii) protected data sharing in healthcare information system viz., HonestChain. DefenseChain features a consortium Blockchain architecture to obtain threat data and select suitable peers to help with cyber attack (e.g., DDoS, Advance Persistent Threat, Cryptojacking) detection and mitigation. As part of DefenseChain, we propose a novel economic model for creation and sustenance of the consortium with peers through a reputation estimation scheme that uses 'Quality of Detection' and 'Quality of Mitigation' metrics. Similarly, HonestChain features a consortium Blockchain architecture to allow protected data sharing between multiple domains/entities (e.g., health data service providers, hospitals and research labs) with incentives and in a standards-compliant manner (e.g., HIPAA, common data model) to enable predictive healthcare analytics. Using an OpenCloud testbed with configurations with Hyperledger Composer as well as a simulation setup, our evaluation experiments for DefenseChain and HonestChain show that our reputation system outperforms state-of-the-art solutions and our consortium blockchain approach is highly scalableIncludes bibliographical references (pages 45-52)

An Authentication and Access Control Model for Healthcare based Cloud Services

Electronic Health Record (EHR) systems are used as an efficient and effective method of exchanging patients’ health information with doctors and other key stakeholders in the health sector to obtain improved patient treatment decisions and diagnoses. As a result, questions regarding the security of sensitive user data are highlighted. To encourage people to move their sensitive health records to cloud networks, a secure authentication and access control mechanism that protects users’ data should be established. Furthermore, authentication and access control schemes are essential in the protection of health data, as numerous responsibilities exist to ensure security and privacy in a network. So, the main goal of our suggested solution is to maintain a secure authentication and access control mechanism for health cloud data. Thus, in this work, Security Secret Key Provider (SSKP) phase is proposed for the E-healthcare-based cloud that consists of two parts. The first is an authentication scheme that is Security Secret Key (SSK) and the second is a modular access control mechanism. We explain the methodology of the proposed approach through appropriate evaluation results, which improves system security and performance by minimizing the time spent to get authentication and access the data. Simulation results indicate that our approach is significantly more effective than existing research.

A systematic literature review of cloud computing in eHealth

Cloud computing in eHealth is an emerging area for only few years. There needs to identify the state of the art and pinpoint challenges and possible directions for researchers and applications developers. Based on this need, we have conducted a systematic review of cloud computing in eHealth. We searched ACM Digital Library, IEEE Xplore, Inspec, ISI Web of Science and Springer as well as relevant open-access journals for relevant articles. A total of 237 studies were first searched, of which 44 papers met the Include Criteria. The studies identified three types of studied areas about cloud computing in eHealth, namely (1) cloud-based eHealth framework design (n=13); (2) applications of cloud computing (n=17); and (3) security or privacy control mechanisms of healthcare data in the cloud (n=14). Most of the studies in the review were about designs and concept-proof. Only very few studies have evaluated their research in the real world, which may indicate that the application of cloud computing in eHealth is still very immature. However, our presented review could pinpoint that a hybrid cloud platform with mixed access control and security protection mechanisms will be a main research area for developing citizen centred home-based healthcare applications

CloudHealth: A Model-Driven Approach to Watch the Health of Cloud Services

Cloud systems are complex and large systems where services provided by different operators must coexist and eventually cooperate. In such a complex environment, controlling the health of both the whole environment and the individual services is extremely important to timely and effectively react to misbehaviours, unexpected events, and failures. Although there are solutions to monitor cloud systems at different granularity levels, how to relate the many KPIs that can be collected about the health of the system and how health information can be properly reported to operators are open questions. This paper reports the early results we achieved in the challenge of monitoring the health of cloud systems. In particular we present CloudHealth, a model-based health monitoring approach that can be used by operators to watch specific quality attributes. The CloudHealth Monitoring Model describes how to operationalize high level monitoring goals by dividing them into subgoals, deriving metrics for the subgoals, and using probes to collect the metrics. We use the CloudHealth Monitoring Model to control the probes that must be deployed on the target system, the KPIs that are dynamically collected, and the visualization of the data in dashboards.Comment: 8 pages, 2 figures, 1 tabl